You are here

Vascularites

Subscribe to flux Vascularites Vascularites
NCBI: db=pubmed; Term=vasculitis AND ((English[lang] OR French[lang]) AND adult[MeSH] AND "last 90 days"[PDat])
Mis à jour : il y a 20 heures 44 min

Reconstruction of Wegener Granulomatosis Nose Deformity Using Fascia Lata Graft.

mar, 29/01/2019 - 05:45
Related Articles

Reconstruction of Wegener Granulomatosis Nose Deformity Using Fascia Lata Graft.

J Craniofac Surg. 2018 Nov;29(8):2179-2181

Authors: Lasso JM, La Cruz ED

Abstract
Wegener granulomatosis (WG) is a necrotizing vasculitis that involves the upper respiratory tract, the lungs, and the kidneys. It also causes deformities of the nose in practically all patients, altering the cartilaginous and bony structure as well as the inner lining of the nose.The surgical repair of these nasal distortions is a challenge mainly due to the impairment of wound healing and graft take that is caused both by the disease itself and by the prolonged immunosuppressant treatment.Many different reconstruction plans have been developed, using costal or calvarial bone grafts, cartilage grafts and local skin and mucosa flaps. Results have been diverse.The authors present the case of a 56-year-old patient who suffered from WG and consulted for nasal sequelae. She initially underwent several failed attempts at reconstruction; finally, the authors performed a nasal repair using a double strip of fascia lata as a dorsal graft, with no complications and a good aesthetic result.Fascia lata graft is a new and good option for nasal reconstruction in patients with WG because it is easily obtainable, it can be set in place through closed rhinoplasty and it can achieve good vascularization with low risk of resorption or disease reactivation.

PMID: 30277948 [PubMed - indexed for MEDLINE]

Hypocomplementemic urticarial vasculitis occurring in a patient with relapsing polychondritis.

mar, 29/01/2019 - 05:45
Related Articles

Hypocomplementemic urticarial vasculitis occurring in a patient with relapsing polychondritis.

Int J Dermatol. 2018 11;57(11):1363-1364

Authors: Raboudi A, Litaiem N, Jones M, Zeglaoui F

PMID: 29779215 [PubMed - indexed for MEDLINE]

Diagnostic performance of temporal artery ultrasound for the diagnosis of giant cell arteritis: a systematic review and meta-analysis of the literature.

sam, 26/01/2019 - 04:28
Related Articles

Diagnostic performance of temporal artery ultrasound for the diagnosis of giant cell arteritis: a systematic review and meta-analysis of the literature.

Autoimmun Rev. 2019 Jan;18(1):56-61

Authors: Rinagel M, Chatelus E, Jousse-Joulin S, Sibilia J, Gottenberg JE, Chasset F, Arnaud L

Abstract
Despite major recent advances in the therapeutic management of Giant cell arteritis (GCA), the diagnosis accuracy of temporal artery ultrasound remains controversial in this disease. We performed a systematic review to determine the sensitivity, specificity, and summary positive (LR+) and negative (LR-) likelihood ratios of temporal artery ultrasound for the diagnosis of GCA. For this, we searched EMBASE, MEDLINE and the Cochrane Database of Systematic Reviews without language restriction. Original articles reporting on diagnostic accuracy of temporal artery ultrasound compared to temporal artery biopsy, for the diagnosis of GCA, were selected. Sensitivity and specificity from each study were used to fit a bivariate diagnosis accuracy model. Of 1280 articles identified, 48 underwent full-text review, and 25 were included. Based on a total of 20 studies, the sensitivity and specificity of hypoechoic halo compared to positive temporal artery biopsy were respectively of 68% (95% CI: 57-78) and 81% (95%CI: 75-86). The summary mean positive and negative likelihood ratios were respectively of 3.64 (95%CI: 2.76-4.73) and 0.40 (0.28-0.52). Taking into account 11 studies reporting on the presence of any abnormal sign on temporal artery ultrasound yielded similar results with largely overlapping 95% confidence interval regions. This study provides the summary estimates of the diagnostic properties of temporal artery ultrasound compared to temporal artery biopsy, for the diagnosis of GCA. Those parameters allow the calculation of the post-test probability of GCA in a given patient, based on the results of temporal artery ultrasound and will help improving the diagnosis strategy for this common disease.

PMID: 30408588 [PubMed - indexed for MEDLINE]

Serum hepcidin is increased in ANCA-associated vasculitis and correlates with activity markers.

mer, 23/01/2019 - 01:48
Related Articles

Serum hepcidin is increased in ANCA-associated vasculitis and correlates with activity markers.

Physiol Res. 2018 Dec 18;67(6):945-954

Authors: Přikryl P, Hrušková Z, Konopásek P, Hladinová Z, Tesař V, Vokurka M

Abstract
Hepcidin is a key regulator of iron metabolism and plays an important role in many pathologies. It is increased by iron administration and by inflammation, while erythropoiesis downregulates its expression. It decreases iron availability and thus contributes to anemia of chronic diseases. The aim of the study was to measure hepcidin as a marker and pathogenetic factor in ANCA-associated vasculitis (AAV). Hepcidin plasma concentration was measured by the immunological method in 59 patients with AAV and compared to patients with non-vasculitic etiology of chronic kidney disease, patients on hemodialysis (HD), with systemic lupus erythematodes (SLE) and to healthy controls and blood donors, and was correlated with the parameters of iron metabolism, inflammation, activity of the process and kidney function. Hepcidin concentration was increased in patients with AAV, SLE and HD and correlated positively with C-reactive protein, serum ferritin and creatinine, and negatively with hemoglobin and serum transferrin. In active form of AAV it correlated with the clinical scoring system (BVAS). Hepcidin can thus be considered as a pathogenetic factor of anemia in AAV and can be used for evaluation of inflammation in AAV and as an additional marker in active forms of the disease.

PMID: 30204470 [PubMed - indexed for MEDLINE]

Multiple Intracranial Aneurysms from Coccidioidal Meningitis: Case Report Featuring Aneurysm Formation and Spontaneous Thrombosis with Literature Review.

sam, 19/01/2019 - 23:23
Related Articles

Multiple Intracranial Aneurysms from Coccidioidal Meningitis: Case Report Featuring Aneurysm Formation and Spontaneous Thrombosis with Literature Review.

World Neurosurg. 2019 Jan;121:117-123

Authors: Buchanan IA, Ravina K, Strickland B, Fredrickson V, She R, Mathew A, Rennert R, Russin JJ

Abstract
BACKGROUND: Coccidioidal meningitis can progress to vasculitis with aneurysm formation. Although aneurysmogenesis is rare, it carries exceptionally high mortality. Except in one instance, prior case reports have documented universally fatal consequences.
CASE DESCRIPTION: A 26-year-old man developed disseminated coccidioidomycosis with formation of multiple aneurysms throughout the anterior intracranial vasculature bilaterally. This report is unique in that it chronicles the formation and subsequent spontaneous thrombosis of several aneurysms over a 4-week period. In total 10 aneurysms were documented in the same patient-the highest reported to date. The patient was eventually discharged from the hospital for what has heretofore been a universally fatal disease process. Neurologic examination and vascular imaging 1 month after discharge demonstrated stable findings.
CONCLUSIONS: Coccidioidal aneurysms carry a high mortality. The mainstay of therapy remains lifelong triazole antifungal therapy with the addition of liposomal amphotericin in cases of treatment failure. Steroid use is controversial but should be considered whenever there is vascular involvement. Although watchful waiting is reasonable in light of the possibility of spontaneous thrombosis with medical management, dynamic changes in aneurysm size or configuration should prompt timely endovascular or operative interventions.

PMID: 30201579 [PubMed - indexed for MEDLINE]

Improvement of Alveolar Hemorrhaging in an Elderly and Renally Impaired Patient with Relapsing Anti-neutrophil Cytoplasmic Autoantibody-associated Vasculitis by Single Infusion of Rituximab.

sam, 19/01/2019 - 23:23
Related Articles

Improvement of Alveolar Hemorrhaging in an Elderly and Renally Impaired Patient with Relapsing Anti-neutrophil Cytoplasmic Autoantibody-associated Vasculitis by Single Infusion of Rituximab.

Intern Med. 2018 Nov 15;57(22):3267-3270

Authors: Oda K, Ishikawa E, Ito T, Mizoguchi S, Hirabayashi Y, Suzuki Y, Haruki A, Fujimoto M, Murata T, Katayama K, Onishi T, Ito M

Abstract
Rituximab (RTX) has become a therapeutic option for inducing remission of anti-neutrophil cytoplasmic autoantibody-associated vasculitis (AAV). However, the optimum dosage of RTX to induce remission of AAV and reduce adverse events, such as infection, remains unclear. We herein report an elderly and renally impaired patient with alveolar hemorrhaging due to refractory AAV who was successfully treated with single infusion of RTX. Single infusion of RTX may be a therapeutic option in refractory AAV patients who are vulnerable to infections.

PMID: 29984747 [PubMed - indexed for MEDLINE]

Disseminated toxoplasmosis with atypical symptoms which developed with exacerbation of systemic lupus erythematosus.

mer, 16/01/2019 - 20:50
Related Articles

Disseminated toxoplasmosis with atypical symptoms which developed with exacerbation of systemic lupus erythematosus.

Lupus. 2019 Jan;28(1):133-136

Authors: Furuya H, Ikeda K, Iida K, Suzuki K, Furuta S, Tamachi T, Suzuki K, Miura G, Hiraguri M, Hase R, Hikosaka K, Norose K, Nakajima H

Abstract
Toxoplasma is a common parasite worldwide that mainly affects the brain, lungs and eyes. Although toxoplasmic encephalitis is a lethal disease without treatment, past case reports show most patients with systemic lupus erythematosus who developed toxoplasmic encephalitis were misdiagnosed and treated as neuropsychiatric systemic lupus erythematosus, which led to unfavorable outcomes. We herein describe a case of disseminated toxoplasmosis affecting all the above organs with atypical symptoms, which developed with exacerbation of systemic lupus erythematosus. She had initially manifested with retinochoroiditis without vitritis, mild cognitive impairment and an isolated lung mass. These are completely different from the classic symptoms of toxoplasmosis that have been reported in patients with HIV infection and/or those after hematopoietic transplantation. Our case, together with previously reported cases, suggests the manifestation of toxoplasmosis that develops in systemic lupus erythematosus patients can be different from that seen in conventional cases and varies between individual patients. Our case highlights both the difficulty in and the importance of diagnosing toxoplasmosis in patients with systemic lupus erythematosus and provides helpful information to identify this rare, devastating, yet treatable disease.

PMID: 30486727 [PubMed - indexed for MEDLINE]

Bacterial endocarditis manifesting as autoimmune pulmonary renal syndrome: ANCA-associated lung hemorrhage and pauci-immune crescentic glomerulonephritis
.

mer, 16/01/2019 - 20:50
Related Articles

Bacterial endocarditis manifesting as autoimmune pulmonary renal syndrome: ANCA-associated lung hemorrhage and pauci-immune crescentic glomerulonephritis
.

Clin Nephrol. 2018 Dec;90(6):431-433

Authors: Mohandes S, Satoskar A, Hebert L, Ayoub I

Abstract
The etiology of pulmonary renal syndrome can be broadly divided into infectious and autoimmune (predominantly ANCA vasculitis). The importance of timely differentiating between them stems from the deleterious effects of their respective treatment if misdiagnosed. Serology and tissue evaluation by pathology are employed to aid in this, however, in rare cases, this can be difficult. We present a case of infectious endocarditis that presented with pulmonary renal syndrome but had positive ANCA serology and a pauci-immune glomerulonephritis picture on kidney biopsy that posed diagnostic difficulty. Factors most helpful in differentiating between the two conditions are highlighted as well as treatment options.
.

PMID: 30369400 [PubMed - indexed for MEDLINE]

ANCA-associated vasculitis in scleroderma: A renal perspective
.

mer, 16/01/2019 - 20:50
Related Articles

ANCA-associated vasculitis in scleroderma: A renal perspective
.

Clin Nephrol. 2018 Dec;90(6):413-418

Authors: Kant S, Shah AA, Hummers LK, Wigley FM, Geetha D

Abstract
AIMS: Overlap syndrome of ANCA-associated vasculitis (AAV) and scleroderma (SSc) is rare with conflicting data on renal outcomes. We describe the clinical characteristics and treatment outcome of ANCA-associated glomerulonephritis (AAG) in SSc patients followed at a single center.
MATERIALS AND METHODS: We conducted a retrospective study of 3,570 patients in our SSc database to identify SSc patients who subsequently developed AAV with renal involvement. Patient demographics, serology, renal function, renal histology, and treatment outcomes were assessed.
RESULTS: Of the 3,570 patients, we identified 7 patients who developed acute glomerulonephritis, and all were ANCA positive. The mean age at SSc diagnosis was 47 years, 4 patients were female, and 6 had diffuse SSc. Anti-nuclear antibody (ANA) was positive in all. Mean time of onset of AAV from time of diagnosis of SSc was 6 years, and all were myeloperoxidase (MPO) positive. Patients presented with hematuria, proteinuria, with or without rise in serum creatinine, and all patients had biopsy-proven crescentic glomerulonephritis. One patient required dialysis at presentation. Five patients were treated with cyclophosphamide and steroids, and 2 were treated with rituximab and steroids. Of the 7 patients, 4 did not receive maintenance immunosuppression. Three patients died, and 1 of them experienced relapse with fulminant alveolar hemorrhage.
CONCLUSION: AAG in SSc is rare, with disease manifestation and course similar to that of AAV. This case series demonstrates that disease remission can be achieved with standard induction therapy. Vasculitis relapse can occur, and similar to idiopathic AAV, maintenance immunosuppression should be initiated to maintain remission.
.

PMID: 30106367 [PubMed - indexed for MEDLINE]

Necrosis of the Fingers and Toes.

dim, 13/01/2019 - 18:22
Related Articles

Necrosis of the Fingers and Toes.

N Engl J Med. 2018 Dec 27;379(26):2557

Authors: Taniguchi Y, Inotani S

PMID: 30586520 [PubMed - indexed for MEDLINE]

Phenotypic Characterization of Circulating CD4+ T Cells in ANCA-Associated Vasculitis.

dim, 13/01/2019 - 18:22
Related Articles

Phenotypic Characterization of Circulating CD4+ T Cells in ANCA-Associated Vasculitis.

J Immunol Res. 2018;2018:6984563

Authors: Lilliebladh S, Johansson Å, Pettersson Å, Ohlsson S, Hellmark T

Abstract
T cell-mediated immune responses are thought to play an important role in the pathogenesis of anti-neutrophil cytoplasmic antibody- (ANCA-) associated vasculitides (AAV). CD4+ T cells can be divided into subsets depending on their expression of chemokine receptors. In this study, different CD4+ T cell populations in patients with AAV were analysed and compared to healthy blood donors as well as therapy controls. 18 patients with active AAV, 46 in remission, 21 healthy controls (HBD), and 15 therapy controls (TC) were enrolled. CD4+ T cells were divided into Th1, Th2, and Th17 cells and further subdivided into naïve, central memory, effector memory, and effector cells. Regulatory T cells were also analysed. Concentrations of cytokines and chemokines produced by the respective CD4+ T cell subset in plasma from 33 of the patients were measured by ELISA and compared to HBD. Clinical data were collected on all patients. CCL20 concentrations and percentages of Th17 cells (p = 0.019) were elevated in AAV patients compared to HBD. AAV patients had lower percentages of naïve CD4+ T cells (p = 0.0016) and a corresponding increase in proportion of effector memory CD4+ T cells when comparing to HBD (p = 0.027). Therapy controls showed similar results as AAV patients. In this study, we found that CD4+ T cell phenotype distribution is altered in AAV patients, in line with previously published work. However, no differences were found between AAV patients and TC, stressing the importance of treatment impact on this kind of studies.

PMID: 30510966 [PubMed - indexed for MEDLINE]

A 19-year old man with IgA vasculitis after vaccination.

dim, 13/01/2019 - 18:22
Related Articles

A 19-year old man with IgA vasculitis after vaccination.

Braz J Infect Dis. 2018 Sep - Oct;22(5):442-444

Authors: Malek A, Gomez-Villegas SI, de la Hoz A, Nowbakht C, Arias CA

Abstract
A 19-year-old patient who mistakenly received two doses of influenza vaccine 10 days before presentation, was admitted with malaise, weakness, and a purpuric non-blanching rash most prominent on the ankles followed by abdominal pain and hematochezia 72h later. The diagnosis of influenza vaccine-related Henoch-Schonlein vasculitis was made. This complication, although rare, is the most common vasculitis related to immunization.

PMID: 30389353 [PubMed - indexed for MEDLINE]

Ustekinumab for refractory giant cell arteritis: A prospective 52-week trial.

dim, 13/01/2019 - 18:22
Related Articles

Ustekinumab for refractory giant cell arteritis: A prospective 52-week trial.

Semin Arthritis Rheum. 2018 12;48(3):523-528

Authors: Conway R, O'Neill L, Gallagher P, McCarthy GM, Murphy CC, Veale DJ, Fearon U, Molloy ES

Abstract
OBJECTIVES: Giant cell arteritis (GCA) is the most common form of systemic vasculitis. Glucocorticoids are an effective treatment but have significant adverse events and relapses are common. Interleukins 12 (IL-12) and 23 (IL-23) stimulate TH1 and TH17 responses and are implicated in the pathogenesis of GCA. The aim of this study was to evaluate the efficacy and safety of IL-12/23 blockade with ustekinumab in GCA.
METHODS: We performed a prospective open label study of ustekinumab in patients with refractory GCA. Ustekinumab 90mg was administered subcutaneously every 12 weeks. The primary outcome was the comparison of the median glucocorticoid dose prior to commencement of ustekinumab and at 52 weeks. Secondary outcomes included physician assessed relapse, acute phase reactants, and imaging assessment of large vessel vasculitis (LVV).
RESULTS: Twenty-five GCA patients received ustekinumab. All patients had failed to taper glucocorticoids despite addition of a median of 1 other immunosuppressive agent. At week 52, median (IQR) daily prednisolone dose decreased from 20 (15, 25)mg to 5 (2.5, 5)mg (p < 0.001). Six patients (24%) stopped prednisolone completely. No patient experienced a relapse of GCA while receiving ustekinumab. Median (IQR) CRP decreased significantly from 12.9 (5.3, 42) to 6 (2.6, 12.5)mg/L (p = 0.006). CT angiography demonstrated improvement of LVV in all patients studied. No unexpected adverse events were observed with ustekinumab.
CONCLUSIONS: Ustekinumab may be effective for the treatment of GCA and warrants further assessment in a randomized controlled trial.

PMID: 29776658 [PubMed - indexed for MEDLINE]

Antineutrophil cytoplasmic antibody-positive familial Mediterranean fever and hyperthyroidism: A case report.

jeu, 10/01/2019 - 15:33
Related Articles

Antineutrophil cytoplasmic antibody-positive familial Mediterranean fever and hyperthyroidism: A case report.

Medicine (Baltimore). 2018 Dec;97(51):e13805

Authors: Segoe S, Sada KE, Hayashi K, Yamamura Y, Morishita M, Watanabe H, Matsumoto Y, Wada J

Abstract
RATIONALE: Familial Mediterranean fever (FMF) is a genetic autoinflammatory disorder characterized by serositis and recurrent fever. Previous reports identified patients with antineutrophil cytoplasmic antibody (ANCA)-positive FMF, but vasculitis symptoms were not reported.
PATIENT CONCERNS: We report the case of a 44-year-old man with numbness. He had a history of 3 episodes of pleurisy and was being treated with propylthiouracil for hyperthyroidism. Because he was ANCA-positive, we suspected drug-induced ANCA-associated vasculitis and propylthiouracil was discontinued. However, his numbness was not ameliorated, and he again developed high fever with pleurisy.
DIAGNOSIS: Diagnosis of FMF was finally made, and genetic analysis revealed compound heterozygous mutations in exon 2 of the familial Mediterranean fever gene (L110P/E148Q).
INTERVENTIONS: The patient was treated with 0.5 mg/day of colchicine.
OUTCOMES: His numbness improved, and fever has not recurred.
LESSONS: Appearance of ANCA and development of vasculitis should be considered in a clinical course of FMF with hyperthyroidism.

PMID: 30572542 [PubMed - indexed for MEDLINE]

Sudden unilateral vision loss in an adult with Behcet disease: A case report.

jeu, 10/01/2019 - 15:33
Related Articles

Sudden unilateral vision loss in an adult with Behcet disease: A case report.

Medicine (Baltimore). 2018 Dec;97(50):e13594

Authors: Gao Y, Lyu S, Bao L, Zhang M

Abstract
RATIONALE: Behcet disease is an autoimmune vasculitis, involving multiple systems and organs. It is often chronic and recurrent, and involves all levels of arteries and veins.
PATIENT CONCERNS: A 40-year-old Chinese male with sudden vision loss in his right eye for 3 days was reported.
DIAGNOSES: The patient was diagnosed as bilateral uveitis (obstructive retinal vasculitis in the right eye) and Behcet disease.
INTERVENTIONS: The patient was given topical corticosteroids and compound tropicamide eye drops in our department. In addition, he was also hospitalized in the Rheumatology Department, and received systemic infusion of methylprednisolone and cyclophosphamide.
OUTCOMES: Best corrected visual acuity vision acuity of the left eye was 20/20 and that of the right eye was no light perception after 2 weeks. During the telephonic follow-up after 1 year, the patient reported 2 recurrent episodes of uveitis in the left eye, which improved after treatment at the local hospital.
LESSONS: It cautions ophthalmologists of the high possibility of vasculitis in young and middle-aged patients with retinal vascular occlusion. It also reminds the ophthalmologists investigate systemic diseases, and obtain detailed medical history, not just depending on specific laboratory findings. This case further suggests that Behcet disease has diverse manifestations, complex diagnosis, and severe lesions, and the recurrence rate must be controlled to minimize irreversible consequences such as sudden vision loss during recurrence.

PMID: 30558031 [PubMed - indexed for MEDLINE]

Onset of Takotsubo Syndrome during the Clinical Course of Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis: A Case Report.

jeu, 10/01/2019 - 15:33
Related Articles

Onset of Takotsubo Syndrome during the Clinical Course of Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis: A Case Report.

Tohoku J Exp Med. 2018 12;246(4):251-256

Authors: Harada M, Ichikawa T, Kobayashi M

Abstract
Anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is a systemic vasculitis resulting in severe organ injuries. ANCA is a disease-labeled antibody of AAV, and myeloperoxidase (MPO) and proteinase 3 are the main targeted antigens of ANCA. Takotsubo syndrome, a transient cardiac dysfunction caused by emotional or physical stress, is characterized by ST-segment elevation and negative T waves in electrocardiogram, transient left ventricular asynergy, and absence of obstructive coronary disease. To the best of our knowledge, only two cases of coexistence of AAV and takotsubo syndrome have been reported. Herein, we report the case of AAV complicated with takotsubo syndrome. A 78-year-old Japanese woman presented with severe renal dysfunction, which was diagnosed as MPO-ANCA-associated systemic vasculitis. Despite the treatment with cyclophosphamide and glucocorticoid, the patient presented with severe respiratory failure due to alveolar hemorrhage and heart failure. Electrocardiography indicated newly developed T wave inversions. Echocardiography demonstrated severe left ventricular dysfunction with hypokinesis of the apical area. Moreover, coronary angiography revealed no noticeable stenotic or obstructive lesions. These findings indicate the onset of takotsubo syndrome. After immunosuppressive therapy, systemic vasculitis and takotsubo syndrome were improved. Although a coexisting case of AAV and takotsubo syndrome is rare, we have to consider the possible complication of takotsubo syndrome in case of presenting acute heart failure. Considering the present case and the previously reported coexisting cases of takotsubo syndrome and AAV, we propose that female sex, initiation of glucocorticoid therapy, and high titer of MPO-ANCA are potential risk factors of developing takotsubo syndrome.

PMID: 30555102 [PubMed - indexed for MEDLINE]

Central Retinal Arterial Occlusion in Granulomatosis with Polyangiitis.

jeu, 10/01/2019 - 15:33
Related Articles

Central Retinal Arterial Occlusion in Granulomatosis with Polyangiitis.

Korean J Ophthalmol. 2018 12;32(6):519-520

Authors: Shim KY, Sohn SI, Kim YC

PMID: 30549477 [PubMed - indexed for MEDLINE]

A Surprising Cause for Intestinal Obstruction.

lun, 07/01/2019 - 14:46
Related Articles

A Surprising Cause for Intestinal Obstruction.

Gastroenterology. 2018 12;155(6):e1-e3

Authors: Gherardi BE, Milito CB, Parente DB

PMID: 30205099 [PubMed - indexed for MEDLINE]

Simultaneous bilateral posterior ischemic optic neuropathy secondary to giant cell arteritis: a case presentation and review of the literature.

ven, 04/01/2019 - 13:04
Related Articles

Simultaneous bilateral posterior ischemic optic neuropathy secondary to giant cell arteritis: a case presentation and review of the literature.

BMC Ophthalmol. 2018 Dec 12;18(1):317

Authors: Albarrak AM, Mohammad Y, Hussain S, Husain S, Muayqil T

Abstract
BACKGROUND: This report highlights a rare case of simultaneous bilateral blindness due to posterior ischemic optic neuropathy. Typically, ophthalmic involvement in giant cell arteritis is monocular or sequential ischemia of the anterior portion of the optic nerve, and less frequently simultaneous.
CASE PRESENTATION: An 80-year-old Saudi male came with a history of simultaneous bilateral vision loss 5 days prior to presentation. The exam showed dilated non-reactive pupils, no light perception in both eyes, and normal fundus exam. C-reactive protein and erythrocyte sedimentation rate levels were high Magnetic resonance imaging and magnetic resonance angiography of the brain showed a right posterior optic nerve lesion and absence of flow in both ophthalmic arteries respectively. A left temporal artery biopsy confirmed giant cell arteritis.
CONCLUSION: The presentation of GCA can be atypical and patients may present with simultaneous blindness. Bilateral simultaneous PION does not exclusively occur in a post surgical setting, emphasizing the importance of decreasing the threshold of suspicion of similar cases to avoid further neurological complications.

PMID: 30541489 [PubMed - indexed for MEDLINE]

Palisaded neutrophilic and granulomatous dermatitis associated with systemic lupus erythematosus: possible involvement of CD163+ M2 macrophages in two cases, and a review of published works.

ven, 04/01/2019 - 13:04
Related Articles

Palisaded neutrophilic and granulomatous dermatitis associated with systemic lupus erythematosus: possible involvement of CD163+ M2 macrophages in two cases, and a review of published works.

Lupus. 2018 Dec;27(14):2220-2227

Authors: Terai S, Ueda-Hayakawa I, Nguyen CTH, Ly NTM, Yamazaki F, Kambe N, Son Y, Okamoto H

Abstract
BACKGROUND: Palisaded neutrophilic and granulomatous dermatitis (PNGD) is a commonly occurring condition related to systemic autoimmune disease. It is characterized histopathologically by a distinct pattern of granulomatous inflammation in the presence or absence of leukocytoclastic vasculitis. The properties of granulomatous cells in PNGD are still uncertain.
OBJECTIVE: We sought further investigation on the phenotype of the infiltrated cells in PNGD from two patients with systemic lupus erythematosus (SLE) and reviewed the previous published reports in order to provide a comprehensive summary on the clinical features of PNGD in SLE.
METHODS: The immunohistochemical features of granulomatous cells in PNGD associated with SLE were analyzed. Immunohistochemical studies were performed on sections from our two cases using antibodies against CD68, CD163, CD15, Factor XIIIa, myeloperoxidase and neutrophil elastase. The clinical characteristics of the SLE patients who developed PNGD were also evaluated. We included all cases retrieved through a PubMed search with the key words PNGD and SLE.
RESULTS: Cutaneous lesions consisted of erythematous plaques distributed on the face and upper limbs in both cases. The infiltrated cells were mainly positive for CD68 and CD163, a phenotype suggestive of M2 macrophages. Some mature neutrophils and lymphocytes were also present. A review of the literature of PNGD associated with SLE revealed a predominance in females, high prevalence of lupus nephritis and a good response to systemic steroids, with frequent skin lesions relapses during tapering of the treatment.
LIMITATIONS: This study examined only two cases; the pathogenesis of the disease remains to be clarified.
CONCLUSION: PNGD lesions were abundantly infiltrated by M2 macrophages, suggesting that they may have a role in this condition. SLE accompanied by PNGD might be associated with lupus nephritis and frequent relapses of skin lesions.

PMID: 30376790 [PubMed - indexed for MEDLINE]

Pages