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NCBI: db=pubmed; Term=vasculitis AND ((English[lang] OR French[lang]) AND adult[MeSH] AND "last 90 days"[PDat])
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Pharmacokinetics of rituximab and clinical outcomes in patients with anti-neutrophil cytoplasmic antibody associated vasculitis.

ven, 01/06/2018 - 04:01
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Pharmacokinetics of rituximab and clinical outcomes in patients with anti-neutrophil cytoplasmic antibody associated vasculitis.

Rheumatology (Oxford). 2018 04 01;57(4):639-650

Authors: Cornec D, Kabat BF, Mills JR, Cheu M, Hummel AM, Schroeder DR, Cascino MD, Brunetta P, Murray DL, Snyder MR, Fervenza F, Hoffman GS, Kallenberg CGM, Langford CA, Merkel PA, Monach PA, Seo P, Spiera RF, St Clair EW, Stone JH, Barnidge DR, Specks U

Abstract
Objectives: To study the determinants of the pharmacokinetics (PK) of rituximab (RTX) in patients with ANCA-associated vasculitis (AAV) and its association with clinical outcomes.
Methods: This study included data from 89 patients from the RTX in AAV trial who received the full dose of RTX (four weekly infusions of 375 mg/m2). RTX was quantified at weeks 2, 4, 8, 16 and 24, and summarized by computing the trapezoidal area under the curve. We explored potential determinants of the PK-RTX, and analysed its association with clinical outcomes: achievement of remission at 6 months, duration of B-cell depletion and time to relapse in patients who achieved complete remission.
Results: RTX serum levels were significantly lower in males and in newly diagnosed patients, and negatively correlated with body surface area, baseline B-cell count and degree of disease activity. In multivariate analyses, the main determinants of PK-RTX were sex and new diagnosis. Patients reaching complete remission at month 6 had similar RTX levels compared with patients who did not reach complete remission. Patients with higher RTX levels generally experienced longer B-cell depletion than patients with lower levels, but RTX levels at the different time points and area under the curve were not associated with time to relapse.
Conclusion: Despite the body-surface-area-based dosing protocol, PK-RTX is highly variable among patients with AAV, its main determinants being sex and newly diagnosed disease. We did not observe any relevant association between PK-RTX and clinical outcomes. The monitoring of serum RTX levels does not seem clinically useful in AAV.

PMID: 29340623 [PubMed - indexed for MEDLINE]

Polyarteritis nodosa.

ven, 01/06/2018 - 04:01
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Polyarteritis nodosa.

Rheumatology (Oxford). 2018 Apr 01;57(4):670

Authors: Micheroli R, Distler O

PMID: 28968697 [PubMed - indexed for MEDLINE]

Treatment of multiple refractory ankle ulcerations in thromboangiitis obliterans: A case report.

mar, 29/05/2018 - 03:07
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Treatment of multiple refractory ankle ulcerations in thromboangiitis obliterans: A case report.

Medicine (Baltimore). 2018 May;97(20):e10798

Authors: Huang ZH, Kuo SY, Chiu YH, Chen HC, Lu CC

Abstract
RATIONALE: Thromboangiitis obliterans (TAOs, or Buerger's disease) present as a non-atherosclerotic segmental occlusive vasculitis within medium- and small-sized blood vessels. TAO frequently occurs in young adults and is associated with cigarette smoking. At present, there are no accurately defined treatments for TAO.
PATIENT CONCERNS: A 34-year-old Asian woman with a 20-year history of heavy cigarette smoking and recurrent, small, and self-limited lower limb ulcerations since adolescence, presented with persisting unhealed ulcerations on both ankles for 6 months. Her wound healing response was poor following the 2-month administration of colchicine, prednisolone, hydroxychloroquine, and mycophenolic acid.
DIAGNOSIS: The patient was diagnosed with TAO with hyperimmunoglobulin E and refractory ulcerations on her ankles.
INTERVENTIONS: The patient received monthly omalizumab (300 mg) and previous medications for 2 months and shifted to omalizumab and colchicine without mycophenolic acid and hydroxychloroquine because of onychomadesis, which was considered to be a possible adverse drug reaction.
OUTCOMES: The wounds healed almost completely. The administration of omalizumab and colchicine will be continued until they the wounds are fully healed.
LESSONS: Mycophenolic acid has a limited function in TAO treatment, especially in cases of refractory skin ulcerations. Omalizumab can be a valuable treatment option for patients with TAO and hyperimmunoglobulin E.

PMID: 29768374 [PubMed - indexed for MEDLINE]

A Randomized Controlled Study to Evaluate the Effectiveness of 2 Treatment Methods in Reducing Incidence of Short Peripheral Catheter-Related Phlebitis.

mar, 29/05/2018 - 03:07
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A Randomized Controlled Study to Evaluate the Effectiveness of 2 Treatment Methods in Reducing Incidence of Short Peripheral Catheter-Related Phlebitis.

J Infus Nurs. 2018 Mar/Apr;41(2):131-137

Authors: Gunasegaran N, See MTA, Leong ST, Yuan LX, Ang SY

Abstract
Short peripheral catheter (SPC)-related phlebitis can lead to bloodstream infections and affect patients' quality of life. A randomized trial was carried out to evaluate the effectiveness of 2 treatment methods in reducing the incidence of SPC-related phlebitis. The 2 treatment methods differed in terms of the cleansing solution used before insertion and dressing material used after removal. The results demonstrated that the type of cleansing solution and postremoval dressing material did not make a difference in the incidence of phlebitis. Strict adherence to aseptic techniques and prompt removal of the SPC remained the cornerstone in the prevention of phlebitis.

PMID: 29489709 [PubMed - indexed for MEDLINE]

Factors Contributing to Phlebitis Among Adult Patients Admitted in the Medical-Surgical Units of a Central Hospital in Harare, Zimbabwe.

mar, 29/05/2018 - 03:07
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Factors Contributing to Phlebitis Among Adult Patients Admitted in the Medical-Surgical Units of a Central Hospital in Harare, Zimbabwe.

J Infus Nurs. 2018 Mar/Apr;41(2):96-102

Authors: Nyika ML, Mukona D, Zvinavashe M

Abstract
This descriptive survey identified factors contributing to phlebitis among 46 adult inpatients using a systematic random sample. The visual infusion phlebitis score was used for assessment. All participants had phlebitis, with stage 4 being most frequent. Factors identified were gender (males-91.7%); immunosuppression (human immunodeficiency virus-63.0%; diabetes-100%; immunosuppressive drugs-100%; absolute leucocyte count <1000 μL-100%); number of catheters inserted (>1-90.9%); site of catheterization (dorsum of wrist-100%); catheter dwell time (2-4 days-100%); catheter gauge (18-gauge-75%); catheter securement (unsecured/contaminated dressing-90%); regularity of catheter flushing (catheter never flushed-72.7%); and continuous infusion (94.2%).

PMID: 29489704 [PubMed - indexed for MEDLINE]

Case 14-2018: A 68-Year-Old Woman with a Rash, Hyponatremia, and Uveitis.

sam, 19/05/2018 - 20:14
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Case 14-2018: A 68-Year-Old Woman with a Rash, Hyponatremia, and Uveitis.

N Engl J Med. 2018 May 10;378(19):1825-1833

Authors: Paras ML, Hyle EP, Foreman RK, Coffey KC

PMID: 29742372 [PubMed - indexed for MEDLINE]

Cardiovascular events in anti-neutrophil cytoplasmic antibody-associated vasculitis: a meta-analysis of observational studies.

sam, 19/05/2018 - 20:14
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Cardiovascular events in anti-neutrophil cytoplasmic antibody-associated vasculitis: a meta-analysis of observational studies.

Rheumatology (Oxford). 2018 Mar 01;57(3):555-562

Authors: Houben E, Penne EL, Voskuyl AE, van der Heijden JW, Otten RHJ, Boers M, Hoekstra T

Abstract
Objectives: Several chronic inflammatory diseases are associated with cardiovascular disease, but the risk in ANCA-associated vasculitis is poorly quantified. The aim of the present study was to review the evidence for an increased cardiovascular risk, including ischaemic heart disease, cerebrovascular accidents and peripheral arterial disease, in patients with ANCA-associated vasculitis.
Methods: A comprehensive systematic review was conducted in accordance with guidelines of preferred reporting items for systematic reviews and meta-analyses. The databases PubMed, Embase.com and the Cochrane Library (Wiley) were searched for original observational studies comparing vasculitis patients with at least one control group. Summary estimates were derived with a random-effects model and reported as relative risks.
Results: One thousand three hundred and seventy-five studies were identified. Seven studies were included, comprising almost 14 000 ANCA-associated vasculitis patients vs general population controls in six studies and chronic kidney disease patients in one study. ANCA-associated vasculitis carried a relative risk of 1.65 (95% CI: 1.23, 2.22) for all cardiovascular events, 1.60 (95% CI: 1.39, 1.84) for ischaemic heart disease and 1.20 (95% CI: 0.98, 1.48) for cerebrovascular accidents. We did not find studies that addressed the risk for peripheral arterial disease separately. No heterogeneity was seen in the estimates.
Conclusion: This meta-analysis of observational studies supports an increase in cardiovascular risk in patients with ANCA-associated vasculitis of ∼65%, similar to that found in other chronic inflammatory diseases. Hence, there is a clear need for active cardiovascular risk management in patients with ANCA-associated vasculitis.

PMID: 29029294 [PubMed - indexed for MEDLINE]

Takayasu arteritis presenting as isolated anterior ischemic optic neuropathy.

sam, 19/05/2018 - 20:14
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Takayasu arteritis presenting as isolated anterior ischemic optic neuropathy.

Int Ophthalmol. 2018 Apr;38(2):823-828

Authors: Tian G, Chen Q, Wang W

Abstract
Takayasu arteritis (TA) is a systemic vasculitis of unknown etiology that affects the aorta and its primary branches or large arteries in the proximal upper or lower extremities. Ocular manifestations of TA include microaneurysm formation, small-vessel dilation, arteriovenous anastomosis, retinal ischemia, and neovascular glaucoma. We herein report a case involving a 23-year-old Asian woman who presented with isolated acute anterior ischemic optic neuropathy and was initially misdiagnosed with optic neuritis. The stenosis and occlusion of the aorta and other proximal arteries on angiography confirmed the diagnosis of TA.

PMID: 28389774 [PubMed - indexed for MEDLINE]

Spectral domain optical coherence tomography evaluation of macular changes in Eales disease.

mer, 16/05/2018 - 17:13
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Spectral domain optical coherence tomography evaluation of macular changes in Eales disease.

Indian J Ophthalmol. 2018 Mar;66(3):433-438

Authors: Goel N, Kumar V, Arora S, Jain P, Ghosh B

Abstract
Purpose: The purpose of the study was to describe macular changes in treatment-naïve eyes with Eales disease using spectral domain optical coherence tomography (SD-OCT).
Methods: A cross-sectional study was done on 79 eyes of 66 patients with Eales disease. Best-corrected visual acuity (BCVA), slit-lamp biomicroscopy (SLB), indirect ophthalmoscopy, fundus fluorescein angiography (FFA), and quantitative (central macular thickness [CMT]) and qualitative analysis on SD-OCT were performed.
Results: Forty-six (58.2%) eyes had macular involvement as assessed with SD-OCT, while in 33 (41.8%) eyes, macula was not affected. Macular edema was the most common feature when macula was affected followed by epiretinal membrane. Mean CMT was higher (315.3 ± 102.3 μm) in eyes with macular involvement than those without it (243.8 ± 19.3 μm). Eyes with active vasculitis involving larger vessels and neovascularization had greater chance of macular involvement. SLB and FFA alone missed 28.3% and 50% eyes with macular abnormalities on SD-OCT, respectively.
Conclusion: While the clinical description of Eales disease points mainly to a peripheral location, macular involvement can be commonly picked up when SD-OCT is used. Macular involvement when present is associated with a poorer BCVA.

PMID: 29480258 [PubMed - indexed for MEDLINE]

Endovascular Management of Multiple Dysplastic Aneurysms in a Young Man with an Unknown Underlying Cause: A Case Report and Review of the Literature.

mer, 16/05/2018 - 17:13
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Endovascular Management of Multiple Dysplastic Aneurysms in a Young Man with an Unknown Underlying Cause: A Case Report and Review of the Literature.

World Neurosurg. 2018 Mar;111:349-357

Authors: Scullen T, Mathkour M, Lockwood J, Ott L, Medel R, Dumont AS, Amenta PS

Abstract
BACKGROUND: Intracranial aneurysms are the leading cause of nontraumatic subarachnoid hemorrhage and are most commonly associated with the anterior cerebral artery (ACA) and anterior communicating artery complex. We describe the presentation and management of a 27-year-old man with concurrent bilateral A1-2 junction aneurysms and fusiform intraorbital ophthalmic artery (OA) aneurysms.
CASE DESCRIPTION: A 27-year-old man with no past medical history presented with 3 months of headaches. Imaging showed a large dysplastic left A1-2 junction aneurysm and a smaller saccular right A1-2 junction aneurysm, with potentially adherent domes. Two fusiform aneurysms of the intraorbital segment of the left OA were also identified. The patient underwent coil-assisted pipeline embolization of the left A1-A2 aneurysm, with complete obliteration and reconstitution of the normal parent vessel. The patient underwent coil embolization of the right A1-2 aneurysm 3 weeks later, which was found to have grown significantly at the time of treatment. Three-month follow-up showed spontaneous resolution of the OA aneurysms, persistent obliteration of the left aneurysm, and significant recurrence of the right aneurysm, which was treated with stent-assisted coil embolization. A second recurrence 3 months later was successfully treated with repeat coiling. At the time of this treatment, the patient was also found to have 2 de novo distal middle cerebral artery and ACA dysplastic aneurysms, which were not treated. Follow-up angiography 6 weeks later showed stable complete obliteration of the right A1-2 aneurysm and interval complete resolution of the dysplastic middle cerebral artery aneurysm. The distal ACA aneurysm was observed to have minimally increased in size; however, the parent vessel showed signs of interval partial thrombosis with contrast stasis within the aneurysm. This final aneurysm is being followed with serial imaging. The patient remains neurologically intact with complete resolution of his headaches.
CONCLUSIONS: We report the case of a young man with no past medical history who presented with multiple dysplastic aneurysms. Successful staged endovascular intervention resulted in obliteration of aneurysms with spontaneous obliteration of the intraorbital OA aneurysms observed at 3 months. We present this case to review the multiple challenges of managing complex ACA aneurysms and to highlight the usefulness of endovascular intervention in their treatment.

PMID: 29289804 [PubMed - indexed for MEDLINE]

Sudden Death Due to Coronary Arteritis.

dim, 13/05/2018 - 15:30
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Sudden Death Due to Coronary Arteritis.

J Forensic Sci. 2018 Mar;63(2):611-613

Authors: Gabarrou G, Guilbeau-Frugier C, Blanc A, Telmon N, Savall F

Abstract
We report the case of a middle-aged man, without medical history, who suddenly died at his workplace. The autopsy highlighted a pathological heart macroscopically, with multiple small white areas on the left myocardium. Coronary dissection revealed a pseudotumoural fibromyxoid aspect within the anterior interventricular artery (AIVA) and the left main coronary trunk, including reduction in their diameter with tight stenosis. Microscopic examination of these arteries showed fibroinflammatory wall destruction. In the left myocardium, there were multiple focal ischemic areas at different stages of recovery. Our case is an illustration of primary ischemic heart disease due to coronary arteritis, with a pseudotumoural presentation, which was revealed by sudden death. We discuss the cause of death and the etiological diagnosis preceding coronary arteritis.

PMID: 28691733 [PubMed - indexed for MEDLINE]

Methylprednisolone and plasmapheresis are effective for life-threatening diffuse alveolar hemorrhage and gastrointestinal hemorrhage in granulomatosis with polyangiitis: A case report and literature review.

jeu, 10/05/2018 - 12:42
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Methylprednisolone and plasmapheresis are effective for life-threatening diffuse alveolar hemorrhage and gastrointestinal hemorrhage in granulomatosis with polyangiitis: A case report and literature review.

Medicine (Baltimore). 2018 Apr;97(17):e0592

Authors: Ning S, Zhang X, Xu C, Dang X, Cheng H, Zhu K, Han Y

Abstract
RATIONALE: The treatment of granulomatosis with polyangiitis (GPA) with life-threatening complications, such as diffuse alveolar hemorrhage (DAH) and gastrointestinal hemorrhage (GIH), remains challenging.
PATIENT CONCERNS: A 70-year-old female presented with a 6-month history of a productive cough and a 10-day history of arthralgia that progressed to respiratory failure and massive hematochezia.
DIAGNOSES: Chest high-resolution computed tomography (HRCT) revealed multiple nodules, masses, and cavities. Urinalysis indicated microscopic hematuria. Test of proteinase3-anti-neutrophil cytoplasmic autoantibody (PR3-ANCA) was positive.
INTERVENTIONS: The patient was transferred to the intensive care unit (ICU) and successfully treated with glucocorticoid pulse therapy and plasmapheresis. We combined mycophenolate mofetil (MMF) with glucocorticoid for maintenance treatment.
OUTCOMES: The patient survived and is in a stable condition. We report this case that presented with a productive cough, followed by arthralgia, DAH, and GIH.
LESSONS: Effective remission-induction therapy is a key to survival, while maintaining a balance between immunosuppression and avoiding infection is another challenge.

PMID: 29703056 [PubMed - indexed for MEDLINE]

A rare case of haemorrhagic shock secondary to spontaneous rupture of a branch of the left colic artery and the right gastric artery.

jeu, 10/05/2018 - 12:42
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A rare case of haemorrhagic shock secondary to spontaneous rupture of a branch of the left colic artery and the right gastric artery.

Ann R Coll Surg Engl. 2018 May;100(5):e125-e127

Authors: Pisavadia B, Hanif M, Rana K, Budhoo M, Zaman S

Abstract
Spontaneous splanchnic artery rupture is associated with up to 70% mortality. Affected vessels are often aneurysmal, secondary to atherosclerosis. We report, to our knowledge, the only case of spontaneous rupture of a branch of the left colic artery and the right gastric artery, possibly secondary to vasculitis.

PMID: 29658342 [PubMed - indexed for MEDLINE]

Decidual granulomatous reaction in a placenta from a preeclamptic pregnancy: a case report and review of the literature.

jeu, 10/05/2018 - 12:42
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Decidual granulomatous reaction in a placenta from a preeclamptic pregnancy: a case report and review of the literature.

Virchows Arch. 2018 Apr;472(4):689-692

Authors: Chen SB, Kudose S, Krigman HR

Abstract
We report a case of decidual perivascular non-necrotizing granulomas in a placenta from a pregnancy complicated by severe preeclampsia with no evidence of infection. The mother was a 20-year-old primigravida with severe preeclampsia diagnosed in the third trimester with subsequent delivery of a healthy baby boy at 37 weeks 5 days gestation. Pathologic examination of the placenta showed scattered non-necrotizing granulomas in decidua, often adjacent to remodeled decidual arteries without fibrinoid necrosis. These were well-formed, non-necrotizing granulomas with scant lymphoid cuffs. Polarization microscopy did not show foreign material. There were no histopathologic or clinical findings suggestive of maternal-fetal infection or systemic vasculitis at the time of delivery, and the mother had no other reported conditions associated with granulomatous inflammation. Our case demonstrates that granulomatous reaction may be seen in the placenta from a pregnancy complicated by severe preeclampsia, although work-up for infection may be indicated.

PMID: 29541857 [PubMed - indexed for MEDLINE]

Behcet disease combined with Sjogren syndrome: A unique case report and literature review.

lun, 07/05/2018 - 12:07
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Behcet disease combined with Sjogren syndrome: A unique case report and literature review.

Medicine (Baltimore). 2018 Mar;97(12):e0138

Authors: Ju FH, Xu TZ, Hong HH, Mao H, Wang M, Wang Z

Abstract
RATIONALE: Behcet disease(BD) and Sjogren syndrome(SS) are separate conditions that rarely concomitantly affect an individual. In theory,mild symptoms of patients with BD or SS are easy to igore and,thus,remain undiagnosed. There,it is reasonable to believe there may be some clinical cases of combined diseases that go undiscovered and which needs to be taken seriously. In addition,it has been suggested that herpes simplex virus(HSV) types 1 and 2 are associated with BD,but have not been shown to be correlated to the direct pathogenesis of BD. The role of HSV in BD needs more research and attention.
PATIENT CONCERNS: Here,we report a young woman who had both BD and SS. The first symptom of the disease was fever. However,the HSV type 1 IgG and HSV type 2 IgM antibody results were positive in our case and,which rendered this case unique.
DIAGNOSES: BD and SS concomitantly affect the individual,and BD was the acute type.
INTERVENTIONS: IV methylprednisolone was used for 9 days and then oral glucocorticoids was used to instead,and the treatment works very well.
OUTCOMES: BD and SS can concomitantly affect an individual,and we believe that HSV-2 may be directly related to the pathogenesis of BD. The nature of BD as an auto-inflammatory disorder, autoimmune disorder, or both, is controversial. If we can find more patients who combined affected these two disease, it might helpful for us to understand the nature of BD.
LESSONS: For patients with clinical diagnosis of BD or SS,we need to be alert that it may combinded the other disease. Long term follow up and detailed inspection are important means to avoid undiscovered.

PMID: 29561414 [PubMed - indexed for MEDLINE]

Successful mesenchymal stem cell treatment of leg ulcers complicated by Behcet disease: A case report and literature review.

sam, 28/04/2018 - 10:06
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Successful mesenchymal stem cell treatment of leg ulcers complicated by Behcet disease: A case report and literature review.

Medicine (Baltimore). 2018 Apr;97(16):e0515

Authors: Li Y, Wang Z, Zhao Y, Luo Y, Xu W, Marion TN, Liu Y

Abstract
RATIONALE: Behçet disease (BD) is a recurrent vasculitis characterized by oral and genital mucous membrane ulcers, uveitis, and skin lesions but only rarely leg ulcers. To our knowledge, no efficacious therapy has been described for BD patients with complicating, destructive leg ulcers.
PATIENT CONCERNS: Here, We report the case of a 55-year-old woman with generalized erythema nodosum-like, papulopustular lesions, recurrent oral and genital ulcers accompanied with recurrent leg ulcers and trouble walking.
DIAGNOSES: Based upon the patient's clinical feature and positive pathergy test , BD was confirmed.
INTERVENTIONS: Conventional immunosuppressive therapy and anti-tumor necrosis factor inhibitors, adalimumab and etanercept, had no demonstrable clinical effect. Mesenchymal stem cell (MSC) injection combined with low-dose prednisone and thalidomide, however, completely ameliorated the ulcers on one leg, significantly improved ulcers on the other leg, and returned normal function to both legs.
OUTCOMES: The ulcerative lesions remained in remission, and the affected leg functioned normally after 34 months' follow-up.
LESSONS: Our experience suggests that MSC infusion might be a potentially successful therapy for intractable drug-resistant BD patients with concomitant leg ulcer.

PMID: 29668637 [PubMed - indexed for MEDLINE]

Relapses in three patients with Takayasu arteritis under tocilizumab treatment detected by contrast enhanced ultrasound.

sam, 28/04/2018 - 10:06
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Relapses in three patients with Takayasu arteritis under tocilizumab treatment detected by contrast enhanced ultrasound.

Vasa. 2018 Feb;47(2):149-152

Authors: Czihal M, Lottspeich C, Schröttle A, Treitl KM, Treitl M, Leipe J, Schulze-Koops H, Hoffmann U, Dechant C

Abstract
Takayasu arteritis (TA) is a rare large vessel vasculitis, affecting the aorta and its major branches, typically in young women. In this case report, we present three cases of young women of Caucasian descent who experienced relapses while under treatment with the monoclonal humanized antibody to the interleukin 6 receptor, tocilizumab. Active vasculitic lesions of the supraaortic (common carotid and axillary) arteries were detected and characterized via high resolution contrast enhanced ultrasound. Based on these cases, we discuss the potential role of contrast enhanced ultrasound in the diagnosis and follow-up of TA as well as the current data on the efficacy of tocilizumab in the treatment of TA.

PMID: 29271720 [PubMed - indexed for MEDLINE]

Treatment of tuberculous aortic pseudoaneurysm associated with vertebral tuberculosis: A case series and a literature review.

mer, 25/04/2018 - 08:53
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Treatment of tuberculous aortic pseudoaneurysm associated with vertebral tuberculosis: A case series and a literature review.

Medicine (Baltimore). 2018 Apr;97(15):e0382

Authors: Xue J, Yao Y, Liu L

Abstract
RATIONALE: Tuberculous aortic pseudoaneurysm associated with vertebral tuberculosis is a rare disease but with very high mortality. We review the literature and find 19 reports with 22 patients. Here we report three cases with vertebral tuberculosis, who also have tuberculous pseudoaneurysm of the aorta. These patients were treated by different methods. We try to analyze the epidemiology, pathogenesis, presentation, and management of this disease to find the best treatment.
PATIENT CONCERNS: The patients presented with different symptoms such as pain (chest, abdominal or back), fever, blood volume reduction or hemorrhagic shock symptoms. Large mass also could be observed by imaging. In addition to clinical manifestations, enhanced computed tomography or magnetic resonance imaging could also help the diagnosis of this disease.
DIAGNOSES: Tuberculous aortic pseudoaneurysm associated with vertebral tuberculosis.
INTERVENTIONS: Three patients were treated with anti-tuberculosis(TB) drugs or combined with different sequences surgical treatment: Case 1 refused to receive pseudoaneurysm surgery and only had anti-TB drug treatment; Case 2 received thoracic spinal surgery first; Case 3 received endovascular stent grafting.
OUTCOMES: Two patients (case 1 and case 2) who refused to undergo aneurysm surgery died. The last patient (case 3) underwent endovascular repair and antibiotic therapy for tuberculosis, and the postoperative course was uneventful; the patient recovered and survived.
LESSONS: Once the diagnosis of tuberculous pseudoaneurysm is confirmed, surgical treatment should be provided immediately combined with anti-tuberculosis drugs. The aim of the treatment is to save lives, prevent relapse, and facilitate the return to normal life, regardless of the size of the pseudoaneurysm. The pseudoaneurysm should be treated first to prevent aneurysm rupture before the vertebral tuberculosis surgery.

PMID: 29642195 [PubMed - indexed for MEDLINE]

Red Blood Cell Distribution Width Can Predict Vasculitis Activity and Poor Prognosis in Granulomatosis with Polyangiitis.

mer, 25/04/2018 - 08:53
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Red Blood Cell Distribution Width Can Predict Vasculitis Activity and Poor Prognosis in Granulomatosis with Polyangiitis.

Yonsei Med J. 2018 Mar;59(2):294-302

Authors: Kim HJ, Yoo J, Jung SM, Song JJ, Park YB, Lee SW

Abstract
PURPOSE: We investigated whether red blood cell distribution width (RDW) predicts vasculitis activity based on Birmingham vasculitis activity score (BVAS) or BVAS for granulomatosis with polyangiitis (GPA) at diagnosis and poor prognosis during follow-up in patients with antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV).
MATERIALS AND METHODS: We reviewed the medical records of 150 patients with AAV. We defined severe GPA as BVAS for GPA ≥7 (the highest quartile). Correlation and standardised correlation coefficients were analysed by linear regression tests. The differences between groups were evaluated by Mann-Whitney test. Relative risk (RR) was assessed by chi square test and Cox hazards model.
RESULTS: RDW was correlated only with the vasculitis activity of GPA among patients with AAV. An increase in RDW was associated with the absence of ear nose throat (ENT) manifestation, but not proteinase 3-ANCA. Significant differences were noted in cumulative refractory free survival according to RDW ≥15.4% (p=0.007) and the absence of ENT manifestation (p=0.036). Multivariate Cox hazards analysis identified RDW ≥15.4% as the only significant predictor of refractory disease in GPA (RR 17.573).
CONCLUSION: RDW predicts vasculitis activity in GPA, and RDW ≥15.4% at diagnosis may increase the risk of severe GPA at diagnosis and predict refractory diseases during follow-up.

PMID: 29436199 [PubMed - indexed for MEDLINE]

In vasculitis of small muscular arteries, activation of vessel-infiltrating CD8 T cells seems to be antigen-independent.

sam, 07/04/2018 - 02:23
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In vasculitis of small muscular arteries, activation of vessel-infiltrating CD8 T cells seems to be antigen-independent.

Virchows Arch. 2018 Feb;472(2):271-279

Authors: Kobayashi M, Ogawa E, Okuyama R, Kanno H

Abstract
The etiology of polyarteritis nodosa (PAN) and localized PAN is still unknown, although a T cell-mediated immune mechanism has been considered. CD8 T cells participate not only in the antigen-dependent adaptive immune system, but also in the antigen-independent innate immune system. Non-antigen-activated CD8 T cells express a unique phenotype: granzyme B (GrB) positive /CD25 negative /programmed death-1 (PD-1) negative. The aims of this study were to assess the participation of T cells, especially innate CD8 T cells, in the development of vasculitis. Twenty-eight consecutive cases of skin biopsy specimens with cutaneous vasculitis of small muscular arteries (CVSMA) were retrieved. The series comprises of 21 cases of cutaneous arteritis, three cases of PAN, and four cases of rheumatoid vasculitis. Cases of antineutrophil cytoplasmic antibody-associated vasculitis were excluded. The phenotypes of infiltrating lymphocytes in vasculitis lesions were evaluated by immunohistochemistry. In most cases of CVSMA, the number of CD8 T cells infiltrating the intima was higher than that of CD4 T cells, and significant numbers of GrB-positive cells, which represent activated CD8 T cells, were observed. However, GrB/CD25-double-positive cells, which correspond to antigen-activated T cells, were very few in a small number of cases. Cells positive for PD-1, which is also expressed on antigen-activated CD8 T cells, were not detected. We conclude that a T cell-mediated immune mechanism, involving cytotoxic CD8 T cells, may play a role in the development of CVSMA. Low expression of CD25 in activated CD8 T cells suggests that activation was antigen-independent.

PMID: 29128969 [PubMed - indexed for MEDLINE]

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