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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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Infliximab associated with life-threatening lung infection in a patient with Behcet disease with intestinal and hematopoietic system involvement: A case report.

ven, 16/02/2018 - 19:53
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Infliximab associated with life-threatening lung infection in a patient with Behcet disease with intestinal and hematopoietic system involvement: A case report.

Medicine (Baltimore). 2017 Dec;96(50):e9202

Authors: Chen Y, Shen Y, Ma HF, Cai JF, Hua YQ, Zou J, Guan JL

Abstract
RATIONALE: Tumor necrosis factor (TNF-α) participates in the pathophysiology of Behcet's disease (BD) and myelodysplastic syndrome (MDS). Infliximab is recommaned for the most severe type of BD, however, there is little evidence for its effectiveness in BD associated MDS.
PATIENT CONCERNS: A 46-year-old female, initially diagnosed with intestinal BD and leukopenia was later diagnosed as MDS. Treatement with infliximab and other immunoregulators lead to life-threatening pneumonia.
DIAGNOSIS: Intestinal BD associated with MDS involving trisomy 8.
INTERVENTIONS: The patient initially treated with methylprednisolone, thalidomide, cyclosporine A, and infliximab, which lead to severe lung infection. Therefore, the patient was transferred to Intensive Care Unit for life supportive, anti-infection and immune improving therapy.
OUTCOMES: The patient survived from the lung infection. With combination of methylprednisolone, thalidomide and cyclosporine A, the patient recovered from her intestinal ulceration and MDS manifestations.
LESSONS: Infliximab treatment may not benefit a patient with BD associated with MDS but place the patient at risk of infection.

PMID: 29390339 [PubMed - indexed for MEDLINE]

The prevalence of Behçet's disease in the north of Jordan: a hospital-based epidemiological survey.

ven, 16/02/2018 - 19:53
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The prevalence of Behçet's disease in the north of Jordan: a hospital-based epidemiological survey.

Clin Exp Rheumatol. 2017 Nov-Dec;35 Suppl 108(6):51-54

Authors: Madanat WY, Alawneh KM, Smadi MM, Saadeh SS, Omari MM, Bani Hani AB, Yazici H

Abstract
OBJECTIVES: To estimate the prevalence of Behçet's disease (BD) in Jordan, with the additional aim of comparing this prevalence among hospital workers in other geographical areas.
METHODS: In the first stage of our survey, 2,569 employees from 6 hospitals in north Jordan were interviewed using a screening questionnaire to identify individuals with recurrent oral ulcers (ROU), a previous diagnosis of BD (PDBD) and/or any major symptom related to BD. In the second stage, all individuals with ROU or PDBD identified at stage 1, were examined by 2 rheumatologists for the presence/confirmation of BD according to the International Study Group (ISG) criteria. Pathergy test was performed according to recommendations.
RESULTS: ROU were present in 210 (8.2%) individuals. BD was confirmed in 10 employees with PDBD. Seven more BD patients were found. Mean age of 17 BD patients was 38.6±10.7 (range 26-65 y). M: F was 2.4:1. Pathergy test was positive in 8/17. A family history of ROU or BD was noted in 9 (52%) and 3 (25.0%), respectively, compared to 227 (8.9%) and 62 (2.6%) in the whole group, excluding the BD patients (p<0.001 and 0.008, respectively). The prevalence rate of BD in the north of Jordan was estimated as 66:10.000 (95% CI 34.8 to 97.5:10000).
CONCLUSIONS: The results of this first ever survey indicated that the prevalence of BD in the north of Jordan is among the highest in the world. This prevalence can now be compared to hospital workers in other geographical areas.

PMID: 29224587 [PubMed - indexed for MEDLINE]

Leukocytoclastic vasculitis complicating cisplatin + radiation treatment for laryngeal cancer: a case report.

ven, 16/02/2018 - 19:53
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Leukocytoclastic vasculitis complicating cisplatin + radiation treatment for laryngeal cancer: a case report.

BMC Cancer. 2017 Dec 06;17(1):831

Authors: Quintanilha JCF, Visacri MB, Amaral LS, Lima CSP, Cintra ML, Moriel P

Abstract
BACKGROUND: Leukocytoclastic vasculitis is typically mediated by deposition of immune complexes and is related to many causes, including medication. To the best of our knowledge, leukocytoclastic vasculitis related to cisplatin has not yet been described in the scientific literature.
CASE PRESENTATION: We report a rare case of leukocytoclastic vasculitis after the first cycle of high-dose cisplatin chemotherapy in a patient with larynx carcinoma. A 48-year-old Caucasian man with larynx carcinoma received a high-dose of cisplatin monochemotherapy (100 mg/m2 every 21 days), along with 70 Gy of radiotherapy divided into 35 sessions, as a therapeutic schedule. Twelve days after the first chemotherapy administration and after 8 sessions of radiotherapy (total of 16 Gy), the patient presented with acute onset of palpable purpura in the lower limbs. The patient was hospitalized for 10 days, and during this period, he underwent several examinations to rule out infectious, autoimmune, and neoplastic disorders. A skin biopsy showed leukocytoclastic vasculitis with a positive pattern for IgM and C3, as detected through direct immunofluorescence. Twenty-five days after cisplatin administration, the chemotherapy regimen was changed to carboplatin AUC 5, and the episodes of purpura ceased, reinforcing the hypothesis of an adverse reaction to cisplatin.
CONCLUSIONS: Cisplatin can induce leukocytoclastic vasculitis and clinicians should be aware of this potential effect for better case management and diagnosis.

PMID: 29212535 [PubMed - indexed for MEDLINE]

Cancer risk in Korean patients with Behçet's disease: A nationwide population-based study.

sam, 10/02/2018 - 17:59
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Cancer risk in Korean patients with Behçet's disease: A nationwide population-based study.

PLoS One. 2017;12(12):e0190182

Authors: Jung YS, Han M, Kim DY, Cheon JH, Park S

Abstract
BACKGROUND: Various immune-mediated diseases are associated with increased malignancy risks. However, the relationship between Behçet's disease (BD) and cancer remains unclear. We conducted a nationwide, population-based study to determine the risk of cancer in patients with BD.
METHODS: Using National Health Insurance claims records, we collected data from 2402 patients diagnosed with BD between 2013 and 2014. Standardized incidence ratios (SIRs) of overall and site-specific cancers in patients with BD in comparison with the general population were calculated.
RESULTS: The risks of overall cancer (SIR, 3.54; 95% confidence interval, 2.35-5.11 in men and 2.17; 1.58-2.92 in women) and solid cancer (3.10; 1.94-4.69 in men and 2.13; 1.52-2.90 in women) were greater in patients with BD than in the general population. There were significantly increased risks for these solid cancers: colorectal (4.26; 1.38-9.94), liver (4.00; 1.09-10.25), bone/articular cartilage (55.66; 1.41-310.14), prostate (7.05; 1.45-20.60), and brain/central nervous system (28.32; 3.43-102.31) in men; and the lips/oral cavity/pharynx (13.97, 1.69-50.47), liver (12.78; 5.14-26.33), lungs (4.35; 1.18-11.13), other female genital organs (53.57; 1.36-298.49), and eyes (128.26; 3.24-714.59) in women. Patients with BD had a greater risk of myelodysplastic syndrome (MDS) than the general population did (65.72; 7.96-237.41 in men and 53.86; 11.11-157.40 in women), but not of hematological cancer.
CONCLUSIONS: Compared to the general population, Korean patients with BD had greater risks of overall cancer, some solid cancers, and MDS, but not of hematological cancer.

PMID: 29287101 [PubMed - indexed for MEDLINE]

A Comparison of Brand and Biosimilar Granulocyte-Colony Stimulating Factors for Prophylaxis of Chemotherapy-Induced Febrile Neutropenia.

dim, 04/02/2018 - 15:27
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A Comparison of Brand and Biosimilar Granulocyte-Colony Stimulating Factors for Prophylaxis of Chemotherapy-Induced Febrile Neutropenia.

J Manag Care Spec Pharm. 2017 Dec;23(12):1221-1226

Authors: Douglas AG, Schwab P, Lane D, Kennedy K, Slabaugh SL, Bowe A

Abstract
BACKGROUND: Filgrastim-sndz, a granulocyte-colony stimulating factor (G-CSF), was introduced as a biosimilar to filgrastim in 2015, but real-world comparative effectiveness for filgrastim versus filgrastim-sndz has not been reported to date.
OBJECTIVES: To (a) compare the incidence of febrile neutropenia for patients taking filgrastim versus those taking filgrastim-sndz and (b) compare the incidence of a potential serious adverse event for filgrastim versus filgrastim-sndz.
METHODS: This retrospective cohort study identified patients receiving a G-CSF following chemotherapy, using administrative claims from the Humana Research Database. Patients enrolled in a Medicare Advantage Prescription Drug plan with a claim for a G-CSF from October 1, 2015, through September 30, 2016, were identified. G-CSF use had to occur within 6 days of exposure to chemotherapy and without any subsequent chemotherapy within 14 days after G-CSF use. Febrile neutropenia requiring hospitalization was defined as hospitalization within 14 days after G-CSF use with (a) diagnosis of infection and/or neutropenia (broad definition) or (b) infection and neutropenia diagnoses (narrow definition). Serious adverse drug events (spleen rupture, acute respiratory syndrome, serious allergic reactions, capillary leak syndrome, thrombocytopenia, leukocytosis, cutaneous vasculitis, or bones and muscle ache) were also identified within 14 days after G-CSF use. An incidence difference of < 1% with 90% CI crossing zero qualified as support for noninferiority. Two-tailed chi-square tests were also used to investigate differences.
RESULTS: A total of 88 filgrastim and 101 filgrastim-sndz patients were identified. Filgrastim and filgrastim-sndz met the criteria for noninferiority based on an incidence difference of -0.6% (90% CI = -5.1%-4.0%; P = 0.84) for the broad definition of febrile neutropenia and a difference of -0.8% (90% CI = -3.8%-2.1%; P = 0.64) for the narrow definition. For the analysis of serious adverse events, an incidence difference of -2.5% (90% CI = -7.5%-2.5%; P = 0.42) for filgrastim compared with filgrastim-sndz was not sufficient to establish noninferiority.
CONCLUSIONS: This study is one of the first analyses of real-world evidence regarding the noninferiority of filgrastim and filgrastim-sndz. The study results support noninferiority of filgrastim and filgrastim-sndz for prevention of febrile neutropenia requiring hospitalization. While noninferiority for serious adverse events was not supported, there was also no statistically significant difference between filgrastim and filgrastim-sndz. The study's small sample size could have limited the analysis of the relatively rare outcomes of febrile neutropenia requiring hospitalization and serious adverse events. A study including a larger numbers of patients taking filgrastim or filgrastim-sndz could provide additional insights.
DISCLOSURES: This study received no outside funding. Douglas, Kennedy, and Slabaugh were employees of Humana Pharmacy Solutions at the time the study was conducted. Bowe, Schwab, and Lane were employees of Comprehensive Health Insights, a wholly owned subsidiary of Humana, at the time the study was conducted. Study concept and design were contributed by Douglas, Kennedy, Schwab, and Lane, along with Slabaugh and Bowe. Bowe took the lead in data collection, assisted by Schwab, and data interpretation was performed by Schwab, along with the other authors. The manuscript was written by Schwab, Lane, and Douglas and revised by Kennedy, Slabaugh, and Bowe, along with Schwab, Lane, and Douglas.

PMID: 29172983 [PubMed - indexed for MEDLINE]

Cogan syndrome: Characteristics, outcome and treatment in a French nationwide retrospective study and literature review.

jeu, 01/02/2018 - 12:50
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Cogan syndrome: Characteristics, outcome and treatment in a French nationwide retrospective study and literature review.

Autoimmun Rev. 2017 Dec;16(12):1219-1223

Authors: Durtette C, Hachulla E, Resche-Rigon M, Papo T, Zénone T, Lioger B, Deligny C, Lambert M, Landron C, Pouchot J, Kahn JE, Lavigne C, De Wazieres B, Dhote R, Gondran G, Pertuiset E, Quemeneur T, Hamidou M, Sève P, Le Gallou T, Grasland A, Hatron PY, Fain O, Mekinian A, SNFMI and CRI

Abstract
BACKGROUND: Cogan syndrome is mainly treated with steroids. We aimed to determine the place of DMARDs and biologic-targeted treatments.
PATIENTS AND METHODS: We conducted a French nationwide retrospective study of patients with Cogan syndrome (n=40) and a literature review of cases (n=22) and analyzed the efficacy of disease-modifying anti-rheumatic drugs (DMARDs) and tumor necrosis factor α (TNF-α) antagonists.
RESULTS: We included 62 patients (31 females) (median age 37years [range 2-76]. At diagnosis, 61 patients (98%) had vestibulo-auditory symptoms, particularly bilateral hearing loss in 41% and deafness in 31%. Ocular signs were present in 57 patients (92%), with interstitial keratitis in 31 (51%). The first-line treatment consisted of steroids alone (n=43; 70%) or associated with other immunosuppressive drugs (n=18; 30%). Overall, 13/43 (30%) and 4/18 (22%) patients with steroids alone and with associated immunosuppressive drugs, respectively (p=0.8), showed vestibulo-auditory response; 32/39 (82%) and 15/19 (79%) ocular response; and 23/28 (82%) and 10/14 (71%) general response. Overall 61 patients had used a total of 126 lines of treatment, consisting of steroids alone (n=51 lines), steroids with DMARDs (n=65) and infliximab (n=10). Vestibulo-auditory response was significantly more frequent with infliximab than DMARDs or steroids alone (80% vs 39% and 35%, respectively), whereas ocular, systemic and acute-phase reactant response rates were similar. Infliximab was the only significant predictor of vestibulo-auditory improvement (odds ratio 20.7 [95% confidence interval 1.65; 260], p=0.019).
CONCLUSION: Infliximab could lead to vestibulo-auditory response in DMARDS and steroid-refractory Cogan syndrome, but prospective studies are necessary.

PMID: 29037902 [PubMed - indexed for MEDLINE]

Imported fire ant envenomation: A clinicopathologic study of a recognizable form of arthropod assault reaction.

jeu, 01/02/2018 - 12:50
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Imported fire ant envenomation: A clinicopathologic study of a recognizable form of arthropod assault reaction.

J Cutan Pathol. 2017 Dec;44(12):1012-1017

Authors: Villada G, Hafeez F, Ollague J, Nousari CH, Elgart GW

Abstract
BACKGROUND: Skin reactions to the sting of the imported fire ant have characteristic clinicopathological features.
METHODS: One case of experimental envenomation was prospectively followed during 48 hours, with biopsies. In addition, 6 cases from our laboratory were retrospectively evaluated histopathologically for the following features: spongiosis, exocytosis (and type of cells), pustule formation, erosion/ulceration, epidermal necrosis, scale/crust, papillary dermal edema, inflammatory dermal infiltrate (cell type, density, depth, distribution, shape), red blood cell extravasation, vasculopathy and vasculitis.
RESULTS: The typical lesion follows a very distinctive clinical and histopathologic evolution over 48 hours, with the formation of a subepidermal pustule overlying a wedge-shaped area of dermal collagen basophilic degeneration with scattered neutrophils. In the 6 cases retrieved from our files, the main features were a superficial and deep dermal, perivascular, periadnexal and interstitial infiltrate consisting of neutrophils, with basophilic degeneration of the collagen. A subepidermal pustule was noted in half of the cases.
CONCLUSIONS: In biopsies taken in a clinical setting, even in the absence of the characteristic subepidermal pustule, the diagnosis of imported fire ant sting can be suspected if there is a superficial and deep perivascular, periadnexal and interstitial infiltrate composed of neutrophils, with some basophilic denaturation of collagen.

PMID: 28873251 [PubMed - indexed for MEDLINE]

Incidence of Adverse Events During Peripheral Administration of Sodium Chloride 3.

jeu, 01/02/2018 - 12:50
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Incidence of Adverse Events During Peripheral Administration of Sodium Chloride 3.

J Intensive Care Med. 2018 Jan;33(1):48-53

Authors: Dillon RC, Merchan C, Altshuler D, Papadopoulos J

Abstract
PURPOSE: Traditionally, sodium chloride 3% has been administered via a central venous line (CVL) because of the perceived risk of infiltration and tissue injury due to its high osmolarity. In clinical practice, sodium chloride 3% is commonly administered through peripheral venous catheters (PVCs) given the necessity of timely administration. However, there is no published data on the safety of administering sodium chloride 3% through PVCs in the adult population. The objective of this study was to evaluate the safety of peripheral venous administration of sodium chloride 3%.
MATERIALS AND METHODS: A retrospective review was conducted in patients who received sodium chloride 3% in the intensive care unit (ICU). Patients were excluded if they had a CVL for the entire duration of the infusion or younger than 18 years at the time of administration. Baseline patient and infusion characteristics were collected. Infusion-related adverse events (IRAEs) were recorded, graded, and interventions required were noted.
RESULTS: A total of 66 patients were included in the analysis. The most common indication was hyponatremia and majority of the patients were managed in the neurosurgical ICU. The most common risk factor for IRAEs was the presence of altered mental status. Four patients experienced an IRAE at an event rate of 6.1%. Patients who experienced an IRAE ranged from 38 to 82 years old. The IRAEs were grade 1 in severity, managed conservatively with removal of the PVC, and 2 of the 4 patients had their infusions restarted peripherally. The time to initial IRAE ranged from 2 to 94 hours. For the entire cohort, hospital and ICU length of stay were 8 and 4 days, respectively.
CONCLUSIONS: The rate of IRAEs related to the infusion of sodium chloride 3% through PVCs appears to be similar to those reported with other hyperosmotic agents and could be considered for patients who need time-sensitive therapy.

PMID: 28372499 [PubMed - indexed for MEDLINE]

The Use and Pitfalls of Intracranial Vessel Wall Imaging: How We Do It.

jeu, 11/01/2018 - 00:50
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The Use and Pitfalls of Intracranial Vessel Wall Imaging: How We Do It.

Radiology. 2018 Jan;286(1):12-28

Authors: Lindenholz A, van der Kolk AG, Zwanenburg JJM, Hendrikse J

Abstract
Intracranial vessel wall magnetic resonance (MR) imaging has gained much attention in the past decade and has become part of state-of-the-art MR imaging protocols to assist in diagnosing the cause of ischemic stroke. With intracranial vessel wall imaging, vessel wall characteristics have tentatively been described for atherosclerosis, vasculitis, dissections, Moyamoya disease, and aneurysms. With the increasing demand and subsequently increased use of intracranial vessel wall imaging in clinical practice, radiologists should be aware of the choices in imaging parameters and how they affect image quality, the clinical indications, methods of assessment, and limitations in the interpretation of these images. In this How I do It article, the authors will discuss the technical requirements and considerations for vessel wall image acquisition in general, describe their own vessel wall imaging protocol at 3 T and 7 T, show a step-by-step basic assessment of intracranial vessel wall imaging as performed at their institution-including commonly encountered artifacts and pitfalls-and summarize the commonly reported imaging characteristics of various intracranial vessel wall diseases for direct clinical applicability. Finally, future technical and clinical considerations for full implementation of intracranial vessel wall imaging in clinical practice, including the need for histologic validation and acquisition time reduction, will be discussed.

PMID: 29261469 [PubMed - indexed for MEDLINE]

Atypical acute retinal necrosis accompanied by Terson's syndrome: a case report.

dim, 07/01/2018 - 23:25
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Atypical acute retinal necrosis accompanied by Terson's syndrome: a case report.

BMC Ophthalmol. 2017 Dec 19;17(1):255

Authors: Lee JY, Kim DY, Lee HJ, Jeong JH, Park SP, Kim JY

Abstract
BACKGROUND: Acute retinal necrosis (ARN) has characterized by panuveitis, vitritis, severe vaso-occlusive vasculitis, and diffuse necrotizing retinitis. There are no case reports on atypical ARN combined with Terson's syndrome. Herein, we report a case of ARN with atypical clinical features combined with Terson's syndrome that we successfully treated by intravitreal ganciclovir injection.
CASE PRESENTATION: A 64-year-old man visited our eye clinic with a complaint of decreased visual acuity in his right eye. At the initial visit, his best corrected visual acuity was 20/125 in the right eye. Slit-lamp examination demonstrated mild hyperemia, keratic precipitates, and anterior chamber inflammatory reaction. Fundus examination revealed multiple diffuse white-yellowish infiltrations in the peripheral retina combined with dot hemorrhages. Ultra-wide-field fluorescence angiography showed obstructive arteritis with peripheral non-perfusion and leakage from the retinal vessels. As a result of the PCR analysis, varicella zoster virus DNA was identified in the aqueous humor. Under the diagnosis with VZV-mediated ARN, we started with intravenous acyclovir and oral prednisolone. After 3 days of the above treatment, the anterior chamber inflammation and vitreous opacity were increased. On fundus examination, multiple whitish infiltrations were increased. In addition, newly developed vitreous and peripapillary hemorrhages were detected. On the T2 brain magnetic resonance imaging (MRI) demonstrated a sub-acute or old hemorrhagic infarction in the right occipital lobe, and contrast-enhancing lesions in the right basal ganglia. The spinal tapping was performed in the department of neurology in our hospital at the time when the patient complained of headache, and intracranial pressure was 31 mmHg. Under the diagnosis of ARN with Terson's syndrome, we started intravitreal ganciclovir (2 mg/0.5 ml) injections. After 5 intravitreal ganciclovir injections over a period of 8 months, the diffuse whitish infiltrating retinal lesions combined with dot hemorrhage were decreased. The vitreous and peripapillary hemorrhage was significantly reduced. There was no recurrence in the patient's right eye, in which his visual acuity had improved to 20/60.
CONCLUSIONS: In the event of a poor response to traditional treatment such as intravenous acyclovir, intravitreal ganciclovir may have a role as an adjunctive therapy in patients of VZV associated ARN combined with Terson's syndrome.

PMID: 29258454 [PubMed - indexed for MEDLINE]

Multiple aneurysms and gastrointestinal involvement in Behcet's disease: A case report.

dim, 07/01/2018 - 23:25
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Multiple aneurysms and gastrointestinal involvement in Behcet's disease: A case report.

Medicine (Baltimore). 2017 Dec;96(49):e9131

Authors: Wang M, Sun W, Chen Z, Wang X, Lv J, Tan Q, Wang Y, Zhou J

Abstract
RATIONALE: Behcet's disease (BD) is a rare systemic vasculitis disorder that can involve vessels of any size.
PATIENT CONCERNS: A 60-year-old female had recurrent painful mouth ulcers about 30 years ago and recently presented with abdominal distension, conjunctival congestion, and chest pain in sequence.
DIAGNOSES: The patient was diagnosed with BD according to the International Criteria for Behcet's Disease (ICBD).
INTERVENTIONS: A therapy of glucocorticoids and cyclophosphamide was administered.
OUTCOMES: After a 3-month treatment, follow-up examination showed a depression of the inflammation and a slight decrease of the arterial aneurysms.
LESSONS: BD patients may get a delayed diagnosis because of the long duration between the first and subsequent manifestations. Suspect patients should be followed-up and the diagnosis of BD should be considered when multiple tissues or organs are involved.

PMID: 29245353 [PubMed - indexed for MEDLINE]

Ten-year progress of coronary artery lesions prior to Behçet disease diagnosis: A case report and care-compliant article.

dim, 07/01/2018 - 23:25
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Ten-year progress of coronary artery lesions prior to Behçet disease diagnosis: A case report and care-compliant article.

Medicine (Baltimore). 2017 Dec;96(49):e9102

Authors: Ma W, Liang Y, Zhu J

Abstract
INTRODUCTION: Behçet disease is a multisystemic chronic inflammatory disorder characterized by recurrent oral aphthous ulcers, genital ulcers, uveitis, and skin lesions. However, particularly part of patients would present cardiovascular involvements and vascular lesions could be the presenting sign of Behçet disease preceding classical symptoms. We presented a middle aged male patient, in whom abdominal aorta pseudoaneurysm was as the first leading sign to reveal Behçet disease, and with his coronary artery lesions progress through a 10-year period before Behçet disease was diagnosed.
CONCLUSIONS: Coronary artery involvement of Behçet disease warrants more attention and investigation; repeated in-stent stenosis, aggressive progress, and elevated inflammation markers should be regard with more care earlier in clinical practice.

PMID: 29245339 [PubMed - indexed for MEDLINE]

Successful treatment of erythema induratum with topical application of antituberculous drugs: A case report.

dim, 07/01/2018 - 23:25
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Successful treatment of erythema induratum with topical application of antituberculous drugs: A case report.

Medicine (Baltimore). 2017 Dec;96(49):e9010

Authors: Mei X, Zhao J

Abstract
RATIONALE: Erythema induratum, a chronic recurrent lobular panniculitis with vasculitis, is strongly associated with Mycobacterium tuberculosis infection. The recommended drugs include isoniazid, rifampicin, and pyrazinamide, which are typically administered in combination (orally or intravenously). Till date, there are no reports about topical application of anti-tuberculous (anti-TB) drugs for treatment of erythema induratum.
PATIENT CONCERNS: Herein, we present the case of a 73-year-old woman with recurrent ulceration, scarring and obvious pain in her lower legs.
DIAGNOSES: She was diagnosed of erythema induratum.
INTERVENTIONS: Topical anti-TB treatment (3.75% isoniazid twice a day) was necessitated by the development of severe gastrointestinal upset and significant reduction in platelets after oral treatment with isoniazid and rifampicin.
OUTCOMES: The skin lesions showed improvement at one month and remitted mostly at two months. After 6 months, the skin lesions have subsided and no obvious side effects were observed.
LESSONS: Our experience may help expand the therapeutic regimens for cutaneous tuberculosis, and provide physicians with alternative options for management of tuberculosis.

PMID: 29245283 [PubMed - indexed for MEDLINE]

Transcriptional profiling of PBMCs unravels B cell mediated immunopathogenic imprints of HCV vasculitis.

dim, 07/01/2018 - 23:25
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Transcriptional profiling of PBMCs unravels B cell mediated immunopathogenic imprints of HCV vasculitis.

PLoS One. 2017;12(12):e0188314

Authors: Comstock E, Kim CW, Murphy A, Emmanuel B, Zhang X, Sneller M, Poonia B, Kottilil S

Abstract
B cell depletion therapy using rituximab has been shown to be effective in achieving remission in patients with HCV-mixed cryoglobulinemic (MC) vasculitis. Previously, we have demonstrated abnormalities in peripheral immune cells involving neutrophils, chemotaxis, and innate immune activation among patients with HCV-MC vasculitis when compared to HCV patients without vasculitis. In this study, we evaluated the effect of B cell depletion therapy on transcriptional profiles of peripheral blood mononuclear cells before and after riruximab therapy, in order to unravel the pathogenic mechanism involved in HCV-MC vasculitis induced by abnormal B cell proliferation. DNA microarray analysis was performed using RNA from PBMCs from seven patients with HCV-MC vasculitis and seven normal volunteers. DNA was hybridized to Affymetrix U133A chips. After normalization, differentially expressed gene list with treatment was generated using partitional clustering. RT-PCR, flow cytometry, and enzyme immunoassay (EIA) was used to validate DNA microarray findings. Differentially expressed genes included B cells and non-B cell genes. Validation of genes using purified cell subsets demonstrated distinct effect of B cell depletion therapy on non-B cells, such as monocytes, T cells, and NK cells. Notably, B lymphocyte stimulator (BLyS) levels were persistently elevated in patients who subsequently relapsed. In conclusion, pathogenesis of HCV-MC vasculitis is mediated by abnormal proliferation of B cells, driven by BLyS, leading to significant effects on non-B cells in mediating symptomatology. Future therapeutics using a combination approach of B cell depletion and proliferation may be desired to achieve long-term remission.

PMID: 29228031 [PubMed - indexed for MEDLINE]

In vivo visualization of braid-like appearance in Kawasaki disease: insights from multi-modality imaging.

dim, 07/01/2018 - 23:25
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In vivo visualization of braid-like appearance in Kawasaki disease: insights from multi-modality imaging.

Int J Cardiovasc Imaging. 2017 Dec;33(12):1891-1893

Authors: Nakano H, Kataoka Y, Yasuda S

Abstract
A 42-year-old gentleman with Kawasaki disease was referred for silent cardiac ischemia at inferior myocardial region. Coronary angiography showed braid-like appearance in the right coronary artery. Several channels at the segment with braid-like appearance were visualized by multi-slice computed tomography and intravascular ultrasound. Interestingly in particular, optical coherence tomography visualized the presence of multiple micro-vessels which were not detectable on other modalities. This case further elucidates distinct morphological features of braid-like lesion which potentially influences blood supply and causing cardiac ischemia.

PMID: 28667489 [PubMed - indexed for MEDLINE]

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