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Abstract
BACKGROUND Though autoimmune phenomena have been regularly associated with chronic urticaria in adults, data in children are sparse. AIM To describe our experience with children and adolescents with chronic urticaria and autoimmunity. METHODS AND RESULTS Of 187 patients referred for evaluation of chronic urticaria during a 7.5 year period, eight (4.3%), all females aged 7-17 years, had increased levels of antithyroid antibody, either antithyroid peroxidase antibody (n = 4, >75 IU/ml), antithyroglobulin antibody (n = 2, >150 IU/ml), or both (n = 2). The duration of urticaria was four months to seven years. Five patients were euthyroid, one of whom was found to have increased antithyroid antibody levels five years after onset of the urticaria. One patient was diagnosed with Hashimoto thyroiditis three years before the urticaria, and was receiving treatment with thyroxine. Two other hypothyroid patients were diagnosed during the initial work up for urticaria (thyroxine 9.2 pmol/l, thyroid stimulating hormone (TSH) 40.2 mIU/l) and five years after onset of the urticaria (thyroxine 14 pmol/l, TSH 10.3 mIU/l). Both were treated with thyroxine but neither had remission of the urticaria. Five patients had a low positive titre of antinuclear antibodies. CONCLUSION Children with chronic urticaria should be screened periodically for thyroxine, TSH, and antithyroid antibodies, as thyroid autoimmunity and hypothyroidism may appear several years after onset of the urticaria.
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Matalon ST, Blank M, Levy Y, Carp HJA, Arad A, Burek L, Grunebaum E, Sherer Y, Ornoy A, Refetoff S, Weiss RE, Rose NR, Shoenfeld Y. The pathogenic role of anti-thyroglobulin antibody on pregnancy: evidence from an active immunization model in mice. Hum Reprod 2003; 18:1094-9. [PMID: 12721190 DOI: 10.1093/humrep/deg210] [Citation(s) in RCA: 73] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The presence of antibodies to thyroglobulin (Tg) is associated with fetal loss even in the absence of thyroid dysfunction. The aim of this study was to examine whether active immunization with Tg could elicit anti-Tg autoantibodies and reproductive failure without interfering with thyroid function. METHODS BALB/c mice that were immunized with human Tg in complete Freund's adjuvant (CFA) or injected with only CFA were studied for the development of antibodies to Tg, T4, dsDNA, ssDNA and cardiolipin. Total T4, free T4 and thyroid-stimulating hormone (TSH) levels were also assessed before and during pregnancy. Percentages of resorbed fetuses (the equivalent to human missed abortion) were compared and autoantibody presence on the placentae and fetuses was examined. RESULTS Following immunization, high levels of anti-Tg were observed in mice immunized with Tg, compared with mice injected with CFA [0.83 +/- 0.23 versus 0.012 +/- 0.016 respectively; mean +/- SD optical density (OD) at 405 nm; P < 0.001]. The specificity of binding to Tg was confirmed by competition assay. Although total T4 levels were increased in comparison with control mice, this was associated with the presence of antibodies to T4. Indeed, free T4 levels and TSH were similar to control mice. Mice were killed after 14 days of pregnancy. The thyroid function and the histology of the thyroid glands were normal. Increased fetal wastage was found among the Tg-immunized mice compared with the CFA-injected mice (P = 0.04), with lower fetal and placental weights (fetal weights: 194 +/- 4 mg versus 240 +/- 6 mg; placental weights: 105 +/- 2 mg versus 130 +/- 3; P < 0.001 for both). Antibodies to Tg were demonstrated only on the placentae of Tg-immunized mice. CONCLUSION Immunization with Tg results in the production of Tg antibodies and fetal resorption. These effects occur in the absence of thyroid dysfunction.
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Rotman-Pikielny P, Levy Y, Eyal A, Shoenfeld Y. Pyomyositis or "injectiositis"--Staphylococcus aureus multiple abscesses following intramuscular injections. THE ISRAEL MEDICAL ASSOCIATION JOURNAL : IMAJ 2003; 5:295-6. [PMID: 14509140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
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204
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Levy Y, Tennebaum A, Ornoy A. Repair behavior in children with intellectual impairments: evidence for metalinguistic competence. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2003; 46:368-381. [PMID: 14700378 DOI: 10.1044/1092-4388(2003/029)] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
This paper tested the prediction that children with cognitive impairments who can use language intentionally will be able to carry out the metalinguistic operations involved in speech monitoring and repair. The specific linguistic characteristics of responses to requests for clarification given by 4 children with lower than normal IQ, ages 3 years 5 months to 6 years 10 months, were investigated. The analysis focused on children's ability to locate the specific errors that provoked neutral requests for clarification and produce repair. Three children could locate their errors and partly succeed in providing repair. It is suggested that ability to perform metaprocedures such as are implicated in repair behavior may be preserved in children with intellectual disabilities and that this ability does not implicate conscious awareness, nor does it depend on mature linguistic competence.
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205
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Amital H, Rewald E, Levy Y, Bar-Dayan Y, Manthorpe R, Engervall P, Sherer Y, Langevitz P, Shoenfeld Y. Fibrosis regression induced by intravenous gammaglobulin treatment. Ann Rheum Dis 2003; 62:175-7. [PMID: 12525390 PMCID: PMC1754436 DOI: 10.1136/ard.62.2.175] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To review case histories of patients in whom fibrosis played a significant role in the pathogenesis of their disease, and to determine whether intravenous gammaglobulin (IVIg) contributed to the regression of their fibrotic condition. METHODS Eight patients with excess fibrotic reaction in the course of diverse diseases were analysed; a tendency that reverted with different IVIg treatment options. Myelofibrosis was predominant in three patients (a patient with a myeloproliferative syndrome, one with systemic lupus erythematosus, and one with Sjögren's syndrome). Three patients had scleroderma as their main feature, one patient had hepatitis C cirrhosis, and one had idiopathic thrombocytopenic purpura. RESULTS Fibrotic excess was reduced in all the patients by IVIg treatment. In five patients the disease as a whole benefited from the infusion of immunoglobulins. CONCLUSION IVIg may enhance resorption of fibrosis and promote healing in patients with fibrotic associated disorders.
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206
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Zandman-Goddard G, Tal S, Levy Y, Korat A. Coexisting chondrocalcinosis, osteoarthritis and popliteal cyst. THE ISRAEL MEDICAL ASSOCIATION JOURNAL : IMAJ 2003; 5:74-5. [PMID: 12592969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
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207
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Raz R, Dyachenko P, Levy Y, Flatau E, Reichman N. A predictive model for the management of community-acquired pneumonia. Infection 2003; 31:3-8. [PMID: 12590325 DOI: 10.1007/s15010-002-2083-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Understanding what determines the prognosis of community-acquired pneumonia (CAP) is especially important for decisions on hospitalization and antimicrobial therapy. The objective of the present study was to compare the predictability of mortality in our patients to that of the pneumonia patient outcomes research team (PORT) study. PATIENTS AND METHODS Data of 320 patients admitted with CAP were retrospectively evaluated and classified according to the published scheme. RESULTS One-month mortality was 14.4%; 1-year mortality was 27.8%, two-thirds from new episodes. Univariate logistic regression risk factors for the 1-month mortality rate included leukocytosis, anemia, hypoalbuminemia, elevated blood urea nitrogen, >or= two comorbidities, tachycardia, tachypnea, acidosis, stupor, age > 65 years and high serum lactic dehydrogenase. These variables, except the last two, plus pleural effusion and bilateral infiltration were also risk factors for 1-year mortality. In the multivariate models, eight of these factors were significant risk factors, four for 1-month mortality and six for 1-year mortality. Our model for prediction of 1-month mortality had a sensitivity of 65%, specificity of 95% and accuracy of 91%. CONCLUSION Agreement between predictions by our model and the published model was considerable, showing that most patients in the low score groups should not have been hospitalized.
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208
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Zandman-Goddard G, Levy Y, Weiss P, Shoenfeld Y, Langevitz P. Transverse myelitis associated with chronic hepatitis C. Clin Exp Rheumatol 2003; 21:111-3. [PMID: 12673901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
An infectious etiology is one of the postulated mechanisms for autoimmune diseases. An emergence of autoimmune phenomena associated with hepatitis C virus (HCV) infection has been reported. Transverse myelitis is an inflammatory disease of the spinal vasculature attributed to viral infections and to autoimmune diseases including systemic lupus erythematosus and the antiphospholipid syndrome. A 34-year-old male was admitted for the rapid onset of numbness of the lower extremities and urinary retention. His past history included hepatitis C infection. The neurological examination and MRI of the thoracic spine confirmed the diagnosis of transverse myelitis. Abnormal laboratory results were hyperglobulinemia, abnormal liver function tests, and positive ANF, anti-dsDNA antibodies, and p and c-ANCA. The patient was treated with high dose prednisone, then tapered to a low dose, but regained only partial neurological function after 15 months of prednisone therapy. Persistent neurological deficits and elevated ANF and ANCA were present at a follow-up of 30 months. We describe the first reported case of a patient with chronic HCV who developed transverse myelitis.
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Shovman O, Levy Y, Tal S, Shoenfeld Y. Omental cake in a male. THE ISRAEL MEDICAL ASSOCIATION JOURNAL : IMAJ 2003; 5:73-4. [PMID: 12592968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
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210
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Levy Y. tude du champ inhomog ne obtenu par la r flexion totale d'une onde plane sur un syst me de couches minces. ACTA ACUST UNITED AC 2002. [DOI: 10.1088/0029-4780/3/1/305] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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211
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Imbert C, Levy Y. Displacement of a totally reflected light beam: filtering of he polarization states and amplification. ACTA ACUST UNITED AC 2002. [DOI: 10.1088/0335-7368/6/5/305] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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212
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Rotman-Pikielny P, Levy Y. Puzzling fever and neutropenia in a patient with Crohn's disease post-coronary artery bypass surgery. THE ISRAEL MEDICAL ASSOCIATION JOURNAL : IMAJ 2002; 4:1158-61. [PMID: 12516918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
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213
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Shovman O, Levy Y, Gilburd B, Shoenfeld Y. Antiinflammatory and immunomodulatory properties of statins. Immunol Res 2002; 25:271-85. [PMID: 12018465 DOI: 10.1385/ir:25:3:271] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Inhibitors of 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase or statins constitute the most powerful class of lipid lowering drugs, widely used in medical practice. During the past several years additional actions of statins unrelated to cholesterol reduction have been identified which includes antiinflammatory and immunomodulatory properties. Since atherosclerosis is a form of inflammation and the immune system play an important role in its pathogenesis, pleiotropic effect of statins may provide complementary explanation to their clinical benefit. This article reviews the data regarding the antiinflammatory and immunomodulatory properties of the statins that are available in the treatment of atherosclerosis and possibly may be applicable in other inflammatory diseases or conditions with the involvement of the immune system.
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Gorshtein A, Levy Y, Shoenfeld Y. Air flights and venous thromboembolism--a preventable condition. THE ISRAEL MEDICAL ASSOCIATION JOURNAL : IMAJ 2002; 4:1080-1. [PMID: 12489511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
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215
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Renaudineau Y, Révélen R, Dueymes M, Levy Y, Youinou P. Autoantibodies to heparan sulfate proteoglycans. Autoimmun Rev 2002; 1:305-12. [PMID: 12848985 DOI: 10.1016/s1568-9972(02)00060-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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216
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Houssiau FA, Vasconcelos C, D'Cruz D, Sebastiani GD, Garrido Ed EDR, Danieli MG, Abramovicz D, Blockmans D, Mathieu A, Direskeneli H, Galeazzi M, Gül A, Levy Y, Petera P, Popovic R, Petrovic R, Sinico RA, Cattaneo R, Font J, Depresseux G, Cosyns JP, Cervera R. Immunosuppressive therapy in lupus nephritis: the Euro-Lupus Nephritis Trial, a randomized trial of low-dose versus high-dose intravenous cyclophosphamide. ARTHRITIS AND RHEUMATISM 2002; 46:2121-31. [PMID: 12209517 DOI: 10.1002/art.10461] [Citation(s) in RCA: 639] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Glomerulonephritis is a severe manifestation of systemic lupus erythematosus (SLE) that is usually treated with an extended course of intravenous (IV) cyclophosphamide (CYC). Given the side effects of this regimen, we evaluated the efficacy and the toxicity of a course of low-dose IV CYC prescribed as a remission-inducing treatment, followed by azathioprine (AZA) as a remission-maintaining treatment. METHODS In this multicenter, prospective clinical trial (the Euro-Lupus Nephritis Trial [ELNT]), we randomly assigned 90 SLE patients with proliferative glomerulonephritis to a high-dose IV CYC regimen (6 monthly pulses and 2 quarterly pulses; doses increased according to the white blood cell count nadir) or a low-dose IV CYC regimen (6 fortnightly pulses at a fixed dose of 500 mg), each of which was followed by AZA. Intent-to-treat analyses were performed. RESULTS Followup continued for a median of 41.3 months in the low-dose group and 41 months in the high-dose group. Sixteen percent of those in the low-dose group and 20% of those in the high-dose group experienced treatment failure (not statistically significant by Kaplan-Meier analysis). Levels of serum creatinine, albumin, C3, 24-hour urinary protein, and the disease activity scores significantly improved in both groups during the first year of followup. Renal remission was achieved in 71% of the low-dose group and 54% of the high-dose group (not statistically significant). Renal flares were noted in 27% of the low-dose group and 29% of the high-dose group. Although episodes of severe infection were more than twice as frequent in the high-dose group, the difference was not statistically significant. CONCLUSION The data from the ELNT indicate that in European SLE patients with proliferative lupus nephritis, a remission-inducing regimen of low-dose IV CYC (cumulative dose 3 gm) followed by AZA achieves clinical results comparable to those obtained with a high-dose regimen.
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Abstract
Intravenous immunoglobulin (IVIG) is an accepted treatment for certain immunodeficiency states, but also for some autoimmune diseases. In other autoimmune conditions (i.e., systemic lupus erythematosus), it is still empirical although very efficacious. Based mainly on animal studies, IVIG has been shown to exert different antitumour mechanisms that result in metastases suppression. This effective therapy is associated with frequent occurrence of either immediate, delayed or late adverse effects, most of which are mild and transient. Efforts are taken in order to minimise these adverse effects both by pharmaceutical companies that attempt to decrease the risk of infectious agents transmission, and by physicians who monitor closely patients and choose the appropriate mode of administration of IVIG with respect to dose, duration of treatment and preparations used. Overall, IVIG is used in severe medical conditions and it is quite safe. Future research would help to further minimise its associated risks.
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218
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Steiner G, Shovman O, Skriner K, Gilburd B, Langevitz P, Miholits M, Hoet R, Levy Y, Zandman-Goddard G, Hoefler E, Smolen JS, Shoenfeld Y. Induction of anti-RA33 hnRNP autoantibodies and transient spread to U1-A snRNP complex of spliceosome by idiotypic manipulation with anti-RA33 antibody preparation in mice. Clin Exp Rheumatol 2002; 20:517-24. [PMID: 12180437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
OBJECTIVE Anti-RA33 antibodies occur in patients with rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), and mixed connective tissue disease (MCTD) and target the A2/B1 protein of the heterogeneous nuclear ribonucleoprotein (hnRNP) complex 4 which forms part of the spliceosome. The aim of the present study was to evaluate the immune response and pathological features induced in mice immunized with anti-RA33 antibodies or patient-derived recombinant single-chain variable fragments (scFv) of anti-RA33 antibodies. METHODS In the first set of the experiment, two strains of mice (C57BL/6J and BALB/c) were immunized with IgG preparations obtained from two patients with RA and one normal donor. One of the patients had high titer anti-RA33 antibodies; the other one showed weak borderline reactivity. In the second set of the experiment three groups of C57BL/6J mice were immunized, respectively, with affinity-purified (AP) anti-RA33 antibodies, scFv of anti-RA33 antibodies and normal human IgG. The immunological response induced in immunized mice was studied by immunoblotting and line immunoassay (LIA). The presence of arthritis, serositis or myositis was assessed six-months following initial immunization. RESULTS While anti-RA33 antibodies developed in only two of the mice immunized with different human IgG fractions, anti-RA33 antibodies were clearly detected in 7 sera of 13 mice immunized with AP anti-RA33 antibodies three months after the boost immunization and, moreover, also in 2 sera of 13 mice immunized with scFv of anti-RA33 antibodies. In contrast, mice immunized with normal human IgG did not develop anti-RA33 antibodies. Interestingly, transient autoantibody production against another nuclear autoantigen, U1 snRNP, was observed in 3 C57BL/6J mice immunized with scFv and in 1 mouse immunized with AP autoantibodies. However, these immunological responses were not associated with pathological findings. CONCLUSIONS Active immunization of naive mice with AP anti-RA33 antibodies and scFv of anti-RA33 antibodies resulted on the one hand in the production of murine anti-RA33 antibodies and led, on the other hand, to transient "autoantibody spread" to snRNP component of the spliceosome and other nuclear autoantigens. This "autoantibody spread" probably reflected disregulation of the idiotypic anti-idiotypic cascade.
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Zandman-Goddard G, Ehrenfeld M, Levy Y, Tal S. Diffuse alveolar hemorrhage in systemic lupus erythematosus. THE ISRAEL MEDICAL ASSOCIATION JOURNAL : IMAJ 2002; 4:470. [PMID: 12073430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
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220
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Sherer Y, Hassin S, Shoenfeld Y, Levy Y, Livneh A, Ohry A, Langevitz P. Transverse myelitis in patients with antiphospholipid antibodies--the importance of early diagnosis and treatment. Clin Rheumatol 2002; 21:207-10. [PMID: 12111625 DOI: 10.1007/s10067-002-8287-2] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Transverse myelitis (TM) is a rare manifestation of systemic lupus erythematosus (SLE) and the antiphospholipid syndrome (APS). No uniform therapeutic protocol exists for its treatment, and the prognosis is usually poor. Here we describe four patients having TM associated with antiphospholipid antibodies. Treatment measures and delay in diagnosis between symptom onset and the initiation of treatment varied between patients, but the earlier the diagnosis and the more aggressive the treatment the better was the patient's outcome. Based on these cases and on a literature review we suggest that early aggressive treatment (usually with pulses of methylprednisolone and cyclophosphamide) might improve the prognosis of patients with TM associated with antiphospholipid antibodies.
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Blank M, Levy Y, Amital H, Shoenfeld Y, Pines M, Genina O. The role of intravenous immunoglobulin therapy in mediating skin fibrosis in tight skin mice. ARTHRITIS AND RHEUMATISM 2002; 46:1689-90. [PMID: 12115202 DOI: 10.1002/art.10363] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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222
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Fadeeva T, Levy Y, Zandman-Goddard G, Segal T, Perelman M. A patient with fever and pulmonary infiltrates. THE ISRAEL MEDICAL ASSOCIATION JOURNAL : IMAJ 2002; 4:395-6. [PMID: 12040839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
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223
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Loulergue JC, Levy Y, Allain C. Investigation of the adsorption of polystyrene by plasmon surface polaritons on metal gratings. Macromolecules 2002. [DOI: 10.1021/ma00144a037] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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224
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Grunebaum E, Levy Y, Shoenfeld Y. Novel aspects of hypogammaglobulinemic states: subcutaneous immunoglobulin treatment. THE ISRAEL MEDICAL ASSOCIATION JOURNAL : IMAJ 2002; 4:288-9. [PMID: 12001706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
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225
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Sherer Y, Dulitzki M, Levy Y, Livneh A, Shoenfeld Y, Langevitz P. Successful pregnancy outcome in a patient with Gaucher's disease and antiphospholipid syndrome. Ann Hematol 2002; 81:161-3. [PMID: 11904743 DOI: 10.1007/s00277-002-0431-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2000] [Accepted: 01/07/2002] [Indexed: 10/27/2022]
Abstract
Gaucher's disease is characterized by increased incidence of several autoantibodies, but autoimmune phenomena are rare in Gaucher patients. We report the first occurrence of Gaucher's disease and antiphospholipid syndrome in the same patient. A 27-year-old woman with hepatosplenomegaly and thrombocytopenia who was diagnosed as having Gaucher's disease with the genotype 1226G/1226G developed Coombs'-positive hemolytic anemia, recurrent abortions, and a high titer of IgG and IgM anticardiolipin antibodies constituting the diagnosis of antiphospholipid syndrome. A successful pregnancy outcome was achieved by combined therapy with aspirin, low-molecular-weight heparin, prednisone, and enzyme replacement therapy with imiglucerase. The possible pathogenicity of antiphospholipid antibodies found in the sera of many asymptomatic Gaucher patients should be further clarified.
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