301
|
Teixeira V, Mohammad AJ, Jones RB, Smith R, Jayne D. Efficacy and safety of rituximab in the treatment of eosinophilic granulomatosis with polyangiitis. RMD Open 2019; 5:e000905. [PMID: 31245051 PMCID: PMC6560673 DOI: 10.1136/rmdopen-2019-000905] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 05/06/2019] [Accepted: 05/15/2019] [Indexed: 12/18/2022] Open
Abstract
Introduction Eosinophilic granulomatosis with polyangiitis (EGPA) is a subset of antineutrophil cytoplasmic antibodies (ANCA) associated vasculitis with distinct pathophysiological mechanisms, clinical features and treatment responses. Rituximab is a licensed therapy for granulomatosis with polyangiitis and microscopic polyangiitis but there is limited experience of rituximab in EGPA. Methods EGPA patients from a tertiary centre who received rituximab for mostly refractory EGPA or in whom cyclophosphamide was contra indicated were studied. A standardised dataset was collected at time of initial treatment and every 3 months for 24 months. Response was defined as a Birmingham Vasculitis Activity Score (BVAS) of 0 and partial response as ≥50% reduction in BVAS from baseline. Remission was defined as a BVAS of 0 on prednisolone dose ≤5 mg. Results Sixty-nine patients (44 female) received rituximab between 2003 and 2017. Improvement (response and partial response) was observed in 76.8% of patients at 6 months, 82.8% at 12 months and in 93.2% by 24 months, while relapses occurred in 54% by 24 months, with asthma being the most frequent manifestation. The median BVAS decreased from 6 at baseline to 1 at 6 months, and 0 at 12 and 24 months. Prednisolone dose (mg/day, median) decreased from 12.5 to 7, 7.5 and 5 at 6, 12 and 24 months, respectively. ANCA positive patients had a longer asthma/ear, nose and throat (ENT) relapse-free survival time and a shorter time to remission. Discussion Rituximab demonstrated some efficacy in EGPA and led to a reduction in prednisolone requirement, but asthma and ENT relapse rates were high despite continued treatment. The ANCA positive subset appeared to have a more sustained response on isolated asthma/ENT exacerbations.
Collapse
Affiliation(s)
- Vítor Teixeira
- Vasculitis and Lupus Clinic, Addenbrooke's Hospital, Cambridge, UK.,Serviço de Reumatologia e Doenças Ósseas Metabólicas, Hospital de Santa Maria, Centro Hospitalar Universitário de Lisboa Norte, Lisbon, Portugal
| | - Aladdin J Mohammad
- Vasculitis and Lupus Clinic, Addenbrooke's Hospital, Cambridge, UK.,Clinical Sciences, Rheumatology, Lund University, Lund, Skåne, Sweden
| | - Rachel B Jones
- Vasculitis and Lupus Clinic, Addenbrooke's Hospital, Cambridge, UK
| | - Rona Smith
- Vasculitis and Lupus Clinic, Addenbrooke's Hospital, Cambridge, UK
| | - David Jayne
- Vasculitis and Lupus Clinic, Addenbrooke's Hospital, Cambridge, UK
| |
Collapse
|
302
|
Ennis D, Lee JK, Pagnoux C. Mepolizumab for the treatment of eosinophilic granulomatosis with polyangiitis. Expert Opin Biol Ther 2019; 19:617-630. [PMID: 31146595 DOI: 10.1080/14712598.2019.1623875] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Eosinophilic granulomatosis with polyangiitis (EGPA) is a rare antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis characterized by asthma, hypereosinophilia, and progressive multiorgan involvement. Although not fully elucidated, advancement in our understanding of the pathophysiology of EGPA has led to the development of multiple new treatment targets. AREAS COVERED Herein we review the epidemiology, clinical manifestations, pathophysiology, treatments, and ongoing research in the management of EGPA. The central role of Interleukin-5 (IL-5) in the development and maintenance of hypereosinophilia will be discussed. The value of mepolizumab, an anti-IL-5 monoclonal antibody, in the treatment of EGPA is reviewed in detail. EXPERT OPINION The available literature supports the use of mepolizumab for the induction and maintenance of remission of refractory, relapsing, or glucocorticoid-dependent EGPA with potentially greater benefit in those who are ANCA-positive or those with greater eosinophilia ( ≥ 150 cells/ μ L). Despite these positive results, relapses remain frequent, and the need for both short- and long-term glucocorticoid use remains common. More research is needed to address these needs and determine the precise role of mepolizumab.
Collapse
Affiliation(s)
- Daniel Ennis
- a Vasculitis Clinic, Division of Rheumatology , Mount Sinai Hospital, University Health Network , Toronto , Canada
| | - Jason Kihyuk Lee
- b Division of Rheumatology, Mount Sinai Hospital, University Health Network , Toronto Allergy and Asthma Clinic , Toronto , Canada
| | - Christian Pagnoux
- a Vasculitis Clinic, Division of Rheumatology , Mount Sinai Hospital, University Health Network , Toronto , Canada.,c Division of Rheumatology, Mount Sinai Hospital, University Health Network , Canadian Vasculitis research network (CanVasc) , Toronto , Canada
| |
Collapse
|
303
|
A delayed diagnosis of eosinophilic granulomatosis with polyangiitis complicated with extensive artery occlusion of lower extremities in children: case report and literature review. Pediatr Rheumatol Online J 2019; 17:26. [PMID: 31138304 PMCID: PMC6537187 DOI: 10.1186/s12969-019-0331-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Accepted: 05/17/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Eosinophilic granulomatosis with polyangiitis (EGPA) is a rare systemic vasculitis in children. A delayed or missed diagnosis of pediatric EGPA is common, owing to the atypical clinical manifestation and limited recognition of this disorder. The vasculitis in EGPA typically involves small to medium size vessels. Extensive occlusion of arteries in the extremities was being extremely rare and has never been reported in children. CASE PRESENTATION A 10-year and 10-month-old girl with recurrent wheezing and breathlessness during exercise, was initially diagnosed with asthma at the age of five years. Despite unexplained manifestations, including intermittent remarkably increased eosinophilia, uncontrolled allergic rhinitis, and recurrent petechia, from the onset of asthma through to its remission, the consideration of EGPA was completely ignored until the patient presented with aggravated petechia and severe ulceration of the lower extremities, associated with extensive stenosis and/or occlusion of the arteries of the shank and foot. Given her history of asthma, eosinophilia, allergic rhinitis, mononeuropathy, pulmonary infiltrates, and vasculitis confirmed by the skin biopsy, the diagnosis of EGPA was ultimately confirmed. Regrettably, the initial inappropriate and irrational use of corticosteroid failed to relieve the symptoms until more aggressive treatment with intravenous methylprednisolone was started. This was followed by methotrexate treatment, with tapering of prednisone, without relapse over a six-month follow-up. CONCLUSIONS Pediatric rheumatologists should be alert to the possibility of EGPA in children with refractory asthma associated with unexplained manifestations, and should be aware of the thromboembolic complications as vascular sequelae of EGPA.
Collapse
|
304
|
Destructive Upper Airway Disease from Eosinophilic Granulomatosis with Polyangiitis (EGPA): The Very First Case. Case Rep Rheumatol 2019; 2019:6173869. [PMID: 31263619 PMCID: PMC6556304 DOI: 10.1155/2019/6173869] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Accepted: 05/05/2019] [Indexed: 11/18/2022] Open
Abstract
Eosinophilic granulomatosis with polyangiitis (EGPA) is a multisystem vasculitic disorder that predominantly affects medium- and small-sized blood vessels. EGPA belongs to a group of vasculitides known as anti-neutrophil cytoplasmic antibody- (ANCA-) associated vasculitis (AAV). Upper airway involvement is seen in all ANCA-associated vasculitides, but destructive upper airway disease has never been reported in patients with EGPA. We report the first case of erosive chondritis and saddle nose deformity in a 50-year-old patient suffering from EGPA.
Collapse
|
305
|
Berlit P, Krämer M. Cerebral involvement in systemic vasculitides: Extracts from the guideline of the German neurological society. Neurol Res Pract 2019; 1:13. [PMID: 33324879 PMCID: PMC7650123 DOI: 10.1186/s42466-019-0016-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 03/22/2019] [Indexed: 01/09/2023] Open
Abstract
Cerebral vasculitis is a rare disorder but plays a major role in the differential diagnosis of stroke, encephalopathy and headache. This guideline was developed in order to support clinicians in the diagnosis and treatment of cerebral manifestations of systemic vasculitides and rheumatic diseases. It is based on a medline research and was developed in a modified Delphi process and approved by the involved societies. This article is an abridged and translated version of the guideline published in DGNeurologie: Berlit, P. & Krämer, M. DGNeurologie (2018) 1: 17. 10.1007/s42451-018-0001-y.
Collapse
Affiliation(s)
- Peter Berlit
- Deutsche Gesellschaft für Neurologie, Reinhardtstr. 27 C, 10117 Berlin, Germany
| | - Markus Krämer
- Neurologie, Alfried-Krupp-Krankenhaus Essen, Alfried-Krupp-Straße 21, 45131 Essen, Germany
| | | |
Collapse
|
306
|
|
307
|
Aouadi S, Bejar D, Attia M, Ghrairi N, Maâlej S, Douik El Gharbi L. Cardiomyopathie fatale au cours de la granulomatose à éosinophiles avec polyangéite (GEPA). Presse Med 2019; 48:573-575. [DOI: 10.1016/j.lpm.2019.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Revised: 03/03/2019] [Accepted: 03/05/2019] [Indexed: 10/27/2022] Open
|
308
|
Clinical characteristics of Polish patients with ANCA-associated vasculitides—retrospective analysis of POLVAS registry. Clin Rheumatol 2019; 38:2553-2563. [DOI: 10.1007/s10067-019-04538-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 03/14/2019] [Accepted: 03/29/2019] [Indexed: 01/18/2023]
|
309
|
Occurrence of cerebral small vessel disease at diagnosis of MPO-ANCA-associated vasculitis. J Neurol 2019; 266:1708-1715. [DOI: 10.1007/s00415-019-09318-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 04/07/2019] [Accepted: 04/09/2019] [Indexed: 01/22/2023]
|
310
|
Abstract
The vasculitides are diseases characterized by inflammation of blood vessels and inflammatory leukocytes in vessel walls. There is an increased propensity for ischemic stroke, resulting from compromise of vessel lumina with distal tissue ischemia; and hemorrhagic or nonhemorrhagic stroke, and aneurysmal formation and bleeding, due to loss of vessel integrity.
Collapse
Affiliation(s)
- David S Younger
- Department of Neurology, Division of Neuro-Epidemiology, New York University School of Medicine, New York, NY, USA; School of Public Health, City University of New York, New York, NY, USA.
| |
Collapse
|
311
|
Xu D, Xu H, Wang F, Wang G, Wei Q, Lei S, Gao Q, Zhang Q, Guo F. Multiple Distinctive Demyelinating Lesions Caused by Eosinophilic Granulomatosis With Polyangiitis: Case Report and Literature Review. Front Neurol 2019; 10:213. [PMID: 30930835 PMCID: PMC6423896 DOI: 10.3389/fneur.2019.00213] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 02/19/2019] [Indexed: 01/20/2023] Open
Abstract
Eosinophilic granulomatosis with polyangiitis (EGPA) is an extremely rare rheumatic immune disease characterized by vasculitis of small- and medium-sized blood vessels. Central nervous system (CNS) involvement frequently consists of cerebrovascular disease; a manifestation with multiple demyelinating lesions has never been reported in detail. This report describes a 38-year-old man, who presented with progressive memory deterioration and underwent microsurgery; EGPA was subsequently confirmed. Unique clinical and radiological features as well as immunohistological outcomes and DNA sequencing revealed a potential disease-associated human leukocyte antigen (HLA) type, and single-nucleotide polymorphisms (SNPs) are described for this uncommon case. Although EGPA rarely involves the CNS, this differential diagnosis should be considered when patients present with a history of nasosinusitis, elevated eosinophil percentage, clinical pulmonitis, and neurological manifestations. Microsurgery is necessary for precise diagnosis and effective treatment.
Collapse
Affiliation(s)
- Dingkang Xu
- Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Hongen Xu
- Center for Precision Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Fang Wang
- Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Guoqing Wang
- Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Qingjie Wei
- Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Shixiong Lei
- Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Qiang Gao
- Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Qi Zhang
- Center for Precision Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,School of Pharmaceutical Sciences, Zhengzhou University, Zhengzhou, China
| | - Fuyou Guo
- Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Key Laboratory of Neurosurgical Diseases, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| |
Collapse
|
312
|
C-Reactive protein as a diagnostic tool in differential diagnosis of hypereosinophilic syndrome and antineutrophil cytoplasmic antibody–negative eosinophilic granulomatosis with polyangiitis. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2019; 7:1347-1351.e3. [DOI: 10.1016/j.jaip.2018.10.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 09/18/2018] [Accepted: 10/05/2018] [Indexed: 01/16/2023]
|
313
|
P-ANCA negative eosinophilic granulomatosis with polyangiitis. Respir Med Case Rep 2019; 27:100830. [PMID: 30989049 PMCID: PMC6446216 DOI: 10.1016/j.rmcr.2019.100830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Revised: 03/24/2019] [Accepted: 03/25/2019] [Indexed: 11/21/2022] Open
Abstract
Vasculitis refers to inflammation of the systemic vessels. Eosinophilic granulomatosis with polyangiitis (EGPA) is a medium and small vessel vasculitis characterized by hypereosinophilia, pulmonary infiltrates, difficult to treat asthma and polyneuropathies. Diagnosis can often be challenging. In this article, we present a case of a young lady who was diagnosed ANCA negative EGPA.
Collapse
|
314
|
Raffray L, Guillevin L. Treatment of Eosinophilic Granulomatosis with Polyangiitis: A Review. Drugs 2019; 78:809-821. [PMID: 29766394 DOI: 10.1007/s40265-018-0920-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Eosinophilic granulomatosis with polyangiitis (formerly Churg-Strauss syndrome) is a rare type of anti-neutrophil cytoplasm antibody-associated vasculitis. Nevertheless, eosinophilic granulomatosis with polyangiitis stands apart because it has features of vasculitis and eosinophilic disorders that require targeted therapies somewhat different from those used for other anti-neutrophil cytoplasm antibody-associated vasculitides. Considerable advances have been made in understanding the underlying pathophysiology of eosinophilic granulomatosis with polyangiitis that have highlighted the key role of eosinophils and opened new therapeutic opportunities. Its conventional treatment relies mainly on agents that decrease inflammation: corticosteroids and immunosuppressant adjunction for severe manifestations. New therapeutic approaches are needed for refractory disease, relapses and issues associated with corticosteroid dependence, especially for asthma manifestations. Drugs under evaluation mostly target eosinophils and B cells. Results of low-evidence-based trials suggested possible efficacies of biologicals: B-cell-blocking rituximab and anti-immunoglobulin E omalizumab. Recently, the first large-scale randomised controlled trial on eosinophilic granulomatosis with polyangiitis proved the efficacy of anti-interleukin-5 mepolizumab. That finding opens a new era in eosinophilic granulomatosis with polyangiitis management, with mepolizumab approval but also in future drug evaluations and trial designs for eosinophilic granulomatosis with polyangiitis. Additional studies are needed to determine which patients would benefit most from targeted therapies and achieve personalised treatment for patients with eosinophilic granulomatosis with polyangiitis. Herein, we review eosinophilic granulomatosis with polyangiitis characteristics and provide an overview of established and novel pharmacological agents.
Collapse
Affiliation(s)
- Loïc Raffray
- Department of Internal Medicine, Félix-Guyon University Hospital of La Réunion, Saint Denis, Réunion Island, France
| | - Loïc Guillevin
- Department of Internal Medicine, Referral Center for Rare Systemic and Autoimmune Diseases, Hôpital Cochin, Université Paris Descartes, Paris, France.
| |
Collapse
|
315
|
Engwenyu LR, Tchakarov A, Zhao B. Eosinophilic granulomatosis with polyangiitis in a continuous flow left ventricular assist device patient: a case report and review of literature. Cardiovasc Pathol 2019; 39:70-73. [DOI: 10.1016/j.carpath.2018.12.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 11/30/2018] [Accepted: 12/14/2018] [Indexed: 02/07/2023] Open
|
316
|
Seltene Ursache einer Hämoptyse. Monatsschr Kinderheilkd 2019. [DOI: 10.1007/s00112-018-0446-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
317
|
Kim MJ, Lee BR, Park JS, Choi YJ, Song MK, Lee S, Suh DI. A pediatric case of eosinophilic granulomatosis with polyangiitis accompanied by heart failure mimicking an asthma attack. ALLERGY ASTHMA & RESPIRATORY DISEASE 2019. [DOI: 10.4168/aard.2019.7.4.212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Min Jung Kim
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Bo Ra Lee
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Ji Soo Park
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Yun Jung Choi
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Mi Kyoung Song
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Soyoung Lee
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Dong In Suh
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| |
Collapse
|
318
|
|
319
|
Steinfeld J, Bradford ES, Brown J, Mallett S, Yancey SW, Akuthota P, Cid MC, Gleich GJ, Jayne D, Khoury P, Langford CA, Merkel PA, Moosig F, Specks U, Weller PF, Wechsler ME. Evaluation of clinical benefit from treatment with mepolizumab for patients with eosinophilic granulomatosis with polyangiitis. J Allergy Clin Immunol 2018; 143:2170-2177. [PMID: 30578883 DOI: 10.1016/j.jaci.2018.11.041] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 11/02/2018] [Accepted: 11/27/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND In a recent phase III trial (NCT02020889) 53% of mepolizumab-treated versus 19% of placebo-treated patients with eosinophilic granulomatosis with polyangiitis (EGPA) achieved protocol-defined remission. OBJECTIVE We sought to investigate post hoc the clinical benefit of mepolizumab in patients with EGPA using a comprehensive definition of benefit encompassing remission, oral glucocorticoid (OGC) dose reduction, and EGPA relapses. METHODS The randomized, placebo-controlled, double-blind, parallel-group trial recruited patients with relapsing/refractory EGPA receiving stable OGCs (prednisolone/prednisone, ≥7.5-50 mg/d) for 4 or more weeks. Patients received 300 mg of subcutaneous mepolizumab or placebo every 4 weeks for 52 weeks. Clinical benefit was defined post hoc as follows: remission at any time (2 definitions used), 50% or greater OGC dose reduction during weeks 48 to 52, or no EGPA relapses. The 2 remission definitions were Birmingham Vasculitis Activity Score of 0 plus OGC dose of 4 mg/d or less (remission 1/clinical benefit 1) or 7.5 mg/d or less (remission 2/clinical benefit 2). Clinical benefit was assessed in all patients and among subgroups with a baseline blood eosinophil count of less than 150 cells/μL, baseline OGC dosage of greater than 20 mg/d, or weight of greater than 85 kg. RESULTS With mepolizumab versus placebo, 78% versus 32% of patients experienced clinical benefit 1, and 87% versus 53% of patients experienced clinical benefit 2 (both P < .001). Significantly more patients experienced clinical benefit 1 with mepolizumab versus placebo in the blood eosinophil count less than 150 cells/μL subgroup (72% vs 43%, P = .033) and weight greater than 85 kg subgroup (68% vs 23%, P = .005); in the OGC greater than 20 mg/d subgroup, results were not significant but favored mepolizumab (60% vs 36%, P = .395). CONCLUSION When a comprehensive definition of clinical benefit was applied to data from a randomized controlled trial, 78% to 87% of patients with EGPA experienced benefit with mepolizumab.
Collapse
Affiliation(s)
- Jonathan Steinfeld
- Respiratory TAU & Flexible Discovery Unit, GlaxoSmithKline, Philadelphia, Pa
| | - Eric S Bradford
- Respiratory Therapeutic Area, GlaxoSmithKline, Research Triangle Park, NC
| | - Judith Brown
- Research and Development, Immuno-Inflammation TAU, Uxbridge, United Kingdom
| | - Stephen Mallett
- Research & Development, Statistics, Programming and Data Standards, GlaxoSmithKline, Stockley Park West, Uxbridge, United Kingdom
| | - Steven W Yancey
- Respiratory Therapeutic Area, GlaxoSmithKline, Research Triangle Park, NC
| | - Praveen Akuthota
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of California San Diego, La Jolla, Calif
| | - Maria C Cid
- Department of Autoimmune Diseases, Hospital Clínic, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Gerald J Gleich
- Departments of Dermatology and Medicine, University of Utah School of Medicine, Salt Lake City, Utah
| | - David Jayne
- Department of Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Paneez Khoury
- Human Eosinophil Section, Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md
| | - Carol A Langford
- Department of Rheumatic and Immunologic Diseases, Center for Vasculitis Care and Research, Cleveland Clinic, Cleveland, Ohio
| | - Peter A Merkel
- Division of Rheumatology, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, Pa
| | - Frank Moosig
- Rheumazentrum, Schleswig-Holstein Mitte, Neumünster, Germany
| | - Ulrich Specks
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minn
| | - Peter F Weller
- Divisions of Allergy and Infectious Diseases, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass
| | | |
Collapse
|
320
|
Nakazawa D, Masuda S, Tomaru U, Ishizu A. Pathogenesis and therapeutic interventions for ANCA-associated vasculitis. Nat Rev Rheumatol 2018; 15:91-101. [DOI: 10.1038/s41584-018-0145-y] [Citation(s) in RCA: 164] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
|
321
|
Gauckler P, Shin JI, Mayer G, Kronbichler A. Eosinophilia and Kidney Disease: More than Just an Incidental Finding? J Clin Med 2018; 7:E529. [PMID: 30544782 PMCID: PMC6306805 DOI: 10.3390/jcm7120529] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 11/29/2018] [Accepted: 12/05/2018] [Indexed: 02/07/2023] Open
Abstract
Peripheral blood eosinophilia (PBE), defined as 500 eosinophils or above per microliter (µL) blood, is a condition that is not uncommon but often neglected in the management of patients with chronic kidney disease (CKD), acute kidney injury (AKI), or patients on renal replacement therapy (RRT). The nature of PBE in the context of kidney diseases is predominantly secondary or reactive and has to be distinguished from primary eosinophilic disorders. Nonetheless, the finding of persistent PBE can be a useful clue for the differential diagnosis of underdiagnosed entities and overlapping syndromes, such as eosinophilic granulomatosis with polyangiitis (EGPA), IgG4-related disease (IgG4-RD), acute interstitial nephritis (AIN), or the hypereosinophilic syndrome (HES). For patients on RRT, PBE may be an indicator for bio-incompatibility of the dialysis material, acute allograft rejection, or Strongyloides hyperinfection. In a subset of patients with EGPA, eosinophils might even be the driving force in disease pathogenesis. This improved understanding is already being used to facilitate novel therapeutic options. Mepolizumab has been licensed for the management of EGPA and is applied with the aim to abrogate the underlying immunologic process by blocking interleukin-5. The current article provides an overview of different renal pathologies that are associated with PBE. Further scientific effort is required to understand the exact role and function of eosinophils in these disorders which may pave the way to improved interdisciplinary management of such patients.
Collapse
Affiliation(s)
- Philipp Gauckler
- Department of Internal Medicine IV (Nephrology and Hypertension), Medical University Innsbruck, 6020 Innsbruck, Austria.
| | - Jae Il Shin
- Department of Pediatrics, Yonsei University College of Medicine, Seoul 03722, Korea.
- Department of Pediatric Nephrology, Severance Children's Hospital, Seoul 03722, Korea.
- Institute of Kidney Disease Research, Yonsei University College of Medicine, Seoul 03722, Korea.
- Division of Cardiology, Emory University School of Medicine, Atlanta, GA 30322, USA.
| | - Gert Mayer
- Department of Internal Medicine IV (Nephrology and Hypertension), Medical University Innsbruck, 6020 Innsbruck, Austria.
| | - Andreas Kronbichler
- Department of Internal Medicine IV (Nephrology and Hypertension), Medical University Innsbruck, 6020 Innsbruck, Austria.
| |
Collapse
|
322
|
Faverio P, Bonaiti G, Bini F, Vaghi A, Pesci A. Mepolizumab as the first targeted treatment for eosinophilic granulomatosis with polyangiitis: a review of current evidence and potential place in therapy. Ther Clin Risk Manag 2018; 14:2385-2396. [PMID: 30573961 PMCID: PMC6292233 DOI: 10.2147/tcrm.s159949] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Mepolizumab is an anti-interleukin-5 (IL-5) humanized monoclonal antibody that binds to free IL-5. It induces bone marrow eosinophil maturation arrest and decreases eosinophil progenitors and subsequent maturation in the blood and bronchial mucosa. Its use has been extensively studied in severe eosinophilic asthma at a dose of 100 mg subcutaneously (SC) every 4 weeks and, more recently, in other hypereosinophilic syndromes. Eosinophilic granulomatosis with polyangiitis (EGPA) is an eosinophilic vasculitis that may involve multiple organs. Characteristic clinical manifestations are asthma, sinusitis, transient pulmonary infiltrates and neuropathy. Among the numerous pathways involved in the pathogenesis of EGPA, the Th-2 phenotype has a main role, as suggested by the prominence of the asthmatic component, in triggering the release of key cytokines for the activation, maturation and survival of eosinophils. In particular, IL-5 is highly increased in active EGPA and its inhibition can represent a potential therapeutic target. In this scenario, mepolizumab may play a therapeutic role. After some positive preliminary observations on the use of mepolizumab in small case series of EGPA patients with refractory or relapsing disease despite standard of care treatment, a randomized controlled trial was published in 2017. Mepolizumab at a dose of 300 mg administered by SC injection every 4 weeks proved effective in prolonging the period of remission of the disease, allowing for reduced steroid use. The positive results of this study, which met both of the primary endpoints, led to the approval in the USA of mepolizumab in adult patients with EGPA by the Food and Drug Administration in 2017. Therefore, mepolizumab can be officially considered as an add-on therapy with steroid-sparing effect in cases of relapsing or refractory EGPA. However, the most appropriate dose and duration of therapy still need to be determined. Future studies on larger multinational populations with prolonged follow-up are warranted.
Collapse
Affiliation(s)
- Paola Faverio
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy,
- Respiratory Unit, San Gerardo Hospital, ASST di Monza, Monza, Italy,
| | - Giulia Bonaiti
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy,
- Respiratory Unit, San Gerardo Hospital, ASST di Monza, Monza, Italy,
| | - Francesco Bini
- ASST-Rhodense, UOC Pneumologia, Garbagnate Milanese, Milan, Italy
| | - Adriano Vaghi
- ASST-Rhodense, UOC Pneumologia, Garbagnate Milanese, Milan, Italy
| | - Alberto Pesci
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy,
- Respiratory Unit, San Gerardo Hospital, ASST di Monza, Monza, Italy,
| |
Collapse
|
323
|
Histopathological Findings and Increased D-Dimer Are Predictive Factors of Systemic Thromboses in Eosinophilic Granulomatosis With Polyangiitis. Am J Dermatopathol 2018; 40:879-883. [DOI: 10.1097/dad.0000000000001202] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
324
|
La CRP, un bio marqueur diagnostique pour différencier le syndrome hyperéosinophilique de la granulomatose éosinophilique avec polyangéite. Rev Med Interne 2018. [DOI: 10.1016/j.revmed.2018.10.260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
325
|
Fina A, Dubus JC, Tran A, Derelle J, Reix P, Fayon M, Couderc L, Donnou MD, Pagnier A, Blanchon S, Faure N, Mely L, Albertini M, de Blic J, Giovannini-Chami L. Eosinophilic granulomatosis with polyangiitis in children: Data from the French RespiRare® cohort. Pediatr Pulmonol 2018; 53:1640-1650. [PMID: 29943913 DOI: 10.1002/ppul.24089] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 06/10/2018] [Indexed: 01/30/2023]
Abstract
OBJECTIVES To describe the characteristics of pediatric cases of eosinophilic granulomatosis with polyangiitis (EGPA), a systemic necrotizing vasculitis rarely diagnosed in children, retrieved from the French Reference Center for rare pediatric lung diseases and compared with adult cases included in the French Vasculitis Study Group cohort. METHODS We collected information on pediatric EGPA disease presentation, management, and outcome. Cases met the Lanham criteria and/or American College of Rheumatology classification criteria. RESULTS Fourteen cases of pediatric EGPA were included, from 1980 to 2012, with a median follow-up of 58.5 months. Median age at diagnosis was 12.3 years. All cases had respiratory involvement. The organ systems most frequently involved were the upper airway (85%), skin (71%), digestive tract (64%), and heart (57%). Neurological and renal involvement were rare. Four of the fourteen children were positive for ANCA (30.7%). During follow-up, three children required intensive care and one child died. The relapse rate was 64%. In comparison with an adult cohort, we found more ENT, heart, and digestive-tract involvement, and fewer neurological manifestations. In children, the delay between asthma onset and diagnosis was shorter, and biopsies showed fewer features of vasculitis. CONCLUSION This French cohort is the biggest pediatric EGPA series described to date, with a long follow-up period. The findings confirm that pediatric EGPA has specific clinical, radiological, and histological characteristics that differ from adult EGPA. Development of systemic symptoms, and consequently diagnosis, occur with a shorter delay in children, mainly during the eosinophilic phase and leading to a specific presentation.
Collapse
Affiliation(s)
- Agnès Fina
- Pediatric Pulmonology and Allergology Department, Hôpitaux pédiatriques de Nice CHU-Lenval, Nice, France
| | - Jean-Christophe Dubus
- Pediatric Pulmonology Department, APHM, Timone Enfant de Marseille, Marseille, France
| | - Antoine Tran
- Pediatric Pulmonology and Allergology Department, Hôpitaux pédiatriques de Nice CHU-Lenval, Nice, France
| | - Jocelyne Derelle
- Pediatric Pulmonology Department, Hôpital de Brabois, CHU de Nancy, Nancy, France
| | - Philippe Reix
- Pediatric Pulmonology Department and Pediatric CRCM, Hôpital Femme Mère Enfant, Hospices civils de Lyon, Bron, France.,UMR 5558 (EMET), CNRS, LBBE, Université de Lyon, Villeurbanne, France
| | - Michael Fayon
- Pediatric Pulmonology Department, Hôpital Pellegrin Enfants, Bordeaux, France
| | - Laure Couderc
- Pediatric Pulmonology Department, CHU Hôpital Charles-Nicolle, Rouen, France
| | | | - Anne Pagnier
- Pediatric Hematology and Oncology Department, CHRU de Grenoble, Grenoble, France
| | - Sylvain Blanchon
- Pediatric Pulmonology and Allergology Department, Hôpital des enfants, CHU de Toulouse, Toulouse, France
| | - Nathalie Faure
- Pediatric Pulmonology Department, Hôpital Clocheville, CHRU de Tours, Tours, France
| | - Laurent Mely
- Pediatric Pulmonology Department, Hôpital Renée Sabran, Giens, France
| | - Marc Albertini
- Pediatric Pulmonology and Allergology Department, Hôpitaux pédiatriques de Nice CHU-Lenval, Nice, France.,Université Côte d'Azur, Nice, France
| | - Jacques de Blic
- Pediatric Pulmonology and Allergology Department, APHP, Hôpital Necker, Paris, France
| | - Lisa Giovannini-Chami
- Pediatric Pulmonology and Allergology Department, Hôpitaux pédiatriques de Nice CHU-Lenval, Nice, France.,Université Côte d'Azur, Nice, France
| |
Collapse
|
326
|
Aging in Primary Systemic Vasculitis: Implications for Diagnosis, Clinical Manifestations, and Management. Drugs Aging 2018; 36:53-63. [DOI: 10.1007/s40266-018-0617-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
|
327
|
Gilyarov MY, Belikova LP, Shchukin IA, Fidler MS, Avakyan GG, Shustrova GE, Martynov MY, Svet AV. [Neurological disorders in eosinophilic granulomatosis with polyangiitis (Churg-Strauss syndrome)]. Zh Nevrol Psikhiatr Im S S Korsakova 2018. [PMID: 28635862 DOI: 10.17116/jnevro201611610193-102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Eosinophilic granulomatosis with polyangiitis - EGPA (Churg-Strauss syndrome) is a rare autoimmune disorder. The pathogenesis of the disease includes production of anti-neutrophil cytoplasmic antibodies directed against myeloperoxidase with the development of small-vessel necrotizing vasculitis and eosinophilic infiltration of organs. The involvement of peripheral and central nervous system is observed in more than 3/4 of cases. The authors describe three patients with EGPA. In a 53-year-old male patient, EGPA manifested with multiple neuropathies, which regressed after treatment with corticosteroids and cytostatics. In a 34-year-old woman, cerebral sinus thrombosis and cerebral infarction developed in the non-active period of long-term EGPA. The patient was treated with anticoagulants. A 77-year-old woman with a newly diagnosed EGPA, confirmed by bone marrow examination for eosinophilia, developed ischemic stroke and polyneuropathy. The causes and mechanisms of development as well as dynamics and outcomes of neurological disorders, differential diagnosis, treatment and prognosis of eosinophilic granulomatosis with polyangiitis are discussed.
Collapse
Affiliation(s)
| | | | - I A Shchukin
- Pirogov City Clinical Hospital, Moscow, Russia; Pirogov Russian National Research Medical University, Moscow, Russia
| | - M S Fidler
- Pirogov City Clinical Hospital, Moscow, Russia; Pirogov Russian National Research Medical University, Moscow, Russia
| | - G G Avakyan
- Pirogov City Clinical Hospital, Moscow, Russia; Pirogov Russian National Research Medical University, Moscow, Russia
| | | | - M Yu Martynov
- Pirogov City Clinical Hospital, Moscow, Russia; Pirogov Russian National Research Medical University, Moscow, Russia
| | - A V Svet
- Pirogov City Clinical Hospital, Moscow, Russia
| |
Collapse
|
328
|
Ito T, Fujita SI, Kanzaki Y, Sohmiya K, Hoshiga M. Eosinophilic Granulomatosis with Polyangiitis (EGPA) with an Unusual Manifestation of Mid-Ventricular Obstruction Caused by Endocardial Thrombus. AMERICAN JOURNAL OF CASE REPORTS 2018; 19:1197-1203. [PMID: 30293983 PMCID: PMC6187986 DOI: 10.12659/ajcr.910861] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Patient: Male, 46 Final Diagnosis: Eosinophilic granulomatosis with polyangiitis Symptoms: Chest pain Medication: — Clinical Procedure: Skin biopsy Specialty: Cardiology
Collapse
Affiliation(s)
- Takahide Ito
- Department of Cardiology, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Shu-Ichi Fujita
- Department of Cardiology, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Yumiko Kanzaki
- Department of Cardiology, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Koichi Sohmiya
- Department of Cardiology, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Masaaki Hoshiga
- Department of Cardiology, Osaka Medical College, Takatsuki, Osaka, Japan
| |
Collapse
|
329
|
Miyazaki M, Hattori H, Suzuki A, Serizawa N, Uto K, Fukushima K, Momose M, Shiga T, Hagiwara N. Successfully treated eosinophilic granulomatosis with polyangiitis relapse presenting as myocarditis and followed by multimodality imaging. J Cardiol Cases 2018; 18:145-148. [PMID: 30279934 DOI: 10.1016/j.jccase.2018.06.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 06/08/2018] [Accepted: 06/11/2018] [Indexed: 11/30/2022] Open
Abstract
A 60-year-old man with eosinophilic granulomatosis with polyangiitis (EGPA), which was diagnosed 12 years earlier and managed with prednisolone, was admitted to our hospital because of dyspnea and paresthesias in both hands. Laboratory test revealed peripheral eosinophilia along with elevated troponin T and brain natriuretic peptide (BNP). The patient's clinical picture was consistent with myocarditis and relapse of EGPA. Endomyocardial biopsy showed marked infiltration of eosinophils in myocardium, which confirmed relapse of EGPA with myocarditis. Thallium-201 and iodine-123-beta-methyl iodophenyl pentadecanoic acid dual single-photon emission computed tomography (TL-BMIPP SPECT), as well as cardiac magnetic resonance imaging (CMR), also confirmed cardiac involvement. The patient was treated with methylprednisolone and improved dramatically. CMR and TL-BMIPP SPECT performed after discharge showed improvement of abnormal lesions, while anomalies detected by these modalities remained. This is a case of EGPA relapse presenting as myocarditis despite treatment with prednisolone. <Learning objective: Cardiac involvement and relapse are frequent in eosinophilic granulomatosis with polyangiitis patients. Patients should be screened and monitored carefully for cardiac involvement during follow-up by multimodality imaging.>.
Collapse
Affiliation(s)
- Midori Miyazaki
- Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan
| | - Hidetoshi Hattori
- Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan
| | - Atsushi Suzuki
- Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan
| | - Naoki Serizawa
- Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan
| | - Kenta Uto
- Department of Pathology, Tokyo Women's Medical University, Tokyo, Japan
| | - Kenji Fukushima
- Department of Diagnostic Imaging and Nuclear Medicine, Tokyo Women's Medical University, Tokyo, Japan
| | - Mitsuru Momose
- Department of Diagnostic Imaging and Nuclear Medicine, Tokyo Women's Medical University, Tokyo, Japan
| | - Tsuyoshi Shiga
- Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan
| | - Nobuhisa Hagiwara
- Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan
| |
Collapse
|
330
|
Les endocardites non infectieuses. Rev Med Interne 2018; 39:782-791. [DOI: 10.1016/j.revmed.2018.03.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2017] [Revised: 02/05/2018] [Accepted: 03/03/2018] [Indexed: 12/18/2022]
|
331
|
Nakayama T, Murai S, Ohte N. Dilated Cardiomyopathy with Eosinophilic Granulomatosis with Polyangiitis in Which Active Myocardial Inflammation Was Only Detected by Endomyocardial Biopsy. Intern Med 2018; 57:2675-2679. [PMID: 29709930 PMCID: PMC6191588 DOI: 10.2169/internalmedicine.0330-17] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Eosinophilic granulomatosis with polyangiitis (EGPA) is a rare type of systemic vasculitis. Cardiac involvement is the main cause of death in patients with this disease. We herein report a case of congestive heart failure in a patient with EGPA. Neither 67Ga scintigraphy nor cardiac magnetic resonance imaging detected inflammation of the myocardium; however, myocardial biopsy revealed numerous infiltrating inflammatory cells, thereby fulfilling the criteria of inflammatory dilated cardiomyopathy. We improved the left ventricular systolic function by increasing the patient's prednisolone dosage. This case shows that in some cases the detection myocardial inflammation - which allows for appropriate therapy - may only be achieved by myocardial biopsy.
Collapse
Affiliation(s)
- Takafumi Nakayama
- Department of Cardio-Renal Medicine and Hypertension, Nagoya City University Graduate School of Medical Sciences, Japan
| | - Shunsuke Murai
- Department of Cardio-Renal Medicine and Hypertension, Nagoya City University Graduate School of Medical Sciences, Japan
| | - Nobuyuki Ohte
- Department of Cardio-Renal Medicine and Hypertension, Nagoya City University Graduate School of Medical Sciences, Japan
| |
Collapse
|
332
|
Peripheral Nervous System Involvement in Lymphoproliferative Disorders. Mediterr J Hematol Infect Dis 2018; 10:e2018057. [PMID: 30210750 PMCID: PMC6131106 DOI: 10.4084/mjhid.2018.057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 08/06/2018] [Indexed: 01/04/2023] Open
Abstract
Peripheral neuropathies are a vast group of diseases with heterogeneous aetiologies, including genetic and acquired causes. Several haematological disorders may cause an impairment of the peripheral nervous system, with diverse mechanisms and variable clinical, electrophysiological and pathological manifestations. In this practical review, we considered the main phenotypes of peripheral nervous system diseases associated with lymphoproliferative disorders. The area of intersection of neurological and haematological fields is of particular complexity and raises specific problems in the clinical practice of lymphoproliferative disorders. The personal crosstalk between neurologists and haematologists remains a fundamental tool for a proper diagnostic process which may lead to successful treatments in most cases.
Collapse
|
333
|
Wick MR. Pulmonary disorders that are potentially associated with anti- neutrophilic cytoplasmic antibodies: A brief review. Semin Diagn Pathol 2018; 35:304-314. [PMID: 30173882 DOI: 10.1053/j.semdp.2018.08.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis frequently manifests with involvement of the lungs and kidneys, and it also may affect other anatomic sites. This article presents the patterns of pulmonary injury in which ANCA-associated vasculitis is included in the differential diagnosis, with a discussion of antineutrophil cytoplasmic antibody testing methods. The histologic features of non-vasculitic, potentially-ANCA-associated pulmonary lesions are reviewed briefly as well.
Collapse
Affiliation(s)
- Mark R Wick
- Division of Surgical Pathology and Cytopathology, University of Virginia Medical Center, Charlottesville, VA, United States.
| |
Collapse
|
334
|
Abstract
PURPOSE OF REVIEW Immune axonal polyneuropathy is caused by a diverse group of disorders that share similar presentations and treatment regimens. This article focuses on the clinical findings, evaluation, and management of immune-mediated causes of axonal polyneuropathy, focusing primarily on large fiber sensorimotor polyneuropathy. RECENT FINDINGS Specific characteristics of an immune-mediated polyneuropathy have been incorporated in a new diagnostic screening tool that is highly sensitive and can easily be used in the outpatient clinic setting. New insights into autoantibodies may help identify the presence of an underlying autoimmune or paraneoplastic disease as the cause of a polyneuropathy. SUMMARY This article provides readers with further understanding into the autoimmune causes of axonal polyneuropathy and will help the clinician recognize key clinical features that may lead to timely diagnosis and treatment.
Collapse
|
335
|
Berti A, Volcheck GW, Cornec D, Smyth RJ, Specks U, Keogh KA. Severe/uncontrolled asthma and overall survival in atopic patients with eosinophilic granulomatosis with polyangiitis. Respir Med 2018; 142:66-72. [PMID: 30170804 DOI: 10.1016/j.rmed.2018.07.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 07/14/2018] [Accepted: 07/23/2018] [Indexed: 01/26/2023]
Abstract
BACKGROUND Although asthma, rhinitis/rhinosinusitis and peripheral eosinophilia are present in virtually all patients with eosinophilic granulomatosis with polyangiitis (EGPA), the role of atopy in these patients is not well defined. OBJECTIVE To clarify the role of atopy in patients affected with EGPA. METHODS Clinical, laboratory and standard spirometry data have been abstracted from medical records. Only patients who underwent skin and/or specific IgE testing for common aeroallergens before the vasculitic phase were included. RESULTS Overall, 33.5% (63) of our patients underwent skin and/or specific IgE testing to aeroallergens. Atopy related to aeroallergens was confirmed in 22.3% (two-third of those tested), and was associated with more severe/uncontrolled asthma (p < 0.001), including a greater use of oral glucocorticoids for respiratory manifestations the year before the diagnosis of EGPA (p = 0.013). Atopic patients with EGPA had higher total serum IgE levels and less renal disease at EGPA diagnosis compared to non-atopic patients (p < 0.05). Among atopic patients, the majority had multiple sensitizations (76%); dust mite and grass pollen were the most common respiratory allergens identified. The number of allergens did not correlate with peripheral eosinophilia, total serum IgE, ESR, or measures of airway obstruction (p > 0.05 in all cases). The presence of atopy increased the risk of severe/uncontrolled asthma, but not the risk of severe vasculitis (Five Factor Score≥1). Atopic patients had a better overall survival (p = 0.027). CONCLUSION In EGPA, atopy is associated with better prognosis and more severe/uncontrolled asthma manifestations in the year before the development of vasculitis, but not with more severe vasculitis at presentation.
Collapse
Affiliation(s)
- Alvise Berti
- Immunology, Rheumatology, Allergy and Rare Diseases Department, San Raffaele Scientific Institute, Milan and Santa Chiara Hospital, Trento, Italy; Division of Pulmonary and Critical Care Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Gerald W Volcheck
- Division of Allergic Diseases, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Divi Cornec
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN, USA; INSERM UMR1227, Lymphocytes B et Autoimmunité, Université de Bretagne Occidentale, CHU de Brest, Brest, France
| | - Robert J Smyth
- Royal College of Surgeons in Ireland, Dublin, Dublin 2, Ireland
| | - Ulrich Specks
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Karina A Keogh
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN, USA.
| |
Collapse
|
336
|
Abstract
Vasculitis is an inflammatory condition that targets the blood vessels, which may occur in isolation or as a component of a systemic inflammatory condition. Although many of the vasculitides can directly affect the organs of the gastrointestinal system, some types exhibit a proclivity for certain gastrointestinal and hepatic organs. Often a patient presents with nonspecific symptoms, delaying the diagnosis and treatment of the underlying vasculitis. Vasculitis can also present with severe manifestations, such as upper gastrointestinal bleeds and bowel perforation. It is important to identify the signs and symptoms of vasculitis in gastrointestinal system and institute appropriate treatment.
Collapse
Affiliation(s)
- Eric Anderson
- Denver Veterans Affairs Medical Center, University of Colorado School of Medicine, Denver, CO, USA
| | - Neel Gakhar
- Denver Veterans Affairs Medical Center, University of Colorado School of Medicine, Denver, CO, USA
| | - Courtney Stull
- Denver Veterans Affairs Medical Center, University of Colorado School of Medicine, Denver, CO, USA
| | - Liron Caplan
- Denver Veterans Affairs Medical Center, University of Colorado School of Medicine, Denver, CO, USA.
| |
Collapse
|
337
|
Naito T, Hayashi H, Kashiwada T, Saito Y, Abe S, Kubota K, Gemma A. Pulmonary embolism and deep vein thrombosis in eosinophilic granulomatosis with polyangiitis successfully treated with rivaroxaban. Respir Med Case Rep 2018; 25:33-35. [PMID: 29998056 PMCID: PMC6038334 DOI: 10.1016/j.rmcr.2018.05.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Revised: 05/02/2018] [Accepted: 05/08/2018] [Indexed: 11/27/2022] Open
Abstract
A 41-year-old woman presented complaining of cough and purpura for one month. On her first visit, a blood test demonstrated peripheral blood eosinophilia, but chest radiography showed no abnormalities. However, 2 days after the first visit, she went to the emergency room because of fever and right-sided chest pain. Contrast-enhanced computed tomography of the chest showed pulmonary embolism and air space consolidation. Thrombosis was present in the popliteal vein. Bronchoscopy revealed alveolar hemorrhage and increased eosinophils in the bronchoalveolar lavage fluid, and a skin biopsy demonstrated a perivascular eosinophilic infiltrate. The patient was diagnosed with eosinophilic granulomatosis with polyangiitis (EGPA). We started steroid therapy and low-molecular-weight heparin (LMWH). The chest pain and fever disappeared, and the peripheral eosinophil count normalized. However, the thrombosis in the leg worsened. It was dramatically improved by changing from LMWH to oral rivaroxaban. The thrombogenic risk of eosinophilia should be recognized. This case suggests that oral rivaroxaban is useful when thrombosis is uncontrolled by LMWH in a patient with EGPA.
Collapse
Affiliation(s)
- Tomoyuki Naito
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Hiroki Hayashi
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Takeru Kashiwada
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Yoshinobu Saito
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Shinji Abe
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Kaoru Kubota
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Akihiko Gemma
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| |
Collapse
|
338
|
Tsurikisawa N, Oshikata C, Watanabe M, Tsuburai T, Kaneko T, Saito H. Innate immune response reflects disease activity in eosinophilic granulomatosis with polyangiitis. Clin Exp Allergy 2018; 48:1305-1316. [PMID: 29908086 DOI: 10.1111/cea.13209] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Revised: 05/04/2018] [Accepted: 05/08/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND Eosinophilic granulomatosis with polyangiitis (EGPA) is a disease characterized by allergic granulomatosis, necrotizing vasculitis, and peripheral blood eosinophilia. Interleukin (IL)-33, thymic stromal lymphopoietin (TSLP), and type 2 innate lymphoid cells (ILC2) are involved in the innate and type 2 immune responses in EGPA. However, the relationships among these molecules and the mechanisms underlying the development of EGPA remain unknown. OBJECTIVE We investigated the relationships among peripheral blood eosinophil count, serum IL-33 and TSLP concentration, and peripheral blood ILC2 count in patients with EGPA, chronic eosinophilic pneumonia (CEP), or bronchial asthma (BA). METHODS We recruited 86 patients with EGPA in three groups (remission, relapse, and onset), 25 patients with CEP at active or inactive stages of disease, and 11 patients with BA. In patients with EGPA, CEP, or BA, serum IL-33, sST2, and TSLP concentrations were determined using ELISA and peripheral blood ILC2 counts (as Lin-1- CD127+ CRTH2+ cells) were determined using flow cytometry. RESULTS Peripheral blood eosinophil count or ILC2 count, and serum sST2 or TSLP concentration were higher in patients with EGPA at onset than in those with EGPA at relapse or remission, or in those with BA or CEP. Serum IL-33 concentration was higher in patients with EGPA at relapse than in those with EGPA at onset or remission, or in those with BA or CEP. In a logistic regression model, EGPA disease activity was correlated with serum IL-33 concentration and peripheral blood ILC2 count, but not daily systemic and inhaled corticosteroid dose or immunosuppressant use. Eosinophil count was correlated with peripheral blood ILC2 count and serum TSLP concentration, but not serum IL-33 concentration. CONCLUSIONS Increased peripheral blood ILC2 count and serum IL-33 concentration were associated with disease activity in EGPA. Increases in serum IL-33 concentration may indicate the presence of active vasculitis rather than peripheral or tissue eosinophilia.
Collapse
Affiliation(s)
- Naomi Tsurikisawa
- Department of Allergy, Hiratuska City Hospital, Hiratsuka, Japan.,Department of Allergy and Respirology, National Hospital Organization Sagamihara National Hospital, Sagamihara, Japan.,Department of Pulmonology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Chiyako Oshikata
- Department of Allergy, Hiratuska City Hospital, Hiratsuka, Japan.,Department of Allergy and Respirology, National Hospital Organization Sagamihara National Hospital, Sagamihara, Japan.,Department of Pulmonology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Maiko Watanabe
- Division of Microbiology, National Institute of Health Science, Kawasaki, Japan
| | - Takahiro Tsuburai
- Department of Allergy and Respirology, National Hospital Organization Sagamihara National Hospital, Sagamihara, Japan.,Department of Respirology, St. Marianna University School of Medicine, Yokohama City Seibu Hospital, Yokohama, Japan
| | - Takeshi Kaneko
- Department of Pulmonology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Hiroshi Saito
- Clinical Research Center, National Hospital Organization Sagamihara National Hospital, Sagamihara, Japan
| |
Collapse
|
339
|
Marzano AV, Raimondo MG, Berti E, Meroni PL, Ingegnoli F. Cutaneous Manifestations of ANCA-Associated Small Vessels Vasculitis. Clin Rev Allergy Immunol 2018; 53:428-438. [PMID: 28578472 DOI: 10.1007/s12016-017-8616-5] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Skin lesions are frequent manifestations of underlying systemic conditions, including systemic autoimmune vasculitis. In particular, anti-neutrophil cytoplasmic antibodies (ANCA) are associated with distinct forms of vasculitis characterized by inflammatory cell infiltration of the walls of small and medium-sized vessels leading to vascular destruction and tissue necrosis. ANCA-associated vasculitis is rare and systemic diseases, which can be classified based on different distribution of vascular inflammation and presence or absence of granulomatosis and asthma. Despite their diversities, ANCA-associated vasculitis, namely microscopic polyangiitis, granulomatosis with polyangiitis and eosinophilic granulomatosis with polyangiitis, can all display a broad variety of cutaneous manifestations, which can appear during the course of the disease or even as first sign at the time of onset. Different skin manifestations might coexist in the same patient and occur in different occasions during the course of the vasculitis. Thus, a deep knowledge of the spectrum of skin lesions as part of ANCA-associated vasculitis is mandatory for a correct diagnostic process, whenever cutaneous vasculitis is suspected. Due to this broad variety of manifestations, the diagnosis of skin involvement in ANCA-associated vasculitis is very challenging and it must be supported by a detailed medical history, accurate physical examination, specific histopathological analysis of skin biopsy and the presence of ANCA serology. In this review, we focus on the cutaneous manifestations that can develop in the context of ANCA-associated vasculitis, detailing the clinical features, the histopathological aspects as well as the direct immunofluorescence studies for each of the three conditions. Moreover, we acknowledged the differential diagnoses that must be ruled out in the diagnostic process and the main therapeutic approaches available for treatment of ANCA-associated vasculitis.
Collapse
Affiliation(s)
- Angelo Valerio Marzano
- Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Unità Operativa di Dermatologia, IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Maria Gabriella Raimondo
- Division of Rheumatology, ASST Pini, Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Emilio Berti
- Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Unità Operativa di Dermatologia, IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Pier Luigi Meroni
- Division of Rheumatology, ASST Pini, Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy. .,Experimental Laboratory of Immunological and Rheumatologic Researches, IRCCS Istituto Auxologico Italiano, Cusano Milanino, Milan, Italy.
| | - Francesca Ingegnoli
- Division of Rheumatology, ASST Pini, Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| |
Collapse
|
340
|
Savige J, Trevisin M, Pollock W. Testing and reporting antineutrophil cytoplasmic antibodies (ANCA) in treated vasculitis and non-vasculitic disease. J Immunol Methods 2018; 458:1-7. [DOI: 10.1016/j.jim.2018.02.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Revised: 02/22/2018] [Accepted: 02/22/2018] [Indexed: 12/23/2022]
|
341
|
Clinical, Dermoscopic and Histologic Features of Recurrent Cutaneous Eosinophilic Vasculitis Cases. ACTAS DERMO-SIFILIOGRAFICAS 2018; 110:590-596. [PMID: 29937063 DOI: 10.1016/j.ad.2017.12.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 12/14/2017] [Accepted: 12/27/2017] [Indexed: 11/22/2022] Open
Abstract
Primary recurrent cutaneous eosinophilic vasculitis is a rare condition characterized by pruritic, erythematous, purpuric plaques associated to edema. We compared and analyze the clinical, dermoscopic and histological features of the disease in 4 patients from our hospital and 13 patients published in the literature. Seventeen patients were included, with a median age of 56yo, a median duration of disease of 6 months. Lesions were most frequently generalized (47%) or localized in lower limbs (41%). The most frequent features were purpuric color (71%), local edema (65%), necrotizing vasculitis (94%) and eosinophil infiltration (100%) in histology. Most of the patients (82.4%) were given oral steroids with a median dose of 30mg. Primary recurrent cutaneous eosinophilic vasculitis might be an infra-diagnosed condition. The analysis of the patients allowed us to propose diagnostic criteria for the definition of this disease. We suggest a therapeutic strategy with high-potency steroids and dapsone, which might be considered as first-line treatment.
Collapse
|
342
|
Ohe M, Shida H, Horita T, Furuya K. Successful additional clarithromycin and tacrolimus treatment for hypereosinophilia associated with eosinophilic granulomatosis with polyangiitis. Transl Clin Pharmacol 2018; 26:60-63. [PMID: 32055550 PMCID: PMC6989262 DOI: 10.12793/tcp.2018.26.2.60] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Revised: 04/17/2018] [Accepted: 04/18/2018] [Indexed: 11/21/2022] Open
Abstract
A 41-year-old man suffering from eosinophilic granulomatosis with polyangiitis (EPGA), diagnosed at another clinic on the basis of American College of Rheumatology Criteria, with a history of bronchial asthma, eosinophilia, mononeuritis multiplex, and non-fixed pulmonary infiltrates, was admitted to our department for further treatment. The patient complained of chest pain that started recently. An echocardiogram identified myocardial thickening and decreased wall motion, based on which the patient was diagnosed as having EPGA with myocarditis. The patient was successfully treated using glucocorticoids, such as methyl prednisolone (PSL) and PSL in combination with cyclophosphamide (CPM). However, CPM administration was discontinued afterwards because of the risk of bone marrow toxicity, the increased eosinophilic count (EOC) that we considered as an index of disease activity. Subsequently, the patient received additional clarithromycin (CAM) and tacrolimus (TAC) treatment considering their immunomodulatory effects. As a result, the EOC decreased and the PSL dosage could be reduced. This case shows that additional CAM and TAC treatment may be beneficial in some cases of EPGA.
Collapse
Affiliation(s)
- Masashi Ohe
- Department of Internal Medicine, JCHO Hokkaido Hospital, Sapporo 062-8618, Japan
| | - Haruki Shida
- Department of Internal Medicine, JCHO Hokkaido Hospital, Sapporo 062-8618, Japan
| | - Tetsuya Horita
- Department of Internal Medicine, JCHO Hokkaido Hospital, Sapporo 062-8618, Japan
| | - Ken Furuya
- Department of Internal Medicine, JCHO Hokkaido Hospital, Sapporo 062-8618, Japan
| |
Collapse
|
343
|
Saku A, Furuta S, Hiraguri M, Ikeda K, Kobayashi Y, Kagami SI, Kurasawa K, Matsumura R, Nakagomi D, Sugiyama T, Umibe T, Watanabe N, Nakajima H. Longterm Outcomes of 188 Japanese Patients with Eosinophilic Granulomatosis with Polyangiitis. J Rheumatol 2018; 45:1159-1166. [PMID: 29907668 DOI: 10.3899/jrheum.171352] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/07/2018] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Patients with eosinophilic granulomatosis with polyangiitis (EGPA) frequently experience relapses, which lead to cumulative organ damage. In this retrospective observational study, we aimed to reveal the risk factors for relapse in EGPA. METHODS A total of 188 Japanese patients with EGPA diagnosed between 1996 and 2015 were identified from medical records in 10 hospitals. The diagnosis was based on the American College of Rheumatology 1990 criteria or Lanham's criteria. Baseline characteristics, treatments, asthma exacerbation, and relapses were evaluated by retrospective chart review. RESULTS The median followup period was 56 months. The median age at disease onset was 59.7 years. At the disease onset, 95.2% of the patients had a history of bronchial asthma and 44.7% were positive for antineutrophil cytoplasmic antibodies. The cumulative survival and relapse-free survival rates at 5 years were 89.6% and 64.0%, respectively. Multivariate analysis with 2 models, proportional hazards, and competing risk models, was performed to identify the factors associated with relapse. The proportional hazards model identified azathioprine (AZA) maintenance therapy and high eosinophil counts at onset as independent factors with lower relapse risks, and high immunoglobulin E (IgE) levels at onset as a risk factor for relapse. The competing risk model identified no statistically significant factors. CONCLUSION Although potential benefit of AZA maintenance therapy in preventing relapse of EGPA was suggested by the proportional hazards model, there was a discrepancy in the results between the models. Eosinophil counts and IgE levels at onset were also identified as candidates of factors associated with relapse in EGPA.
Collapse
Affiliation(s)
- Aiko Saku
- From the Department of Allergy and Clinical Immunology, Chiba University Hospital; Department of Internal Medicine, Narita Red Cross Hospital; Department of Internal Medicine, Chiba Aoba Municipal Hospital; Department of Allergy and Clinical Immunology, Asahi General Hospital, Chiba; Department of Rheumatology, Dokkyo Medical University, Tochigi; Department of Rheumatology, Allergy and Clinical Immunology, National Hospital Organization Chiba-East Hospital, Chiba; Third Department of Internal Medicine, University of Yamanashi, Yamanashi; Department of Rheumatology, National Hospital Organization Shimoshizu Hospital; Department of Internal Medicine, Matsudo City Hospital; Centre for Rheumatic Diseases, Chibaken Saiseikai Narashino Hospital, Chiba, Japan.,A. Saku, MD, Chiba University Hospital; S. Furuta, MD, PhD, Chiba University Hospital; M. Hiraguri, MD, PhD, Narita Red Cross Hospital; K. Ikeda, MD, PhD, Chiba University Hospital; Y. Kobayashi, MD, PhD, Chiba Aoba Municipal Hospital; S.I. Kagami, MD, PhD, Asahi General Hospital; K. Kurasawa, MD, PhD, Dokkyo Medical University; R. Matsumura, MD, PhD, Chiba-East Hospital; D. Nakagomi, MD, PhD, University of Yamanashi; T. Sugiyama, MD, PhD, Shimoshizu Hospital; T. Umibe, MD, PhD, Matsudo City Hospital; N. Watanabe, MD, PhD, Chibaken Saiseikai Narashino Hospital; H. Nakajima, MD, PhD, Chiba University Hospital
| | - Shunsuke Furuta
- From the Department of Allergy and Clinical Immunology, Chiba University Hospital; Department of Internal Medicine, Narita Red Cross Hospital; Department of Internal Medicine, Chiba Aoba Municipal Hospital; Department of Allergy and Clinical Immunology, Asahi General Hospital, Chiba; Department of Rheumatology, Dokkyo Medical University, Tochigi; Department of Rheumatology, Allergy and Clinical Immunology, National Hospital Organization Chiba-East Hospital, Chiba; Third Department of Internal Medicine, University of Yamanashi, Yamanashi; Department of Rheumatology, National Hospital Organization Shimoshizu Hospital; Department of Internal Medicine, Matsudo City Hospital; Centre for Rheumatic Diseases, Chibaken Saiseikai Narashino Hospital, Chiba, Japan. .,A. Saku, MD, Chiba University Hospital; S. Furuta, MD, PhD, Chiba University Hospital; M. Hiraguri, MD, PhD, Narita Red Cross Hospital; K. Ikeda, MD, PhD, Chiba University Hospital; Y. Kobayashi, MD, PhD, Chiba Aoba Municipal Hospital; S.I. Kagami, MD, PhD, Asahi General Hospital; K. Kurasawa, MD, PhD, Dokkyo Medical University; R. Matsumura, MD, PhD, Chiba-East Hospital; D. Nakagomi, MD, PhD, University of Yamanashi; T. Sugiyama, MD, PhD, Shimoshizu Hospital; T. Umibe, MD, PhD, Matsudo City Hospital; N. Watanabe, MD, PhD, Chibaken Saiseikai Narashino Hospital; H. Nakajima, MD, PhD, Chiba University Hospital.
| | - Masaki Hiraguri
- From the Department of Allergy and Clinical Immunology, Chiba University Hospital; Department of Internal Medicine, Narita Red Cross Hospital; Department of Internal Medicine, Chiba Aoba Municipal Hospital; Department of Allergy and Clinical Immunology, Asahi General Hospital, Chiba; Department of Rheumatology, Dokkyo Medical University, Tochigi; Department of Rheumatology, Allergy and Clinical Immunology, National Hospital Organization Chiba-East Hospital, Chiba; Third Department of Internal Medicine, University of Yamanashi, Yamanashi; Department of Rheumatology, National Hospital Organization Shimoshizu Hospital; Department of Internal Medicine, Matsudo City Hospital; Centre for Rheumatic Diseases, Chibaken Saiseikai Narashino Hospital, Chiba, Japan.,A. Saku, MD, Chiba University Hospital; S. Furuta, MD, PhD, Chiba University Hospital; M. Hiraguri, MD, PhD, Narita Red Cross Hospital; K. Ikeda, MD, PhD, Chiba University Hospital; Y. Kobayashi, MD, PhD, Chiba Aoba Municipal Hospital; S.I. Kagami, MD, PhD, Asahi General Hospital; K. Kurasawa, MD, PhD, Dokkyo Medical University; R. Matsumura, MD, PhD, Chiba-East Hospital; D. Nakagomi, MD, PhD, University of Yamanashi; T. Sugiyama, MD, PhD, Shimoshizu Hospital; T. Umibe, MD, PhD, Matsudo City Hospital; N. Watanabe, MD, PhD, Chibaken Saiseikai Narashino Hospital; H. Nakajima, MD, PhD, Chiba University Hospital
| | - Kei Ikeda
- From the Department of Allergy and Clinical Immunology, Chiba University Hospital; Department of Internal Medicine, Narita Red Cross Hospital; Department of Internal Medicine, Chiba Aoba Municipal Hospital; Department of Allergy and Clinical Immunology, Asahi General Hospital, Chiba; Department of Rheumatology, Dokkyo Medical University, Tochigi; Department of Rheumatology, Allergy and Clinical Immunology, National Hospital Organization Chiba-East Hospital, Chiba; Third Department of Internal Medicine, University of Yamanashi, Yamanashi; Department of Rheumatology, National Hospital Organization Shimoshizu Hospital; Department of Internal Medicine, Matsudo City Hospital; Centre for Rheumatic Diseases, Chibaken Saiseikai Narashino Hospital, Chiba, Japan.,A. Saku, MD, Chiba University Hospital; S. Furuta, MD, PhD, Chiba University Hospital; M. Hiraguri, MD, PhD, Narita Red Cross Hospital; K. Ikeda, MD, PhD, Chiba University Hospital; Y. Kobayashi, MD, PhD, Chiba Aoba Municipal Hospital; S.I. Kagami, MD, PhD, Asahi General Hospital; K. Kurasawa, MD, PhD, Dokkyo Medical University; R. Matsumura, MD, PhD, Chiba-East Hospital; D. Nakagomi, MD, PhD, University of Yamanashi; T. Sugiyama, MD, PhD, Shimoshizu Hospital; T. Umibe, MD, PhD, Matsudo City Hospital; N. Watanabe, MD, PhD, Chibaken Saiseikai Narashino Hospital; H. Nakajima, MD, PhD, Chiba University Hospital
| | - Yoshihisa Kobayashi
- From the Department of Allergy and Clinical Immunology, Chiba University Hospital; Department of Internal Medicine, Narita Red Cross Hospital; Department of Internal Medicine, Chiba Aoba Municipal Hospital; Department of Allergy and Clinical Immunology, Asahi General Hospital, Chiba; Department of Rheumatology, Dokkyo Medical University, Tochigi; Department of Rheumatology, Allergy and Clinical Immunology, National Hospital Organization Chiba-East Hospital, Chiba; Third Department of Internal Medicine, University of Yamanashi, Yamanashi; Department of Rheumatology, National Hospital Organization Shimoshizu Hospital; Department of Internal Medicine, Matsudo City Hospital; Centre for Rheumatic Diseases, Chibaken Saiseikai Narashino Hospital, Chiba, Japan.,A. Saku, MD, Chiba University Hospital; S. Furuta, MD, PhD, Chiba University Hospital; M. Hiraguri, MD, PhD, Narita Red Cross Hospital; K. Ikeda, MD, PhD, Chiba University Hospital; Y. Kobayashi, MD, PhD, Chiba Aoba Municipal Hospital; S.I. Kagami, MD, PhD, Asahi General Hospital; K. Kurasawa, MD, PhD, Dokkyo Medical University; R. Matsumura, MD, PhD, Chiba-East Hospital; D. Nakagomi, MD, PhD, University of Yamanashi; T. Sugiyama, MD, PhD, Shimoshizu Hospital; T. Umibe, MD, PhD, Matsudo City Hospital; N. Watanabe, MD, PhD, Chibaken Saiseikai Narashino Hospital; H. Nakajima, MD, PhD, Chiba University Hospital
| | - Shin-Ichiro Kagami
- From the Department of Allergy and Clinical Immunology, Chiba University Hospital; Department of Internal Medicine, Narita Red Cross Hospital; Department of Internal Medicine, Chiba Aoba Municipal Hospital; Department of Allergy and Clinical Immunology, Asahi General Hospital, Chiba; Department of Rheumatology, Dokkyo Medical University, Tochigi; Department of Rheumatology, Allergy and Clinical Immunology, National Hospital Organization Chiba-East Hospital, Chiba; Third Department of Internal Medicine, University of Yamanashi, Yamanashi; Department of Rheumatology, National Hospital Organization Shimoshizu Hospital; Department of Internal Medicine, Matsudo City Hospital; Centre for Rheumatic Diseases, Chibaken Saiseikai Narashino Hospital, Chiba, Japan.,A. Saku, MD, Chiba University Hospital; S. Furuta, MD, PhD, Chiba University Hospital; M. Hiraguri, MD, PhD, Narita Red Cross Hospital; K. Ikeda, MD, PhD, Chiba University Hospital; Y. Kobayashi, MD, PhD, Chiba Aoba Municipal Hospital; S.I. Kagami, MD, PhD, Asahi General Hospital; K. Kurasawa, MD, PhD, Dokkyo Medical University; R. Matsumura, MD, PhD, Chiba-East Hospital; D. Nakagomi, MD, PhD, University of Yamanashi; T. Sugiyama, MD, PhD, Shimoshizu Hospital; T. Umibe, MD, PhD, Matsudo City Hospital; N. Watanabe, MD, PhD, Chibaken Saiseikai Narashino Hospital; H. Nakajima, MD, PhD, Chiba University Hospital
| | - Kazuhiro Kurasawa
- From the Department of Allergy and Clinical Immunology, Chiba University Hospital; Department of Internal Medicine, Narita Red Cross Hospital; Department of Internal Medicine, Chiba Aoba Municipal Hospital; Department of Allergy and Clinical Immunology, Asahi General Hospital, Chiba; Department of Rheumatology, Dokkyo Medical University, Tochigi; Department of Rheumatology, Allergy and Clinical Immunology, National Hospital Organization Chiba-East Hospital, Chiba; Third Department of Internal Medicine, University of Yamanashi, Yamanashi; Department of Rheumatology, National Hospital Organization Shimoshizu Hospital; Department of Internal Medicine, Matsudo City Hospital; Centre for Rheumatic Diseases, Chibaken Saiseikai Narashino Hospital, Chiba, Japan.,A. Saku, MD, Chiba University Hospital; S. Furuta, MD, PhD, Chiba University Hospital; M. Hiraguri, MD, PhD, Narita Red Cross Hospital; K. Ikeda, MD, PhD, Chiba University Hospital; Y. Kobayashi, MD, PhD, Chiba Aoba Municipal Hospital; S.I. Kagami, MD, PhD, Asahi General Hospital; K. Kurasawa, MD, PhD, Dokkyo Medical University; R. Matsumura, MD, PhD, Chiba-East Hospital; D. Nakagomi, MD, PhD, University of Yamanashi; T. Sugiyama, MD, PhD, Shimoshizu Hospital; T. Umibe, MD, PhD, Matsudo City Hospital; N. Watanabe, MD, PhD, Chibaken Saiseikai Narashino Hospital; H. Nakajima, MD, PhD, Chiba University Hospital
| | - Ryutaro Matsumura
- From the Department of Allergy and Clinical Immunology, Chiba University Hospital; Department of Internal Medicine, Narita Red Cross Hospital; Department of Internal Medicine, Chiba Aoba Municipal Hospital; Department of Allergy and Clinical Immunology, Asahi General Hospital, Chiba; Department of Rheumatology, Dokkyo Medical University, Tochigi; Department of Rheumatology, Allergy and Clinical Immunology, National Hospital Organization Chiba-East Hospital, Chiba; Third Department of Internal Medicine, University of Yamanashi, Yamanashi; Department of Rheumatology, National Hospital Organization Shimoshizu Hospital; Department of Internal Medicine, Matsudo City Hospital; Centre for Rheumatic Diseases, Chibaken Saiseikai Narashino Hospital, Chiba, Japan.,A. Saku, MD, Chiba University Hospital; S. Furuta, MD, PhD, Chiba University Hospital; M. Hiraguri, MD, PhD, Narita Red Cross Hospital; K. Ikeda, MD, PhD, Chiba University Hospital; Y. Kobayashi, MD, PhD, Chiba Aoba Municipal Hospital; S.I. Kagami, MD, PhD, Asahi General Hospital; K. Kurasawa, MD, PhD, Dokkyo Medical University; R. Matsumura, MD, PhD, Chiba-East Hospital; D. Nakagomi, MD, PhD, University of Yamanashi; T. Sugiyama, MD, PhD, Shimoshizu Hospital; T. Umibe, MD, PhD, Matsudo City Hospital; N. Watanabe, MD, PhD, Chibaken Saiseikai Narashino Hospital; H. Nakajima, MD, PhD, Chiba University Hospital
| | - Daiki Nakagomi
- From the Department of Allergy and Clinical Immunology, Chiba University Hospital; Department of Internal Medicine, Narita Red Cross Hospital; Department of Internal Medicine, Chiba Aoba Municipal Hospital; Department of Allergy and Clinical Immunology, Asahi General Hospital, Chiba; Department of Rheumatology, Dokkyo Medical University, Tochigi; Department of Rheumatology, Allergy and Clinical Immunology, National Hospital Organization Chiba-East Hospital, Chiba; Third Department of Internal Medicine, University of Yamanashi, Yamanashi; Department of Rheumatology, National Hospital Organization Shimoshizu Hospital; Department of Internal Medicine, Matsudo City Hospital; Centre for Rheumatic Diseases, Chibaken Saiseikai Narashino Hospital, Chiba, Japan.,A. Saku, MD, Chiba University Hospital; S. Furuta, MD, PhD, Chiba University Hospital; M. Hiraguri, MD, PhD, Narita Red Cross Hospital; K. Ikeda, MD, PhD, Chiba University Hospital; Y. Kobayashi, MD, PhD, Chiba Aoba Municipal Hospital; S.I. Kagami, MD, PhD, Asahi General Hospital; K. Kurasawa, MD, PhD, Dokkyo Medical University; R. Matsumura, MD, PhD, Chiba-East Hospital; D. Nakagomi, MD, PhD, University of Yamanashi; T. Sugiyama, MD, PhD, Shimoshizu Hospital; T. Umibe, MD, PhD, Matsudo City Hospital; N. Watanabe, MD, PhD, Chibaken Saiseikai Narashino Hospital; H. Nakajima, MD, PhD, Chiba University Hospital
| | - Takao Sugiyama
- From the Department of Allergy and Clinical Immunology, Chiba University Hospital; Department of Internal Medicine, Narita Red Cross Hospital; Department of Internal Medicine, Chiba Aoba Municipal Hospital; Department of Allergy and Clinical Immunology, Asahi General Hospital, Chiba; Department of Rheumatology, Dokkyo Medical University, Tochigi; Department of Rheumatology, Allergy and Clinical Immunology, National Hospital Organization Chiba-East Hospital, Chiba; Third Department of Internal Medicine, University of Yamanashi, Yamanashi; Department of Rheumatology, National Hospital Organization Shimoshizu Hospital; Department of Internal Medicine, Matsudo City Hospital; Centre for Rheumatic Diseases, Chibaken Saiseikai Narashino Hospital, Chiba, Japan.,A. Saku, MD, Chiba University Hospital; S. Furuta, MD, PhD, Chiba University Hospital; M. Hiraguri, MD, PhD, Narita Red Cross Hospital; K. Ikeda, MD, PhD, Chiba University Hospital; Y. Kobayashi, MD, PhD, Chiba Aoba Municipal Hospital; S.I. Kagami, MD, PhD, Asahi General Hospital; K. Kurasawa, MD, PhD, Dokkyo Medical University; R. Matsumura, MD, PhD, Chiba-East Hospital; D. Nakagomi, MD, PhD, University of Yamanashi; T. Sugiyama, MD, PhD, Shimoshizu Hospital; T. Umibe, MD, PhD, Matsudo City Hospital; N. Watanabe, MD, PhD, Chibaken Saiseikai Narashino Hospital; H. Nakajima, MD, PhD, Chiba University Hospital
| | - Takeshi Umibe
- From the Department of Allergy and Clinical Immunology, Chiba University Hospital; Department of Internal Medicine, Narita Red Cross Hospital; Department of Internal Medicine, Chiba Aoba Municipal Hospital; Department of Allergy and Clinical Immunology, Asahi General Hospital, Chiba; Department of Rheumatology, Dokkyo Medical University, Tochigi; Department of Rheumatology, Allergy and Clinical Immunology, National Hospital Organization Chiba-East Hospital, Chiba; Third Department of Internal Medicine, University of Yamanashi, Yamanashi; Department of Rheumatology, National Hospital Organization Shimoshizu Hospital; Department of Internal Medicine, Matsudo City Hospital; Centre for Rheumatic Diseases, Chibaken Saiseikai Narashino Hospital, Chiba, Japan.,A. Saku, MD, Chiba University Hospital; S. Furuta, MD, PhD, Chiba University Hospital; M. Hiraguri, MD, PhD, Narita Red Cross Hospital; K. Ikeda, MD, PhD, Chiba University Hospital; Y. Kobayashi, MD, PhD, Chiba Aoba Municipal Hospital; S.I. Kagami, MD, PhD, Asahi General Hospital; K. Kurasawa, MD, PhD, Dokkyo Medical University; R. Matsumura, MD, PhD, Chiba-East Hospital; D. Nakagomi, MD, PhD, University of Yamanashi; T. Sugiyama, MD, PhD, Shimoshizu Hospital; T. Umibe, MD, PhD, Matsudo City Hospital; N. Watanabe, MD, PhD, Chibaken Saiseikai Narashino Hospital; H. Nakajima, MD, PhD, Chiba University Hospital
| | - Norihiko Watanabe
- From the Department of Allergy and Clinical Immunology, Chiba University Hospital; Department of Internal Medicine, Narita Red Cross Hospital; Department of Internal Medicine, Chiba Aoba Municipal Hospital; Department of Allergy and Clinical Immunology, Asahi General Hospital, Chiba; Department of Rheumatology, Dokkyo Medical University, Tochigi; Department of Rheumatology, Allergy and Clinical Immunology, National Hospital Organization Chiba-East Hospital, Chiba; Third Department of Internal Medicine, University of Yamanashi, Yamanashi; Department of Rheumatology, National Hospital Organization Shimoshizu Hospital; Department of Internal Medicine, Matsudo City Hospital; Centre for Rheumatic Diseases, Chibaken Saiseikai Narashino Hospital, Chiba, Japan.,A. Saku, MD, Chiba University Hospital; S. Furuta, MD, PhD, Chiba University Hospital; M. Hiraguri, MD, PhD, Narita Red Cross Hospital; K. Ikeda, MD, PhD, Chiba University Hospital; Y. Kobayashi, MD, PhD, Chiba Aoba Municipal Hospital; S.I. Kagami, MD, PhD, Asahi General Hospital; K. Kurasawa, MD, PhD, Dokkyo Medical University; R. Matsumura, MD, PhD, Chiba-East Hospital; D. Nakagomi, MD, PhD, University of Yamanashi; T. Sugiyama, MD, PhD, Shimoshizu Hospital; T. Umibe, MD, PhD, Matsudo City Hospital; N. Watanabe, MD, PhD, Chibaken Saiseikai Narashino Hospital; H. Nakajima, MD, PhD, Chiba University Hospital
| | - Hiroshi Nakajima
- From the Department of Allergy and Clinical Immunology, Chiba University Hospital; Department of Internal Medicine, Narita Red Cross Hospital; Department of Internal Medicine, Chiba Aoba Municipal Hospital; Department of Allergy and Clinical Immunology, Asahi General Hospital, Chiba; Department of Rheumatology, Dokkyo Medical University, Tochigi; Department of Rheumatology, Allergy and Clinical Immunology, National Hospital Organization Chiba-East Hospital, Chiba; Third Department of Internal Medicine, University of Yamanashi, Yamanashi; Department of Rheumatology, National Hospital Organization Shimoshizu Hospital; Department of Internal Medicine, Matsudo City Hospital; Centre for Rheumatic Diseases, Chibaken Saiseikai Narashino Hospital, Chiba, Japan.,A. Saku, MD, Chiba University Hospital; S. Furuta, MD, PhD, Chiba University Hospital; M. Hiraguri, MD, PhD, Narita Red Cross Hospital; K. Ikeda, MD, PhD, Chiba University Hospital; Y. Kobayashi, MD, PhD, Chiba Aoba Municipal Hospital; S.I. Kagami, MD, PhD, Asahi General Hospital; K. Kurasawa, MD, PhD, Dokkyo Medical University; R. Matsumura, MD, PhD, Chiba-East Hospital; D. Nakagomi, MD, PhD, University of Yamanashi; T. Sugiyama, MD, PhD, Shimoshizu Hospital; T. Umibe, MD, PhD, Matsudo City Hospital; N. Watanabe, MD, PhD, Chibaken Saiseikai Narashino Hospital; H. Nakajima, MD, PhD, Chiba University Hospital
| |
Collapse
|
344
|
Eosinophilic granulomatosis with polyangiitis and laryngeal involvement: review of the literature and a cross-sectional prospective experience. The Journal of Laryngology & Otology 2018; 132:619-623. [PMID: 29888684 DOI: 10.1017/s0022215118000737] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Eosinophilic granulomatosis with polyangiitis and granulomatosis with polyangiitis show variable otorhinolaryngological involvement. Up to 14 per cent of granulomatosis with polyangiitis patients have subglottis involvement; little is known about the laryngeal involvement in eosinophilic granulomatosis with polyangiitis. METHOD A literature review was conducted, together with a prospective cross-sectional analysis of 43 eosinophilic granulomatosis with polyangiitis patients. All patients underwent fibre-optic laryngoscopy with narrow-band imaging, and completed health-related questionnaires. RESULTS The literature review showed only two cases of laryngeal involvement in eosinophilic granulomatosis with polyangiitis; in our cohort, no cases of subglottis stenosis were found, but local signs of laryngeal inflammation were present in 72 per cent of cases. Of the patients, 16.2 per cent had a pathological Reflux Finding Score (of 7 or higher). CONCLUSION Laryngeal inflammation in eosinophilic granulomatosis with polyangiitis is frequent. It is possibly due more to local factors than to eosinophilic granulomatosis with polyangiitis itself. However, ENT evaluation is needed to rule out possible subglottis inflammation. These findings are in line with current literature and worthy of confirmation in larger cohorts.
Collapse
|
345
|
Rastogi U, Sergie Z, Pinney S, Moss N. Recurrence of eosinophilic granulomatosis with polyangitis after orthotopic heart transplant. Am J Transplant 2018; 18:1544-1547. [PMID: 29392845 DOI: 10.1111/ajt.14679] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2017] [Revised: 12/26/2017] [Accepted: 01/21/2018] [Indexed: 01/25/2023]
Abstract
Eosinophilic granulomatosis with polyangitis (EGPA), previously referred to as Churg-Strauss syndrome, is a necrotizing small vessel vasculitis associated with eosinophilic infiltrates and extravascular granulomas. We report a case of a Caucasian woman successfully bridged to heart transplantation with a continuous flow left ventricular assist device (LVAD) who survived recurrence of EGPA in the allograft.
Collapse
Affiliation(s)
- Ujjwal Rastogi
- Department of Cardiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ziad Sergie
- Department of Cardiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Sean Pinney
- Department of Cardiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Noah Moss
- Department of Cardiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| |
Collapse
|
346
|
Nakamoto K, Saraya T, Ogawa Y, Ishii H, Takizawa H. Comparison of findings on thoracic computed tomography with the severity and duration of bronchial asthma in patients with eosinophilic granulomatosis with polyangiitis. Respir Med 2018; 139:101-105. [PMID: 29857992 DOI: 10.1016/j.rmed.2018.05.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Revised: 04/26/2018] [Accepted: 05/03/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND Eosinophilic granulomatosis with polyangiitis (EGPA) is a systemic necrotizing vasculitis with eosinophilia. EGPA can occur in patients with comorbid bronchial asthma (BA) and other pulmonary diseases. However, because of its rarity, there are few reports on thoracic computed tomography (CT) findings in patients with EGPA, especially in relation to comorbid BA. The aim of this study was to compare between the clinical characteristics of EGPA, the severity and duration of BA, and the findings on thoracic CT. METHODS We retrospectively reviewed the records of patients with EGPA who were admitted to our hospital from 2001 to 2015. All patients satisfied the criteria for EGPA according to American College of Rheumatology or Lanham's criteria. Patients without asthma (n = 2) and those in whom CT was not performed (n = 3) were excluded. RESULTS We identified 31 patients who had EGPA comorbid with BA. The median duration of BA was 6 years. CT revealed parenchymal opacification (ground-glass opacity and/or consolidation; n = 17), airway abnormalities (bronchial wall thickening and/or bronchiectasis; n = 15), pleural effusion (n = 4), interlobular septal thickening (n = 5), and mediastinal lymphadenopathy (n = 4). Importantly, the group with severe BA had a significantly higher incidence of airway abnormalities than the group with mild to moderate BA (81.8% vs 30.0%, P = 0.009). The frequency of airway abnormalities was significantly higher in patients with EGPA who had a history of asthma of 5 years or more than in their counterparts with a shorter asthma history (66.7% vs 10.0%, P = 0.006), particularly bronchial wall thickening (52.4% vs 10.0%, P = 0.046). CONCLUSIONS The most common finding on thoracic CT in patients who had EGPA comorbid with BA was parenchymal opacification followed by airway abnormalities. The severity and duration of BA in these patients may affect the findings on thoracic CT.
Collapse
Affiliation(s)
- Keitaro Nakamoto
- Department of Respiratory Medicine, Kyorin University School of Medicine, Mitaka, Tokyo, Japan.
| | - Takeshi Saraya
- Department of Respiratory Medicine, Kyorin University School of Medicine, Mitaka, Tokyo, Japan.
| | - Yukari Ogawa
- Department of Respiratory Medicine, Kyorin University School of Medicine, Mitaka, Tokyo, Japan.
| | - Haruyuki Ishii
- Department of Respiratory Medicine, Kyorin University School of Medicine, Mitaka, Tokyo, Japan.
| | - Hajime Takizawa
- Department of Respiratory Medicine, Kyorin University School of Medicine, Mitaka, Tokyo, Japan.
| |
Collapse
|
347
|
Lamprecht P, Kerstein A, Klapa S, Schinke S, Karsten CM, Yu X, Ehlers M, Epplen JT, Holl-Ulrich K, Wiech T, Kalies K, Lange T, Laudien M, Laskay T, Gemoll T, Schumacher U, Ullrich S, Busch H, Ibrahim S, Fischer N, Hasselbacher K, Pries R, Petersen F, Weppner G, Manz R, Humrich JY, Nieberding R, Riemekasten G, Müller A. Pathogenetic and Clinical Aspects of Anti-Neutrophil Cytoplasmic Autoantibody-Associated Vasculitides. Front Immunol 2018; 9:680. [PMID: 29686675 PMCID: PMC5900791 DOI: 10.3389/fimmu.2018.00680] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 03/20/2018] [Indexed: 12/11/2022] Open
Abstract
Anti-neutrophil cytoplasmic autoantibodies (ANCA) targeting proteinase 3 (PR3) and myeloperoxidase expressed by innate immune cells (neutrophils and monocytes) are salient diagnostic and pathogenic features of small vessel vasculitis, comprising granulomatosis with polyangiitis (GPA), microscopic polyangiitis, and eosinophilic GPA. Genetic studies suggest that ANCA-associated vasculitides (AAV) constitute separate diseases, which share common immunological and pathological features, but are otherwise heterogeneous. The successful therapeutic use of anti-CD20 antibodies emphasizes the prominent role of ANCA and possibly other autoantibodies in the pathogenesis of AAV. However, to elucidate causal effects in AAV, a better understanding of the complex interplay leading to the emergence of B lymphocytes that produce pathogenic ANCA remains a challenge. Different scenarios seem possible; e.g., the break of tolerance induced by a shift from non-pathogenic toward pathogenic autoantigen epitopes in inflamed tissue. This review gives a brief overview on current knowledge about genetic and epigenetic factors, barrier dysfunction and chronic non-resolving inflammation, necro-inflammatory auto-amplification of cellular death and inflammation, altered autoantigen presentation, alternative complement pathway activation, alterations within peripheral and inflamed tissue-residing T- and B-cell populations, ectopic lymphoid tissue neoformation, the characterization of PR3-specific T-cells, properties of ANCA, links between autoimmune disease and infection-triggered pathology, and animal models in AAV.
Collapse
Affiliation(s)
- Peter Lamprecht
- Department of Rheumatology and Clinical Immunology, University of Lübeck, Lübeck, Germany
| | - Anja Kerstein
- Department of Rheumatology and Clinical Immunology, University of Lübeck, Lübeck, Germany
| | - Sebastian Klapa
- Department of Rheumatology and Clinical Immunology, University of Lübeck, Lübeck, Germany
| | - Susanne Schinke
- Department of Rheumatology and Clinical Immunology, University of Lübeck, Lübeck, Germany
| | - Christian M Karsten
- Institute for Systemic Inflammation Research, University of Lübeck, Lübeck, Germany
| | - Xinhua Yu
- Xiamen-Borstel Joint Laboratory of Autoimmunity, Medical College of Xiamen University, Xiamen, China.,Priority Area Asthma and Allergy, Research Center Borstel, Airway Research Center North (ARCN), German Center for Lung Research (DZL), Borstel, Germany
| | - Marc Ehlers
- Laboratories of Immunology and Antibody Glycan Analysis, Institute for Nutrition Medicine, University of Lübeck and University Medical Center Schleswig Holstein, Lübeck, Germany
| | - Jörg T Epplen
- Department of Human Genetics, Ruhr-University, Bochum, Germany.,University of Witten/Herdecke, ZBAF, Witten, Germany
| | | | - Thorsten Wiech
- Institute of Pathology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Kathrin Kalies
- Institute of Anatomy, University of Lübeck, Lübeck, Germany
| | - Tanja Lange
- Department of Rheumatology and Clinical Immunology, University of Lübeck, Lübeck, Germany
| | - Martin Laudien
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Kiel, Kiel, Germany
| | - Tamas Laskay
- Department for Infectious Diseases and Microbiology, University of Lübeck, Lübeck, Germany
| | - Timo Gemoll
- Department of Surgery, Section for Translational Surgical Oncology and Biobanking, University of Lübeck, University Medical Center Schleswig-Holstein, Lübeck, Germany
| | - Udo Schumacher
- Institute of Anatomy and Experimental Morphology, Center for Experimental Medicine, University Cancer Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sebastian Ullrich
- Institute of Anatomy and Experimental Morphology, Center for Experimental Medicine, University Cancer Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Medical Department 3, Gastroenterology/Rheumatology, Municipal Hospital Kiel, Kiel, Germany
| | - Hauke Busch
- Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany
| | - Saleh Ibrahim
- Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany
| | - Nicole Fischer
- Institute of Medical Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Ralph Pries
- Department of Otorhinolaryngology, University of Lübeck, Lübeck, Germany
| | - Frank Petersen
- Priority Area Asthma and Allergy, Research Center Borstel, Airway Research Center North (ARCN), German Center for Lung Research (DZL), Borstel, Germany
| | - Gesche Weppner
- Department of Rheumatology and Clinical Immunology, University of Lübeck, Lübeck, Germany
| | - Rudolf Manz
- Institute for Systemic Inflammation Research, University of Lübeck, Lübeck, Germany
| | - Jens Y Humrich
- Department of Rheumatology and Clinical Immunology, University of Lübeck, Lübeck, Germany
| | - Relana Nieberding
- Department of Rheumatology and Clinical Immunology, University of Lübeck, Lübeck, Germany
| | - Gabriela Riemekasten
- Department of Rheumatology and Clinical Immunology, University of Lübeck, Lübeck, Germany
| | - Antje Müller
- Department of Rheumatology and Clinical Immunology, University of Lübeck, Lübeck, Germany
| |
Collapse
|
348
|
Kondo T, Amano K. Era of steroid sparing in the management of immune-mediated inflammatory diseases. Immunol Med 2018; 41:6-11. [PMID: 30938261 DOI: 10.1080/09114300.2018.1451593] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Glucocorticoids (GCs) have played a pivotal role in the treatment of immune-mediated inflammatory diseases (IMIDs) for a long time. However, GCs also incur a significant risk of undesirable adverse events such as Cushingoid changes, osteoporosis, glaucoma and metabolic abnormalities such as diabetes and hypercholesterolemia, which may lead to life-threatening cerebrovascular and cardiovascular events. High-dose GCs may also cause mental disorders and osteonecrosis. Recently, new therapeutic strategies have been developed to reduce the dose or even eliminate the need for GCs; multi-target drug therapies for systemic lupus erythematosus (SLE), biological agents such as tocilizumab and rituximab for systemic vasculitis, and anakinra and tocilizumab for adult-onset still's disease. Therefore, the era of GC-sparing or GC-free treatment for IMIDs is on the horizon.
Collapse
Affiliation(s)
- Tsuneo Kondo
- a Department of Rheumatology and Clinical Immunology , Saitama Medical Center, Saitama Medical University , Saitama , Japan
| | - Koichi Amano
- a Department of Rheumatology and Clinical Immunology , Saitama Medical Center, Saitama Medical University , Saitama , Japan
| |
Collapse
|
349
|
Update on the epidemiology, risk factors, and outcomes of systemic vasculitides. Best Pract Res Clin Rheumatol 2018; 32:271-294. [DOI: 10.1016/j.berh.2018.09.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 07/26/2018] [Accepted: 07/30/2018] [Indexed: 02/07/2023]
|
350
|
Beketova TV, Volkov MY, Naryshkin EA, Novoselova TM, Nasonov EL. Imatinib mesylate use in refractory eosinophilic granulomatosis with polyangiitis: a literature review and a case report. Clin Rheumatol 2018; 37:1729-1735. [DOI: 10.1007/s10067-018-4018-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 01/28/2018] [Accepted: 01/31/2018] [Indexed: 10/17/2022]
|