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Kanno H, Osada T, Tateishi A. Establishment of Epstein-Barr Virus (EBV) Latent Gene-Expressing T-Cell Lines with an Expression Vector Harboring EBV Nuclear Antigen 1. Microorganisms 2023; 11:2624. [PMID: 38004636 PMCID: PMC10673024 DOI: 10.3390/microorganisms11112624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/19/2023] [Accepted: 10/21/2023] [Indexed: 11/26/2023] Open
Abstract
Chronic active Epstein-Barr virus (EBV) infection (CAEBV) is characterized by chronic or recurrent infectious mononucleosis-like symptoms and is associated with EBV-associated T/natural killer (NK)-cell lymphoproliferative disorders, which frequently lead to the development of life-threatening complications, such as virus-associated hemophagocytic syndrome and EBV-positive apparent leukemia/lymphoma mainly in T- and NK-cell lineages. In order to clarify the EBV genes responsible for the diseases, we introduced the plasmid coding sequences of EBV-encoded small RNAs (EBERs) and/or latent membrane protein (LMP) 1 into human T-lymphocyte virus-I-negative human T-cell lines using a gene expression vector harboring EBV nuclear antigen 1, established the G418-resistant transformants of five T-cell lines, and quantitatively examined the expression of EBERs and LMP1 using real-time reverse transcriptase-polymerase chain reaction. The expression levels of EBERs in T-cell transformants with EBER DNA paralleled those in EBV-positive human T- and NK-cell lines, SNTK cells. The expression of LMP1 mRNA varied in SNTK cells and in human T-cell transformants, and the expression of LMP1 mRNA in T-cell lines expressing both EBERs and LMP1 was much lower than that in the same cell line expressing LMP1 mRNA alone. The currently employed gene expression system and currently obtained transformants may be useful for the analyses of the pathophysiology of CAEBV and EBV-positive T/NK-cell lymphoproliferative disorders.
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Affiliation(s)
- Hiroyuki Kanno
- Department of Pathology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto 390-8621, Japan; (T.O.)
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Yi T, Steinberg J, Olson S, El‐Said H, Mo J, Anderson E, Gloude N, Schiff D. Chronic active Epstein-Barr virus and hydroa vacciniforme-like lymphoproliferative disorder in a pediatric patient complicated by fatal ruptured cerebral artery aneurysm. Clin Case Rep 2023; 11:e7436. [PMID: 37266348 PMCID: PMC10229749 DOI: 10.1002/ccr3.7436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 03/25/2023] [Accepted: 05/03/2023] [Indexed: 06/03/2023] Open
Abstract
Hydroa vacciniforme-like lymphoproliferative disorder (HV-LPD) is a rare cutaneous form of chronic active Epstein-Barr virus (CAEBV) that presents with vesicular lesions induced by sun-exposure. Arterial aneurysm is a rare but potentially fatal complication of CAEBV and HV-LPD.
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Affiliation(s)
- Troy Yi
- UCSD School of MedicineLa JollaCaliforniaUSA
- Rady Children's HospitalSan DiegoCaliforniaUSA
| | | | - Scott Olson
- UCSD School of MedicineLa JollaCaliforniaUSA
| | - Howaida El‐Said
- UCSD School of MedicineLa JollaCaliforniaUSA
- Rady Children's HospitalSan DiegoCaliforniaUSA
| | - Jun Mo
- UCSD School of MedicineLa JollaCaliforniaUSA
- Rady Children's HospitalSan DiegoCaliforniaUSA
| | - Eric Anderson
- UCSD School of MedicineLa JollaCaliforniaUSA
- Rady Children's HospitalSan DiegoCaliforniaUSA
| | - Nicholas Gloude
- UCSD School of MedicineLa JollaCaliforniaUSA
- Rady Children's HospitalSan DiegoCaliforniaUSA
| | - Deborah Schiff
- UCSD School of MedicineLa JollaCaliforniaUSA
- Rady Children's HospitalSan DiegoCaliforniaUSA
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3
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Teng L, Shen C, Gu W, Wu J, Lu M, Xu X. Epstein-Barr virus infection associated polymyositis and coronary artery dilation. BMC Infect Dis 2022; 22:227. [PMID: 35255852 PMCID: PMC8900426 DOI: 10.1186/s12879-022-07221-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 03/01/2022] [Indexed: 11/25/2022] Open
Abstract
Background Epstein-Barr virus (EBV) infects more than 90% of the population worldwide. However, chronic active EBV infection (CAEBV) is one of the EBV-positive T- or NK-lymphoproliferative diseases with high morbidity and mortality. Here, we report a case of a 9-year girl with CAEBV, successively presenting with polymyositis and coronary artery dilation (CAD). Case presentation The girl complained of fatigue for more than 1 month. Muscle strength examinations had no abnormal findings. Blood chemistries showed elevated alanine aminotransferase (ALT), aspartate aminotransferase (AST), and creatine kinase (CK). Magnetic resonance imaging (MRI) showed spotty high-intensity signals in thigh muscles, and electromyogram suggested myogenic damage. The significant findings were positive EBV antibodies (EBVEA-IgG, EBVCA-IgG, and EBVNA-IgG), increased EBV DNA copies in B, T, and NK cells, and positive EBV-encoded small RNA in biopsy muscle specimen. The girl received ganciclovir, intravenous immunoglobulin, and methylprednisolone, and her symptoms improved. On the 45th day of hospitalization, echocardiograph revealed CAD. She received additional anticoagulants and Tocilizumab. Her condition improved and continued to be followed up at the clinic preparing for hematopoietic stem cell transplantation. Conclusions This is the first reported case of CAEBV successively with polymyositis and CAD. This case makes the diagnoses of autoimmune diseases in children more complicated. Careful investigation of hidden CAEBV should be recommended in children with atypical polymyositis or CAD.
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Affiliation(s)
- Liping Teng
- Department of Rheumatology Immunology & Allergy, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, 310003, Hangzhou, People's Republic of China
| | - Chencong Shen
- Department of Rheumatology Immunology & Allergy, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, 310003, Hangzhou, People's Republic of China
| | - Weizhong Gu
- Department of Pathology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, 310003, Hangzhou, People's Republic of China
| | - Jianqiang Wu
- Department of Rheumatology Immunology & Allergy, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, 310003, Hangzhou, People's Republic of China
| | - Meiping Lu
- Department of Rheumatology Immunology & Allergy, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, 310003, Hangzhou, People's Republic of China. .,Department of Pulmonary Medicine, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, 310003, Hangzhou, People's Republic of China.
| | - Xuefeng Xu
- Department of Rheumatology Immunology & Allergy, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, 310003, Hangzhou, People's Republic of China. .,Department of Pulmonary Medicine, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, 310003, Hangzhou, People's Republic of China.
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Li Q, Li G, Shao D, Yarrabolu T, Yue Y. Case Report: Pediatric Chronic Active Epstein-Barr Virus Infection With Giant Sinus of Valsalva Aneurysms and Aorta and Its Branch Dilations. Front Pediatr 2021; 9:779806. [PMID: 35174114 PMCID: PMC8841759 DOI: 10.3389/fped.2021.779806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Accepted: 12/21/2021] [Indexed: 11/13/2022] Open
Abstract
Chronic active Epstein-Barr virus infection (CAEBV), which often manifests as persistent infectious mononucleosis-like symptoms and can involve multiple organs, is a prolonged or reactivated status of primary EBV infection. Cardiovascular damage is one of the rare but severe complications correlated with poor prognosis among all CAEBV patients. Few published articles have demonstrated systemic arterial lesions involving branches of the aorta as cardiovascular complications. Herein, we report a rare pediatric case of CAEBV associated with giant sinus of Valsalva aneurysms and aorta and its branch dilations.
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Affiliation(s)
- Qirui Li
- Department of Cardiology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Guyu Li
- Department of Pediatrics, Driscoll Children's Hospital, Corpus Christi, TX, United States
| | - Daming Shao
- Department of Medicine, Jacobi Medical Center, New York City, NY, United States
| | - Tharak Yarrabolu
- Department of Cardiology, Driscoll Children's Hospital, Corpus Christi, TX, United States
| | - Yuan Yue
- Department of Cardiology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
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Xiao H, Hu B, Luo R, Hu H, Zhang J, Kuang W, Zhang R, Li L, Liu G. Chronic active Epstein-Barr virus infection manifesting as coronary artery aneurysm and uveitis. Virol J 2020; 17:166. [PMID: 33121509 PMCID: PMC7597064 DOI: 10.1186/s12985-020-01409-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 09/01/2020] [Indexed: 12/15/2022] Open
Abstract
Background Chronic active Epstein–Barr virus (CAEBV) infection is a type of lymphoproliferative disorder characterized by chronic or recurrent infectious mononucleosis (IM)-like symptoms, which can have less-frequent clinical presentations. The prognosis of CAEBV is poor, and hematopoietic stem cell transplantation (HSCT) has been shown to be the only potentially effective treatment. In this article, we present a special CAEBV case of a patient who had no typical IM-like symptoms at the early stage, but manifested with severe and progressive coronary artery aneurysm (CAA), abdominal aortic lesions, and severe uveitis. These manifestations were uncommon features and could only be blocked by HSCT. Case presentation A 4-year-old girl with no special medical history complained of decreased vision for 10 months and cough after physical activities for three months. The blurred vision grew rapidly worse within one month, until only light perception remained. She was diagnosed with uveitis and cataract, and received prednisone and ciclosporin A treatment. However, her vision did not improve. Physical examination showed slight hepatosplenomegaly. Ultrasonic cardiogram showed bilateral CAA (5.0 mm and 5.7 mm for inner diameters), and abdominal CT scan revealed a thickened aortic wall, as well as stenosis and dilation of the segmental abdominal aorta. Other significant findings were increased EBV-DNA (3.29 × 104 copies/mL) from peripheral blood, positive EBV antibodies (EBV-CA-IgG, EBV-EA-IgA, and EBV-NA-IgG), and positive EBV-encoded small RNAs found by bone marrow biopsy. Based on her clinical manifestations and evidence for EBV infection, we diagnosed CAEBV. She received allogeneic HSCT, and the cataract operation was performed after HSCT. EBV-DNA could not be detected in peripheral blood after HSCT. Her CAAs did not progress, and uveitis was well controlled. Her vision recovered gradually over the 3 years after HSCT. Conclusions We present a rare CAEBV case of a patient who suffered from uncommon and severe cardiovascular and ocular involvement that was relieved by HSCT. Therefore, early recognition and diagnosis of CAEBV are of vital importance to improve its prognosis. In summary, this atypical CAEBV case could help us recognize similar cases more easily, make the right diagnosis as early as possible, and deliver proper and timely treatment.
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Affiliation(s)
- Haijuan Xiao
- Department of Infectious Diseases, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Bing Hu
- Department of Infectious Diseases, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Rongmu Luo
- Department of Hematology and Oncology, Affiliated Bayi Children's Hospital, The Seventh Medical Center of PLA General Hospital, Beijing, China
| | - Huili Hu
- Department of Infectious Diseases, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Junmei Zhang
- Department of Rheumatology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Weiying Kuang
- Department of Rheumatology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Rui Zhang
- Hematology Oncology Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Li Li
- Department of Ophthalmology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Gang Liu
- Department of Infectious Diseases, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China.
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Ichimata S, Kobayashi M, Ohya M, Otsuki T, Yanagisawa K, Tateishi K, Kato A, Matsuo A, Kanno H. A fulminant case of classical Hodgkin lymphoma: A diagnostic dilemma of Epstein-Barr virus-positive large B-cell neoplasms. Pathol Int 2019; 69:407-413. [PMID: 31215109 DOI: 10.1111/pin.12800] [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: 12/09/2018] [Revised: 02/14/2019] [Accepted: 03/13/2019] [Indexed: 11/27/2022]
Abstract
We report a fulminant case of classical Hodgkin lymphoma (CHL). The patient died only approximately 2 months after the onset of subjective symptoms. Autopsy specimens revealed atypical cells resembling Hodgkin and Reed-Sternberg (HRS) cells in a rich inflammatory background in various organs. There were marked, characteristic angiodestructive lesions from infiltrating HRS-like cells and numerous macrophages. The HRS-like cells were infected with Epstein-Barr virus (EBV), immunohistochemically positive for PAX5 and CD30, and negative for CD3, CD20, and ALK. Most B-cell markers other than PAX5 were negative, and the HRS-like cells also expressed cytotoxic molecules. Monoclonal rearrangement of immunoglobulin heavy chain was detected by PCR analysis. According to the 2016 WHO classification, we diagnosed mixed cellularity CHL. However, EBV-positive diffuse large B-cell lymphoma (DLBCL), not otherwise specified and EBV-positive B-cell lymphoma, unclassifiable with features intermediate between DLBCL and CHL were considered as differential diagnoses because both tumors are aggressive EBV-positive large B-cell neoplasms with reactive inflammatory cells and sometimes contains HRS-like cells. The clinical condition of the current case was closer to these two entities than to CHL. A diagnosis of EBV-positive large B-cell neoplasms was difficult because of overlapping morphological and immunohistochemical characteristics, but should be considered for prognosis.
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Affiliation(s)
- Shojiro Ichimata
- Department of Pathology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Mikiko Kobayashi
- Department of Pathology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Maki Ohya
- Department of Pathology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Toshiaki Otsuki
- Department of Laboratory Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Katsuya Yanagisawa
- First Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Kazunari Tateishi
- First Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Akane Kato
- First Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Akemi Matsuo
- Department of Respiratory Medicine, Minaminagano Medical Center, Shinonoi General Hospital, Nagano, Japan
| | - Hiroyuki Kanno
- Department of Pathology, Shinshu University School of Medicine, Matsumoto, Japan
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New Insights on the Pathogenesis of Takayasu Arteritis: Revisiting the Microbial Theory. Pathogens 2018; 7:pathogens7030073. [PMID: 30200570 PMCID: PMC6160975 DOI: 10.3390/pathogens7030073] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 09/01/2018] [Accepted: 09/05/2018] [Indexed: 02/07/2023] Open
Abstract
Takayasu arteritis (TAK) is a chronic vasculitis that mainly affects the aorta, its major branches, and the pulmonary arteries. Since the description of the first case by Mikito Takayasu in 1908, several aspects of this rare disease, including the epidemiology, diagnosis, and the appropriate clinical assessment, have been substantially defined. Nevertheless, while it is well-known that TAK is associated with a profound inflammatory process, possibly rooted to an autoimmune disorder, its precise etiology has remained largely unknown. Efforts to identify the antigen(s) that trigger autoimmunity in this disease have been unsuccessful, however, it is likely that viruses or bacteria, by a molecular mimicry mechanism, initiate or propagate the auto-immune process in this disease. In this article, we summarize recent advances in the understanding of TAK, with emphasis on new insights related to the pathogenesis of this entity that may contribute to the design of novel therapeutic approaches.
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Jiang S, Li X, Cao J, Wu D, Kong L, Lin L, Jin Z, An J, Wang Y. Early diagnosis and follow-up of chronic active Epstein-Barr-virus-associated cardiovascular complications with cardiovascular magnetic resonance imaging: A case report. Medicine (Baltimore) 2016; 95:e4384. [PMID: 27495050 PMCID: PMC4979804 DOI: 10.1097/md.0000000000004384] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Chronic active Epstein-Barr virus (EBV) infection (CAEBV) is characterized as chronic or recurrent mononucleosis-like symptoms and elevated EBV deoxyribonucleic acid (EBV-DNA) copies. Cardiovascular complications have high morbidity and mortality. The treatment regimen for CAEBV has not been established yet, resulting in poor prognoses. Herein, we present a case of cardiovascular magnetic resonance imaging (CMRI) evaluation with a series of sequences for CAEBV-associated cardiovascular involvement, which has never been reported. CASE PRESENTATION A 16-year-old female (body weight, 55 kg) developed a persistent fever and a positive EBV-DNA level of 28,000 copies/mL. Computed tomography angiography (CTA) showed aneurysms involving the aorta and its major branches, as well as multiple aneurysms and stenoses of the coronary arteries. CMRI of the coronary arteries depicted the dilution and stenosis of the arterial lumen as well as the thickening of the arterial wall. Late gadolinium enhancement (LGE) showed subendocardial and transmural delayed enhancement of the left ventricle, suggesting myocardial infarction.CAEBV and associated cardiovascular complications were diagnosed. After treatment with Medrol and Leflunomide, the clinical manifestation and serological parameters reversed to normal. However, the EBV-DNA level increased again to 13,900 copies/mL 2 months later. A follow-up with aorta CTA showed that the arterial walls of the bilateral common iliac artery aneurysms were thicker with new-onset mural thrombi. The aorta CTA also showed new-onset occlusion of the right coronary artery, but a follow-up of CMRI at the same day did not find new-onset delayed enhancement lesion. CONCLUSION This case reminds clinicians of the vital importance of early diagnosis and close follow-up of CAEBV-associated cardiovascular complications. With cine imaging, coronary artery imaging, LGE imaging, and other novel techniques, CMRI can effectively and comprehensively reveal the early and dynamic changes, and act as an important tool in the field of cardiovascular diseases.
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Affiliation(s)
| | | | | | - Di Wu
- Department of Rheumatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College
| | | | | | - Zhengyu Jin
- Department of Radiology
- Correspondence: Yining Wang, Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.1, Shuaifuyuan, Dongcheng District, Beijing 100730, China (e-mail: ); Zhengyu Jin, Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.1, Shuaifuyuan, Dongcheng District, Beijing 100730, China (e-mail: )
| | - Jing An
- MR Collaborations NE Asia, Siemens Healthcare, Beijing, China
| | - Yining Wang
- Department of Radiology
- Correspondence: Yining Wang, Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.1, Shuaifuyuan, Dongcheng District, Beijing 100730, China (e-mail: ); Zhengyu Jin, Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.1, Shuaifuyuan, Dongcheng District, Beijing 100730, China (e-mail: )
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Lymphocytic Arteritis in Epstein-Barr Virus Vulvar Ulceration (Lipschütz Disease): A Report of 7 Cases. Am J Dermatopathol 2016; 37:691-8. [PMID: 26291418 DOI: 10.1097/dad.0000000000000316] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Epstein-Barr virus (EBV) infection can rarely present as painful genital ulcers, mostly in young female adolescents. Typically diagnosed by clinical findings, EBV vulvar ulceration (EBVVU) is rarely biopsied. Herein, the authors report the histopathology in 8 biopsies from 7 EBVVU patients, all serologically confirmed for acute (4/7) or reactivated-chronic (3/7) EBV infection. The 7 women all presented with 1 or more painful, punched-out vulvar ulcers. Only patients with acute EBV infection showed other clinical findings: fever and/or atypical lymphocytosis affected 75% (3/4); lymphadenopathy in 50%; and malaise/fatigue, dysuria and/or hepatomegaly in 25%. All reactivated-chronic EBVVU had a solitary ulcer, and 2 had history of a similar episode of vulvar ulceration (aphthosis). Histopathologically, lymphocytic arteritis was identified in 88% (7/8); a submucosal scar was found in the eighth specimen. Other histopathologies included venulitis (62%), endarteritis obliterans (38%), thrombosis (25%), neutrophilic sebaceous adenitis (25%), and mucosal lymphoid hyperplasia (12%). Dense angiocentric CD3 CD4 T-cell lymphocyte-predominant infiltrates were found, regionally or diffusely. In 2 specimens, neutrophils compromised half of the infiltrate. Minor components of CD8, CD20, and CD30 lymphocytes, CD123 plasmacytoid monocytes, CD68 macrophages, and plasma cells were present. Small-vessel endothelium and smooth muscle adjacent to the ulcers faintly expressed cytoplasmic EBV latent membrane protein-1 (LMP1). In situ hybridization for early EBV mRNA (EBER) identified rare solitary or scattered clustered positive lymphocytes in 38%. Polymerase chain reaction for EBV DNA was positive in one EBER positive biopsy. EBV infection has been documented in muscular vessel vasculitis. Based on the aforementioned, EBVVU appears to be the consequence of localized lymphocytic arteritis.
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Fujimoto M, Kaku Y, Yamakawa N, Kawabata D, Ohmura K, Koyanagi I, Mimori T, Kabashima K, Haga H. Methotrexate-associated EBV-positive vasculitis in the skin: a report of two cases simulating rheumatoid vasculitis. J Cutan Pathol 2016; 43:520-525. [DOI: 10.1111/cup.12690] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Revised: 05/28/2015] [Accepted: 07/25/2015] [Indexed: 01/19/2023]
Affiliation(s)
- Masakazu Fujimoto
- Department of Diagnostic Pathology; Kyoto University Hospital; Kyoto Japan
| | - Yo Kaku
- Department of Dermatology; Kyoto University Hospital; Kyoto Japan
| | - Noriyuki Yamakawa
- Department of Rheumatology and Clinical Immunology; Kyoto University Hospital; Kyoto Japan
| | - Daisuke Kawabata
- Department of Rheumatology and Clinical Immunology; Kyoto University Hospital; Kyoto Japan
| | - Koichiro Ohmura
- Department of Rheumatology and Clinical Immunology; Kyoto University Hospital; Kyoto Japan
| | - Itsuko Koyanagi
- Department of Diagnostic Pathology; Kyoto University Hospital; Kyoto Japan
| | - Tsuneyo Mimori
- Department of Rheumatology and Clinical Immunology; Kyoto University Hospital; Kyoto Japan
| | - Kenji Kabashima
- Department of Dermatology; Kyoto University Hospital; Kyoto Japan
| | - Hironori Haga
- Department of Diagnostic Pathology; Kyoto University Hospital; Kyoto Japan
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Increased Circulating Th17 Cells, Serum IL-17A, and IL-23 in Takayasu Arteritis. Autoimmune Dis 2016; 2016:7841718. [PMID: 27034824 PMCID: PMC4808531 DOI: 10.1155/2016/7841718] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Revised: 02/19/2016] [Accepted: 02/21/2016] [Indexed: 12/14/2022] Open
Abstract
Introduction. Th17, γδT, NK, and NKT cells in peripheral blood and serum IL-17 and IL-23 in Takayasu arteritis (TA) were measured and correlated with disease activity. Methods. Th17 (anti-CD3APC, CD4PECy7, and IL-17PE), NKT, NK (anti-CD3APC, CD56FITC), and γδT (anti-CD3FITC and γδTCRAPC) cells were enumerated by flow cytometry in peripheral blood of 30 patients with TA (ACR1990 criteria) and 20 healthy controls, serum IL-17 and IL-23 measured by ELISA. Relation with disease activity (NIH criteria, ITAS2010) was analyzed (using nonparametric tests, median with interquartile range). Results. Mean age of patients was 33.47 ± 11.78 years (25 females); mean symptom duration was 7.1 ± 5.3 years. 13 were not on immunosuppressants; 12 were active (ITAS2010 ≥ 4). The percentage of Th17 cells was significantly expanded in TA (patients 2.1 (1.5–3.2) versus controls 0.75 (0.32–1.2); p < 0.0001) with no differences in other cell populations. Serum IL-17 and IL-23 (pg/mL) in patients (6.2 (4.6–8.5) and 15 (14.9–26.5), resp.) were significantly higher (p < 0.001) than controls (3.9 (3.9–7.3) and undetectable median value, resp.). Subgroup analysis revealed no correlation of Th17 cells, serum IL-17, and IL-23 with disease activity or medications, nor any significant difference before and after medication. Conclusions. There is significant expansion of Th17 cells and elevated serum IL-17 and IL-23 levels in TA patients compared to healthy controls.
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12
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Mikelarena E, Gainza E, Ysa A, Fonseca JL. Aneurysmal degeneration of the femoral artery secondary to an anaplastic large cell lymphoma. J Vasc Surg 2016; 63:241-2. [PMID: 26718824 DOI: 10.1016/j.jvs.2014.05.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Accepted: 05/19/2014] [Indexed: 11/27/2022]
Affiliation(s)
- Ederi Mikelarena
- Department of Vascular Surgery, Hospital de Cruces, Barakaldo, Spain
| | - Estepan Gainza
- Department of Radiology, Hospital de Cruces, Barakaldo, Spain
| | - August Ysa
- Department of Vascular Surgery, Hospital de Cruces, Barakaldo, Spain.
| | - Juan L Fonseca
- Department of Vascular Surgery, Hospital de Cruces, Barakaldo, Spain
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13
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Teng GG, Chatham WW. Vasculitis related to viral and other microbial agents. Best Pract Res Clin Rheumatol 2015; 29:226-43. [PMID: 26362741 DOI: 10.1016/j.berh.2015.05.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Accepted: 05/08/2015] [Indexed: 12/11/2022]
Abstract
Vasculitis due to infection may occur as a consequence of the inflammation of vessel walls due to direct or contiguous infection, type II or immune complex-mediated reaction, cell-mediated hypersensitivity, or inflammation due to immune dysregulation triggered by bacterial toxin and/or superantigen production. As immunosuppressive therapy administered in the absence of antimicrobial therapy may increase morbidity and fail to effect the resolution of infection-associated vascular inflammation, it is important to consider infectious entities as potential inciting factors in vasculitis syndromes. The causality between infection and vasculitis has been established in hepatitis B-associated polyarteritis nodosa (HBV-PAN) and hepatitis C-associated (cryoglobulinemic) vasculitis (HCV-CV). The review summarizes the recent literature on the pathophysiological mechanisms and the approaches to the management of HBV-PAN and HCV-CV. Roles of other viral and microbial infections, which either manifest as vasculitic syndromes or are implicated in the pathogenesis of primary vasculitides, are also discussed.
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Affiliation(s)
- Gim Gee Teng
- Division of Rheumatology, University Medicine Cluster, National University Health System, Singapore; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore
| | - W Winn Chatham
- Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, AL, USA.
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14
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Nussbaum ES, Defillo A, Mcdonald W, Hanson S, Zelensky A. Diffuse idiopathic intracranial fusiform aneurysm development. Case report and literature review. Surg Neurol Int 2014; 5:107. [PMID: 25101202 PMCID: PMC4123257 DOI: 10.4103/2152-7806.136702] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2013] [Indexed: 11/19/2022] Open
Abstract
Background: Fusiform intracranial aneurysms (FIAs) are uncommon lesions representing less than 15% of all intracranial aneurysms in most large series. Their etiology has been linked to a variety of causes including atherosclerosis, fibromuscular dysplasia, cystic medial necrosis, connective tissue disease, hypertension, diabetes, hyperlipidemia, infection, cardiac myxoma, oral contraceptive use, vasculitis, and lymphoproliferative disorders. The finding of numerous lesions in a single patient is distinctly uncommon. Case Description: We describe the unique case of a 47-year-old female who developed multiple FIAs over a 6-year period without an obvious underlying pathology. The patient's medical history was significant for obesity, migraine headaches, insomnia, breast cancer, and chronic skin rash. Various diagnoses were explored including infectious etiologies, autoimmune vasculopathies, malignancy-related causes, connective tissue disorders, and underlying genetic conditions. However, all investigations, including aneurysm wall and skin biopsies were negative or deemed noncontributory toward making a definitive diagnosis. Conclusion: We report an unusual case of a patient with a normal cerebral angiogram developing numerous, FIAs without obvious underlying etiology over a 6-year period. Close clinical and radiological follow-up is recommended in this case because the natural history of the disease is unclear at this point. The literature regarding potential causes of multiple fusiform intracranial aneuryms is reviewed.
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Affiliation(s)
- Eric S Nussbaum
- Department of Neurosurgery, National Brain Aneurysm Center at the John Nasseff Neuroscience Institute, St. Paul, Minnesota, USA ; Minnesota Neurovascular and Skull Base Surgery, Minneapolis, Minnesota, USA
| | - Archie Defillo
- Centra Care, St. Cloud Hospital, St. Cloud, Minnesota, USA
| | - William Mcdonald
- Department of Pathology, Division of Neuropathology, Allina Health, Minneapolis, Minnesota, USA
| | - Sandra Hanson
- John Nasseff Neuroscience Institute, Director Stroke Care, Allina Health, United Hospital, St. Paul, Minnesota, USA
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15
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Chiu TM, Lin YM, Wang SC, Tsai YG. Hypersensitivity to mosquito bites as the primary clinical manifestation of an Epstein-Barr virus infection. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2014; 49:613-6. [PMID: 24662020 DOI: 10.1016/j.jmii.2014.01.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2013] [Revised: 11/08/2013] [Accepted: 01/15/2014] [Indexed: 11/29/2022]
Abstract
Hypersensitivity to mosquito bites (HMB) is a rare disease characterized by intense local skin reactions with general symptoms, such as high fever and regional lymphadenopathy after mosquito bites. Epstein-Barr virus (EBV) chronic infection and NK cell lymphoproliferative disease have been reported first in diagnosed HMB patients. Here, we present the case of a 6-year-old girl with 2 months' history of bullae and necrotic skin lesions, accompanied by a high temperature, visual hallucinations, and liver dysfunction after mosquito bites. A histopathologic examination of the skin lesion showed vasculitis and EBV infection. We could not detect any findings of hematologic malignancies or NK cell proliferative disease in the patient. Clinicians should closely evaluate HMB patients for possible development of lymphoproliferative status or hematologic malignant disorders.
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Affiliation(s)
- Tsu-Man Chiu
- Department of Dermatology, Changhua Christian Hospital, Changhua, Taiwan
| | - Yueh-Min Lin
- Department of Pathology, Changhua Christian Hospital, Changhua, Taiwan
| | - Shing-Chuang Wang
- Department of Pediatrics, Changhua Christian Hospital, Changhua, Taiwan
| | - Yi-Giien Tsai
- Department of Pediatrics, Changhua Christian Hospital, Changhua, Taiwan; School of Medicine, Chung Shan Medical University, Taichung, Taiwan; School of Medicine, Kaohsiung Medicial University, Kaohsiung, Taiwan.
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16
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Ichinose K, Origuchi T, Tashiro N, Kawashiri SY, Iwamoto N, Fujikawa K, Aramaki T, Arima K, Tamai M, Yamasaki S, Nakamura H, Moriuchi H, Kawakami A. An elderly patient with chronic active Epstein–Barr virus infection with mixed cryoglobulinemia and review of the literature. Mod Rheumatol 2014. [DOI: 10.3109/s10165-012-0731-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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17
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Patil AKB, Azad ZR, Mathew V, Alexander M. Chronic meningitis and central nervous system vasculopathy related to Epstein Barr virus. Ann Indian Acad Neurol 2013; 15:303-6. [PMID: 23349599 PMCID: PMC3548372 DOI: 10.4103/0972-2327.104342] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2011] [Revised: 01/11/2012] [Accepted: 07/17/2012] [Indexed: 12/01/2022] Open
Abstract
Chronic active Epstein Barr virus (EBV) infection causes a wide spectrum of manifestation, due to meningeal, parenchymal and vascular involvement. An 11-year-old boy presented with chronic headache, fever and seizures of 18 months duration. His magnetic resonance imaging Brain showed fusiform aneurysmal dilatations of arteries of both the anterior and posterior cerebral circulation. Cerebrospinal fluid (CSF) showed persistent lymphocytic pleocytosis, raised proteins and low sugar with positive polymerase chain reaction for EBV. He later developed pancytopenia due to bone marrow aplasia, with secondary infection and expired. From clinical, imaging and CSF findings, he had chronic lymphocytic meningitis with vasculopathy, which was isolated to the central nervous system. He later had marrow aplasia probably due to X-linked lymphoproliferative disorder related to EBV infection. Vasculopathy, especially diffuse fusiform aneurysmal dilatation associated with chronic EBV infection, is rare, but has been described, similar to our case report.
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Affiliation(s)
- Anil Kumar B Patil
- Section of Neurology, Department of Neurological Sciences. Christian Medical College, Vellore, Tamil Nadu, India
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18
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Ichinose K, Origuchi T, Tashiro N, Kawashiri SY, Iwamoto N, Fujikawa K, Aramaki T, Arima K, Tamai M, Yamasaki S, Nakamura H, Moriuchi H, Kawakami A. An elderly patient with chronic active Epstein-Barr virus infection with mixed cryoglobulinemia and review of the literature. Mod Rheumatol 2012; 23:1022-8. [PMID: 22895834 DOI: 10.1007/s10165-012-0731-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2012] [Accepted: 07/23/2012] [Indexed: 12/01/2022]
Abstract
A 76-year-old woman was diagnosed with chronic active Epstein-Barr virus (EBV) infection (CAEBV) with sustained fever, anemia, numbness of the lower limbs, and liver dysfunction. The patient had an unusual anti-EBV antibody profile and high viral load, positive rheumatoid factor, and cryoglobulinemia. She suffered from recurrent hemosputum with pleural effusion and thrombocytopenia caused by CAEBV infection, and she died in July 2008. Here, we present a rare case of CAEBV infection with cryoglobulinemia in an elderly patient.
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Affiliation(s)
- Kunihiro Ichinose
- Department of Rheumatology, Unit of Translational Medicine, Graduate School of Biomedical Sciences, Nagasaki University, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan,
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19
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Hashimoto T, Sakata Y, Fukushima K, Maeda T, Arita Y, Shioyama W, Nakaoka Y, Hori Y, Morii E, Aozasa K, Kanakura Y, Yamauchi-Takihara K, Komuro I. Pulmonary arterial hypertension associated with chronic active Epstein-Barr virus infection. Intern Med 2011; 50:119-24. [PMID: 21245635 DOI: 10.2169/internalmedicine.50.4143] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 45-year-old man with chronic active Epstein-Barr virus (EBV) infection (CAEBV) with natural killer cell type developed pulmonary arterial hypertension (PAH). After chemotherapy, he showed marked depression of the EBV DNA genome in the peripheral blood, but PAH sustained. He died of heart failure due to PAH, and the histo-pathological examination revealed pulmonary vascular abnormalities without lung disease on autopsy. Although the EBV DNA genome and the infiltrating lymphocytes were not detected in the lung, his clinical course suggested that his PAH might be caused by CAEBV. This is the first reported case of PAH associated CAEBV in an adult.
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Affiliation(s)
- Takahiro Hashimoto
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
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20
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Brunner J, Feldman BM, Tyrrell PN, Kuemmerle-Deschner JB, Zimmerhackl LB, Gassner I, Benseler SM. Takayasu arteritis in children and adolescents. Rheumatology (Oxford) 2010; 49:1806-14. [PMID: 20562196 DOI: 10.1093/rheumatology/keq167] [Citation(s) in RCA: 135] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Takayasu arteritis is a devastating vasculitis of the aorta and its major branches. The clinical manifestations in paediatric patients are less specific than in adults: in children the disease presents with fever, arthralgias and hypertension. Intramural inflammation results in narrowing of the blood vessel lumen and therefore hypoperfusion of the parenchyma. Conventional angiography is the gold standard diagnostic procedure. Corticosteroids, cyclophosphamide, MTX and biological therapies such as TNF-α blocking agents are treatment options.
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Affiliation(s)
- Juergen Brunner
- Department of Pediatrics, Pediatric Rheumatology, Medical University Innsbruck, Innsbruck, Austria.
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21
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Hasegawa D, Kaji M, Takeda H, Kawasaki K, Takahashi H, Ochiai H, Morio T, Omori Y, Yokozaki H, Kosaka Y. Fatal degeneration of specialized cardiac muscle associated with chronic active Epstein-Barr virus infection. Pediatr Int 2009; 51:846-8. [PMID: 20158631 DOI: 10.1111/j.1442-200x.2009.02925.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Daiichiro Hasegawa
- Department of Hematology and Oncology, Kobe Children's Hospital, Kobe, Japan.
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22
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Lidar M, Lipschitz N, Langevitz P, Barzilai O, Ram M, Porat-Katz BS, Pagnoux C, Guilpain P, Sinico RA, Radice A, Bizzaro N, Damoiseaux J, Tervaert JWC, Martin J, Guillevin L, Bombardieri S, Shoenfeld Y. Infectious serologies and autoantibodies in Wegener's granulomatosis and other vasculitides: novel associations disclosed using the Rad BioPlex 2200. Ann N Y Acad Sci 2009; 1173:649-57. [PMID: 19758211 DOI: 10.1111/j.1749-6632.2009.04641.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
In this study we assess the presence of antibodies against infectious agents as well as for a variety of autoantibodies in an attempt to establish associations between various vasculitides and infections in order to shed light on the etiopathogenesis of these diseases and perhaps implicate a potential cure. Sera from patients with Wegener's granulomatosis (WG), polyarteritis nodosa, microscopic polyangiitis, Churg Strauss, and giant cell arteritis were compared to healthy control sera. Serum samples were assessed, using the Bio-Rad BioPlex 2200, for the presence of Toxoplama gondii, cytomegalovirus (CMV), Epstein-Barr virus (EBV), Treponema pallidum, and Saccharomyces cerevisiae. Hepatitis B virus (HBV), hepatitis C virus (HCV), and anti-Helicobacter pylori antibodies were assessed by ELISA. In addition, sera were tested for a panel of antibodies associated with thrombophilia as well as various autoantibodies. The prevalence of antibodies toward HCV and H. pylori was significantly higher among patients with WG. IgG antibodies toward T. gondii and IgM antibodies toward CMV were significantly more common among WG patients than among controls. WG patients exhibited more antibodies toward EBV viral capsid antigen IgG and EBV early antigen IgG compared to sera from healthy controls. In WG, positive associations were disclosed between CMV IgG antibodies and the presence of gastrointestinal manifestations and renal involvement, and there was a higher Birmingham vasculitis activity score in association with elevated titers of EBV viral capsid antigen IgG antibodies. Otorhinolaryngeal manifestations were more common in those with positive IgG antibodies for EBV early antigen. Our results unveil novel associations between WG and various infectious agents, including HCV, H. pylori, T. gondii, CMV, and EBV. In addition to putative roles in initiation and exacerbation of the vasculitic process, it seems that these infectious agents also modulate the clinical phenotype of the disease.
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Affiliation(s)
- Merav Lidar
- Center for Autoimmune Disease, Rheumatology Unit, Sheba Medical Center, Tel Hashomer, Israel
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23
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Shimura C, Satoh T, Takayama K, Yokozeki H. Methotrexate-related lymphoproliferative disorder with extensive vascular involvement in a patient with rheumatoid arthritis. J Am Acad Dermatol 2009; 61:126-9. [DOI: 10.1016/j.jaad.2008.10.051] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2008] [Revised: 10/24/2008] [Accepted: 10/29/2008] [Indexed: 11/24/2022]
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24
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Muneuchi J, Ohga S, Ishimura M, Ikeda K, Yamaguchi K, Nomura A, Takada H, Abe Y, Hara T. Cardiovascular complications associated with chronic active Epstein-Barr virus infection. Pediatr Cardiol 2009; 30:274-81. [PMID: 19184184 DOI: 10.1007/s00246-008-9343-8] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2008] [Revised: 09/29/2008] [Accepted: 11/09/2008] [Indexed: 12/31/2022]
Abstract
This study aimed to assess the outcome of cardiovascular diseases for patients with chronic active Epstein-Barr virus infection (CAEBV). The study enrolled 15 patients (7 boys and 8 girls) who fulfilled the diagnostic criteria for CAEBV, including 10 patients with T-cell type and 3 patients with natural killer (NK)-cell type. The median age at the CAEBV onset was 6.3 years (range, 1.2-17.8 years). Regular cardiologic studies were performed during the median follow-up period of 8 years (range, 2-20 years). Nine patients (60%) had cardiac diseases including coronary artery lesion (CAL) (n = 4, 44%), decreased left ventricular ejection fraction and pericardial effusion in (n = 3, 33%), complete atrioventricular block (n = 1), and sudden arrest (n = 1). The frequency of fever (78%, p = 0.04) or cytopenias (100%, p = 0.01), as the major symptom among patients with cardiac complications, was higher than among those without complications. The median time from disease onset to detection of CAL was 3.4 years (range, 1.8-8.6 years). The mean z-score increased to 3.98. Seven patients (78%) with cardiac complications died of disease progression, hematopoietic stem cell transplantation-related events, or both. In two patients, CAL regressed after allogeneic cord blood transplantation. Among CAEBV patients, CAL was the most common cardiac complication and could not be controlled without the eradication of EBV-infected T- and NK-cells.
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Affiliation(s)
- Jun Muneuchi
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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25
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Pipitone N, Salvarani C. The role of infectious agents in the pathogenesis of vasculitis. Best Pract Res Clin Rheumatol 2009; 22:897-911. [PMID: 19028370 PMCID: PMC7106215 DOI: 10.1016/j.berh.2008.09.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/29/2022]
Abstract
Numerous human studies and animal models have implicated various infectious agents in the pathogenesis of vasculitis in susceptible hosts. However, the link between infection and vasculitis is very complex and only incompletely understood. In fact, different agents can induce the same type of vasculitis, as the case of leukocytoclastic vasculitis exemplifies. Conversely, the same agent can give rise to a panoply of host responses ranging from a clinically silent infection or localized organ involvement to devastating, widespread vasculitis.
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Affiliation(s)
- Nicolò Pipitone
- Department of Rheumatology, Arcispedale Santa Maria Nuova, Reggio Emilia, Italy
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26
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O'Connor MB, O'Donovan N, Phelan MJ, Regan MJ. Difficulties in diagnosing Takayasu's arteritis and the benefits of modern day imaging. Ir J Med Sci 2009; 178:385-7. [PMID: 19198973 DOI: 10.1007/s11845-009-0290-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2009] [Accepted: 01/14/2009] [Indexed: 11/24/2022]
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27
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McCarthy EM, Cunnane G. Basic clinical examination skills may save lives. Rheumatol Int 2008; 29:217-8. [DOI: 10.1007/s00296-008-0657-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2008] [Accepted: 07/25/2008] [Indexed: 11/29/2022]
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28
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O'Connor MB, Murphy E, O'Donovan N, Murphy M, Phelan MJ, Regan MJ. Takayasu's Arteritis presenting as a dissecting aortic aneurysm history: a case report. CASES JOURNAL 2008; 1:52. [PMID: 18644125 PMCID: PMC2494540 DOI: 10.1186/1757-1626-1-52] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/07/2008] [Accepted: 07/21/2008] [Indexed: 11/29/2022]
Abstract
Introduction Takayasu's Arteritis, formerly known as "pulseless disease", is a chronic idiopathic vasculitis which affects the large vessels in the body. First described in the 1800's, this rare condition is more commonly found in Asian women in their 40's. The aorta and its main branches are the primary vessels affected, with the most typical features reflected as ischemia or aneurysm formation. With Takayasu's Arteritis being a rare condition and its acute phase presentation often similar to other conditions, diagnosis is often difficult. Case Presentation A 48 year old Irish Caucasian female, who presented as a typical history of an aortic dissection (chest pain radiating to her back in an interscapular region and a systolic blood pressure differential of 50 mmHg between her right and left upper limbs), was investigated with a number of imaging modalities and diagnosed with Takayasu's Arteritis, involving arteries affecting a number of organs. She was treated as per protocol for Takayasu's Arteritis. A diagnosis of cervical cancer quickly followed. Conclusion This case report highlights that a differential diagnosis should never be dispelled based upon a "typical" history. The importance of modern day imaging techniques such as CT, MRI and angiography, can often be paramount to confirming a diagnosis and the extent of the pathology. A possible link between Takayasu's Arteritis and gynaecological malignancies may exist.
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Affiliation(s)
- Mortimer B O'Connor
- The Department of Medicine, South Infirmary - Victoria University Hospital, Cork, Ireland.
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29
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Kanno H, Watabe D, Shimizu N, Sawai T. Adhesion of Epstein-Barr virus-positive natural killer cell lines to cultured endothelial cells stimulated with inflammatory cytokines. Clin Exp Immunol 2008; 151:519-27. [PMID: 18190605 DOI: 10.1111/j.1365-2249.2007.03584.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Chronic active Epstein-Barr virus (EBV) infection (CAEBV) is characterized by chronic recurrent infectious mononucleosis-like symptoms. Approximately one-fourth of CAEBV patients develop vascular lesions with infiltration of EBV-positive lymphoid cells. Furthermore, EBV-positive natural killer (NK)/T cell lymphomas often exhibit angiocentric or angiodestructive lesions. These suggest an affinity of EBV-positive NK/T cells to vascular components. In this study, we evaluated the expression of adhesion molecules and cytokines in EBV-positive NK lymphoma cell lines, SNK1 and SNK6, and examined the role of cytokines in the interaction between NK cell lines and endothelial cells. SNKs expressed intercellular adhesion molecule-1 (ICAM-1) and vascular cell adhesion molecule-1 (VCAM-1) at much higher levels than those in EBV-negative T cell lines. SNKs produced the larger amount of tumour necrosis factor (TNF)-alpha, which caused increased expression of ICAM-1 and VCAM-1 in cultured human endothelial cells, than that from EBV-negative T cell lines. Furthermore, SNKs exhibited increased adhesion to cultured endothelial cells stimulated with TNF-alpha or interleukin (IL)-1beta, and the pretreatment of cytokine-stimulated endothelial cells with anti-VCAM-1-antibodies reduced cell adhesion. These indicate that the up-regulated expression of VCAM-1 on cytokine-stimulated endothelial cells would be important for the adhesion of EBV-positive NK cells and might initiate the vascular lesions.
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Affiliation(s)
- H Kanno
- Department of Pathology, Iwate Medical University School of Medicine, Morioka, Japan.
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30
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Imashuku S. Systemic type Epstein-Barr virus-related lymphoproliferative diseases in children and young adults: challenges for pediatric hemato-oncologists and infectious disease specialists. Pediatr Hematol Oncol 2007; 24:563-8. [PMID: 18092246 DOI: 10.1080/08880010701640499] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Involvement of Epstein-Barr virus (EBV) has long been known in the development of various tumor-forming proliferating diseases, such as nasopharyngeal carcinoma in adults. However, in children and young adults more attention should be focused on systemic, severe type EBV-related diseases, such as fatal infectious mononucleosis, hemophagocytic syndrome, or chronic active EBV infection (CAEBV). These disorders show the typical clinical features of hemophagocytic lymphohistiocytosis (HLH). Although viral infectious diseases are mostly taken care of by infectious disease specialists, pediatric hemato-oncologists need to intervene in the treatment of this kind of disease because of their clonal and neoplastic disease characteristics and of their hematologically problematic, rapid, and life-threatening clinical courses.
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Affiliation(s)
- Shinsaku Imashuku
- Division of Pediatrics and Hematology, Takasago-seibu Hospital, Hyogo Prefecture, Japan.
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31
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Caldeira T, Meireles C, Cunha F, Valbuena C, Aparício J, Ribeiro A. Systemic polyarteritis nodosa associated with acute Epstein-Barr virus infection. Clin Rheumatol 2007; 26:1733-5. [PMID: 17205216 DOI: 10.1007/s10067-006-0486-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2006] [Revised: 10/30/2006] [Accepted: 11/07/2006] [Indexed: 10/23/2022]
Abstract
Polyarteritis nodosa (PAN) is a rare cause of systemic vasculitis in children, affecting medium and small-sized arteries. We report on a patient who presented with prolonged fever, shock, acute renal failure with nephrotic range proteinuria, hypertension, and sudden deterioration of consciousness. Cranial tomography revealed a left extensive hemorrhagic lesion. Renal biopsy revealed a large fibrinoid necrosis lesion consistent with PAN. Epstein-Barr virus (EBV) infection was confirmed by real-time polymerase chain reaction (RT-PCR) detection of EBV DNA. The patient was successfully treated with oral prednisolone and intravenous pulse of cyclophosphamide. To our knowledge, this is the first reported case of c-PAN related to active EBV infection.
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Affiliation(s)
- Teresa Caldeira
- Pediatric Intensive Care Unit, UAG-MC, Hospital S. João, Alameda Prof. Hernâni Monteiro, 4200 Porto, Portugal.
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32
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Yetkin E, Yetkin G, Turhan H. Aneurismal disease of different vascular territories: is it a rare association? Int J Cardiol 2006; 105:100-1. [PMID: 16207554 DOI: 10.1016/j.ijcard.2004.11.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2004] [Accepted: 11/12/2004] [Indexed: 11/25/2022]
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33
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Kim MJ, Lee JJ, Park KS, Kim SY, Kil HR. A Case of Chronic Active Epstein-Barr Virus Infection with Autoimmnune Hepatitis and a Coronary Aneurysm. THE KOREAN JOURNAL OF HEMATOLOGY 2006. [DOI: 10.5045/kjh.2006.41.4.311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Mi Jin Kim
- Department of Pediatrics, College of Medicine, Chungnam National University, Daejeon, Korea
| | - Ji Joung Lee
- Department of Pediatrics, College of Medicine, Chungnam National University, Daejeon, Korea
| | - Kyoung Soo Park
- Department of Pediatrics, College of Medicine, Chungnam National University, Daejeon, Korea
| | - Sun Young Kim
- Department of Pediatrics, College of Medicine, Chungnam National University, Daejeon, Korea
| | - Hong Ryang Kil
- Department of Pediatrics, College of Medicine, Chungnam National University, Daejeon, Korea
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34
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Kanno H, Onodera H, Endo M, Maeda F, Chida S, Akasaka T, Sawai T. Vascular lesion in a patient of chronic active Epstein-Barr virus infection with hypersensitivity to mosquito bites: vasculitis induced by mosquito bite with the infiltration of nonneoplastic Epstein-Barr virus-positive cells and subsequent development of natural killer/T-cell lymphoma with angiodestruction. Hum Pathol 2005; 36:212-8. [PMID: 15754300 DOI: 10.1016/j.humpath.2004.11.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
This report describes a vasculitis and subsequently developing angiodestructive lymphoma in an 11-year-old Japanese-Filipino girl exhibiting mosquito allergy with the background of chronic active Epstein-Barr virus (EBV) infection. She developed necrotic skin ulcer at the site of mosquito bite, and histopathological examination revealed EBV-positive mononuclear cell infiltration throughout the wall of small-sized muscular artery. These EBV-positive lymphoid cells were oligoclonal in Southern blot analysis for EBV terminal repeats. Effectiveness of steroid therapy also supports the nonneoplastic nature. Approximately 1 year later, she developed progressive large skin ulcer without mosquito bites. Microscopically, the angiocentric or angiodestructive pattern of EBV-positive atypical cells supported the diagnosis of extranodal natural killer/T-cell lymphoma. Southern blot analysis revealed the monoclonal neoplastic nature of EBV-positive cells. In contrast to the primary mosquito bite lesion, natural killer/T-cell lymphoma cells exhibited the higher expression of EBV latent membrane protein 1 mRNA and the apparent protein expression detected by immunohistochemistry.
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MESH Headings
- Animals
- Child
- Culicidae
- Epstein-Barr Virus Infections/immunology
- Epstein-Barr Virus Infections/pathology
- Female
- Herpesvirus 4, Human/genetics
- Herpesvirus 4, Human/isolation & purification
- Humans
- Immunohistochemistry
- Insect Bites and Stings/immunology
- Insect Bites and Stings/pathology
- Insect Bites and Stings/virology
- Killer Cells, Natural/immunology
- Lymphoma, T-Cell, Cutaneous/immunology
- Lymphoma, T-Cell, Cutaneous/pathology
- Necrosis
- RNA, Messenger/metabolism
- RNA, Viral/genetics
- Skin/blood supply
- Skin/pathology
- Vasculitis, Leukocytoclastic, Cutaneous/immunology
- Vasculitis, Leukocytoclastic, Cutaneous/pathology
- Viral Matrix Proteins/genetics
- Viral Matrix Proteins/metabolism
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Affiliation(s)
- Hiroyuki Kanno
- Department of Pathology, Iwate Medical University School of Medicine, Morioka 020-8505, Japan.
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Kumar Chauhan S, Kumar Tripathy N, Sinha N, Singh M, Nityanand S. Cellular and humoral immune responses to mycobacterial heat shock protein-65 and its human homologue in Takayasu's arteritis. Clin Exp Immunol 2005; 138:547-53. [PMID: 15544635 PMCID: PMC1809240 DOI: 10.1111/j.1365-2249.2004.02644.x] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Expression of heat shock protein (HSP)-65 as well as infiltration of T-cells in arterial lesions and raised levels of circulating antibodies against mycobacterial HSP65 (mHSP65) led us to the concept that mHSP65 or its human homologue (hHSP60) might be involved in the etiopathogenesis of Takayasu's arteritis (TA). Therefore, we investigated mHSP65 and hHSP60 reactive peripheral blood T-cell subsets by BrdU incorporation assay and flow cytometry as well as investigating the different isotypes of anti-mHSP65 and hHSP60 antibodies by ELISA. Eighty-four percent (22/26) of the TA patients were observed to show T-cell proliferation to mHSP65 and hHSP60 whereas only 16% (3/18) healthy controls showed such proliferation (P <0.001). Both HSPs induced proliferation of exclusively CD4+ T-cells and not CD8+ T-cells. We also observed a significantly higher prevalence of only the IgG isotype reactive to mHSP65 and hHSP60 in TA as compared to HC (mHSP65: 92% TA versus 11% HC, P <0.0001 and hHSP60: 84% versus 22%, P <0.001). Our data show a significant correlation between mHSP65 and hHSP60 reactive T-cells (CD3+: r=0.901; CD4+: r=0.968) as well as anti-mHSP65 and anti-hHSP60 IgG antibodies (r=0.814) suggesting an infection induced autoimmunity in TA, possibly induced by molecular mimicry between mHSP65 and hHSP60 or other tissue specific antigens.
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Affiliation(s)
- S Kumar Chauhan
- Department of Haematology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
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Gordon LK, Goldman M, Sandusky H, Ziv N, Hoffman GS, Goodglick T, Goodglick L. Identification of candidate microbial sequences from inflammatory lesion of giant cell arteritis. Clin Immunol 2004; 111:286-96. [PMID: 15183149 DOI: 10.1016/j.clim.2003.12.016] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2003] [Accepted: 12/31/2003] [Indexed: 10/26/2022]
Abstract
Giant cell arteritis (GCA) is a granulomatous inflammatory disease of medium and large arteries which is prevalent in the elderly population. The etiology of GCA is unknown, although the immunologic features suggest the possible presence of a microorganism. Our group has examined whether microbial DNA fragments were present at GCA lesions and whether such microbial fragments could be associated with disease pathogenesis. Initial identification of microbial sequences was performed using genomic representational difference analysis (RDA). Laser dissecting microscopy was used to isolate cells from GCA lesions and adjacent uninvolved temporal artery. Using genomic RDA, we isolated 10 gene fragments; three of these sequences had high homology with prokaryotic genes and were considered high-priority candidates for further study. An examination of serum from GCA(+) individuals (in contrast to healthy age-matched controls) showed the presence of IgG which recognized in vitro translated proteins from these clones.
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Affiliation(s)
- Lynn K Gordon
- Jules Stein Eye Institute, UCLA School of Medicine and the Greater Los Angeles Veterans Affairs Healthcare System, Los Angeles, CA 90095-1732, USA
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37
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Abstract
Recent clinical studies indicate that the number of microbial infections (the "pathogen burden") critically determines the development and progression of atherosclerotic disease. Viruses or bacteria with a specific tropism for cells of the vascular wall may contribute to the initial vascular injury via direct cytopathic effects or via the induction of genuine autoimmune responses. Immunopathological processes such as molecular mimicry, epitope spreading, or bystander activation of self-reactive lymphocytes most likely fuel the chronic inflammatory process in the vascular wall. Recognition of atherogenesis as a pathogen-driven, immunopathological process makes this disease amenable to new treatment strategies such as vaccination or immunomodulation.
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Affiliation(s)
- Burkhard Ludewig
- Research Departmrnt, Kantonal Hospital St. Gallen, 9007 St. Gallen, Switzerland.
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Affiliation(s)
- Gary S Hoffman
- Centrer for Vasculitis Care and Research, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
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Barton M, Melbourne R, Morais P, Christie C. Kawasaki syndrome associated with group A streptococcal and Epstein-Barr virus co-infections. ANNALS OF TROPICAL PAEDIATRICS 2002; 22:257-60. [PMID: 12369491 DOI: 10.1179/027249302125001543] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
We present a case of Kawasaki syndrome complicated by coronary aneurysm in a 6-year-old boy with laboratory evidence of group A streptococcal infection and infectious mononucleosis. The case demonstrates that evidence of acute infection in a patient with features suggestive of Kawasaki syndrome should not exclude a diagnosis of the latter. Immunoglobulin therapy should be considered seriously in highly suggestive cases, even if diagnostic criteria are not fulfilled.
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Affiliation(s)
- Michelle Barton
- Section of Child Health, University of the West Indies, Mona Campus, Mona, Kingston 7, Jamaica, West Indies.
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40
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Abstract
The occurrence, albeit infrequent, of systemic vasculitis in closely related family members suggests that both environmental and genetic factors may play a role in the pathogenesis of these diseases. Malfunction of immune regulation in the systemic vasculitides may indicate a role for genes that encode molecules critical to the immune responses. The extremely polymorphic sequences of MHC molecules may provide a structural basis for associations of MHC genes and systemic vasculitis. This review summarizes recent reports of MHC associations, mechanisms by which MHC may play a role in certain vasculitides, and also examines the role for genes encoding non-MHC molecules, such as Fcgamma receptors, cytokines and T cell co-stimulators. Data suggest that the pathogenesis of systemic vasculitides such as giant-cell arteritis, Takayasu's arteritis and Wegener's granulomatosis might be governed by multiple genes encoding host defence molecules, in conjunction with environmental factors.
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Affiliation(s)
- D Huang
- Lerner Research Institute, The Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
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41
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Dutz JP, Benoit L, Wang X, Demetrick DJ, Junker A, de Sa D, Tan R. Lymphocytic vasculitis in X-linked lymphoproliferative disease. Blood 2001; 97:95-100. [PMID: 11133747 DOI: 10.1182/blood.v97.1.95] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Systemic vasculitis is an uncommon manifestation of X-linked lymphoproliferative disease (XLP), a disorder in which there is a selective immune deficiency to Epstein-Barr virus (EBV). The molecular basis for XLP has recently been ascribed to mutations within SLAM-associated protein (SAP), an SH2 domain-containing protein expressed primarily in T cells. The authors describe a patient who died as a result of chronic systemic vasculitis and fulfilled clinical criteria for the diagnosis of XLP. Sequencing of this patient's SAP gene uncovered a novel point mutation affecting the SH2 domain. The patient presented with virus-associated hemophagocytic syndrome (VAHS) and later had chorioretinitis, bronchiectasis, and hypogammaglobulinemia develop. He further developed mononeuritis and fatal respiratory failure. Evidence of widespread small and medium vessel vasculitis was noted at autopsy with involvement of retinal, cerebral, and coronary arteries as well as the segmental vessels of the kidneys, testes, and pancreas. Immunohistochemical analysis using antibodies to CD20, CD45RO, and CD8 revealed that the vessel wall infiltrates consisted primarily of CD8(+) T cells, implying a cytotoxic T-lymphocyte response to antigen. EBV DNA was detected by polymerase chain reaction (PCR) in arterial wall tissue microdissected from infiltrated vessels further suggesting that the CD8(+) T cells were targeting EBV antigens within the endothelium. The authors propose that functional inactivation of the SAP protein can impair the immunologic response to EBV, resulting in systemic vasculitis.
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Affiliation(s)
- J P Dutz
- Departments of Medicine, Pathology & Laboratory Medicine and Pediatrics, University of British Columbia and British Columbia's Children's Hospital, British Columbia, Canada
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42
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Abstract
Within the past year information has accumulated on the role of infections in the pathogenesis of vasculitis. Superantigens play an important role in the stimulation of the immune system. Behçet's syndrome is a vasculitis that affects children as well as adults. Recently published childhood studies highlight the importance of family history and geographic differences in this disease. Familial Mediterranean fever is a genetic disease manifesting frequently in children. Studies on the function of the mutated protein pyrin in this disease are in progress. Some researchers have proposed that pyrin is an anti-inflammatory protein. Understanding its mode of action will help us understand more of the general inflammatory pathway.
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Affiliation(s)
- S Ozen
- Department of Pediatric Rheumatology and Nephrology, Hacettepe University Faculty of Medicine, Ankara, Turkey.
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43
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Abstract
Vascular inflammation stands at the center of innumerable physiological and pathological processes. Dissecting the mechanisms of successful vascular injury and repair, investigators provide information for scientists and clinicians. The neurologist benefits from studies across several disciplines. Details of the cellular functions in the infiltrates of temporal arteries impart a basis for rational therapy. The interactions of herpes virus with vessels wall remind us of the affinity of numerous infectious agents for the vasculature. Several animal models are enabling us to explore the genetic links in autoimmunity. Although clinical studies may not yet provide us with answers for accurate diagnosis and treatment of many of our patients, data from this year will keep our interest high.
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Affiliation(s)
- P M Moore
- Department of Neurology, University of Pittsburgh, Pennsylvania 15213, USA
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44
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Nikkari S, Relman DA. Molecular approaches for identification of infectious agents in Wegener's granulomatosis and other vasculitides. Curr Opin Rheumatol 1999; 11:11-6. [PMID: 9894625 DOI: 10.1097/00002281-199901000-00003] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The primary symptoms of many vasculitides resemble those of infectious diseases. Patients with Wegener's granulomatosis usually seek medical care for respiratory tract symptoms resembling those caused by infection or allergy. In addition, vasculitis is a well-documented manifestation of infection by some known microbial agents. There have been relatively few controlled studies, however, seeking to identify infectious agents as the triggering factors in systemic vasculitides. Molecular methods offer powerful approaches for the identification of infectious agents in diseases of previously unknown origin. These methods include broad-range amplification of microbial nucleic acid sequences and comparative or subtractive methods, such as differential display and representational difference analysis. Host gene expression profiles (using DNA-chip technology) may also provide clues as to the possible infectious cause of an idiopathic disease. Furthermore, the application of molecular methods may reveal pathologic mechanisms and novel therapeutic strategies for the vasculitides.
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Affiliation(s)
- S Nikkari
- VA Palo Alto Health Care System, CA 94304, USA
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