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Su S, Liang L, Lü L, Li M, Zhang X, Jin Y, Wei W, Wan Z. In-Depth Review of Loeffler Endocarditis: What Have We Learned? J Inflamm Res 2024; 17:1957-1969. [PMID: 38562658 PMCID: PMC10984210 DOI: 10.2147/jir.s458692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 03/19/2024] [Indexed: 04/04/2024] Open
Abstract
Loeffler endocarditis, eosinophilic endocarditis or eosinophilic endomyocardial disease are conditions associated with hypereosinophilia and they affect the heart function. Loeffler endocarditis is a rare endomyocardial disorder thought to be caused by eosinophilic damage. The disorder is characterized by inflammatory infiltration, formation of thrombus within cardiovascular system, and ultimately fibrosis of the afflicted area. It can lead to multiple severe complications, including thromboembolic disease, thickening of fibrous tissue in the endocardium of ventricles, valve involvement, apical obliteration, and various heart disorders. Although early clinical intervention can lead to remission, the underlying mechanisms of the disorder remain unresolved. In the present article, we summarise the existing literature concerning Loeffler endocarditis based on PubMed, Web of Science, and other medical databases to conduct an in-depth review of the epidemiology, etiology, pathophysiological mechanisms, staging, diagnosis, treatment and prognosis of Loeffler endocarditis. Meanwhile, we provide novel patients data and clinical figures of Loeffler endocarditis to supplement the understanding of this cardiac disorder. The findings presented in this article provide a basis for further studies and can be used to improve management of the disorder.
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Affiliation(s)
- Shitong Su
- Department of Emergency Medicine, West China Hospital, Sichuan University, Chengdu, 610041, People’s Republic of China
- Division of Head & Neck Tumor Multimodality Treatment, Cancer Center, West China Hospital, Sichuan University, Chengdu, 610041, People’s Republic of China
| | - Lianjing Liang
- Department of Emergency Medicine, West China Hospital, Sichuan University, Chengdu, 610041, People’s Republic of China
| | - Lin Lü
- Department of Emergency Medicine, West China Hospital, Sichuan University, Chengdu, 610041, People’s Republic of China
| | - Mingfeng Li
- Department of Pathology, West China Hospital, Sichuan University, Chengdu, 610041, People’s Republic of China
| | - Xiaoling Zhang
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, 610041, People’s Republic of China
| | - Yongmei Jin
- Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu, 610041, People’s Republic of China
| | - Wei Wei
- Department of Emergency Medicine, West China Hospital, Sichuan University, Chengdu, 610041, People’s Republic of China
| | - Zhi Wan
- Rare Diseases Center, West China Hospital, Sichuan University, Chengdu, 610041, People’s Republic of China
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Elbahoty M, Elnaggar S, Soror N, Elkeraie A, Youssef A. Co-occurrence of Idiopathic Hypereosinophilic Syndrome in End-Stage Renal Disease Patients Undergoing Maintenance Hemodialysis. Cureus 2024; 16:e53758. [PMID: 38465088 PMCID: PMC10921820 DOI: 10.7759/cureus.53758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2024] [Indexed: 03/12/2024] Open
Abstract
Hypereosinophilic syndrome (HES) is defined as the presence of (1) peripheral blood eosinophilia >1.5 x 109/L for at least one month, (2) evidence of eosinophil-mediated organ damage and/or dysfunction, and (3) exclusion of other potential causes of eosinophilia. In hemodialysis patients, HES has been associated with manifestations because of low blood pressure or gastrointestinal symptoms that result in dialysis intolerance. Very few cases of HES co-occurrence in dialysis patients have been reported in the literature, and their clinical characteristics are not fully understood. Here, we report two end-stage renal disease patients diagnosed with idiopathic HES while undergoing maintenance hemodialysis. The first patient presented with unexplained persistent pruritus and intradialytic hypotension, which started 10 minutes after the dialysis session initiation. Hematologic studies revealed hypereosinophilia which remarkably improved on steroid therapy. The second patient was accidentally discovered with asymptomatic persistent hypereosinophilia. His blood counts improved initially on interferon treatment before achieving full remission on steroid therapy. Neither of the two patients reported any history of allergy or atopic manifestations. Our case report sheds light on the possible occurrence of HES in hemodialysis patients which may be confused with other dialysis-related complications. Although steroids remain the mainstay of treatment, the optimal dose and duration of treatment remain unknown.
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Affiliation(s)
- Mohamed Elbahoty
- Department of Pathology, University of Alabama at Birmingham, Birmingham, USA
- Department of Internal Medicine, Hematology Unit, Faculty of Medicine, Alexandria University, Alexandria, EGY
| | - Sherine Elnaggar
- Nephrology and Hemodialysis Unit, Alexandria University Hospitals, Alexandria, EGY
| | - Nooran Soror
- Department of Internal Medicine, Hematology Unit, Faculty of Medicine, Alexandria University, Alexandria, EGY
| | - Ahmed Elkeraie
- Department of Internal Medicine, Nephrology and Hemodialysis Unit, Faculty of Medicine, Alexandria University, Alexandria, EGY
| | - Ayman Youssef
- Anesthesiology and Critical Care, Duke University Medical Center, Durham, USA
- Department of Internal Medicine, Hematology Unit, Faculty of Medicine, Alexandria University, Alexandria, EGY
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Ivănescu AC, Petre A, Marincaș AS, Bădilă E, Dan GA. The portrait of a stranger: the hypereosinophilic syndrome with cardiac involvement. ROMANIAN JOURNAL OF INTERNAL MEDICINE = REVUE ROUMAINE DE MEDECINE INTERNE 2023; 61:222-227. [PMID: 37493620 DOI: 10.2478/rjim-2023-0016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Indexed: 07/27/2023]
Abstract
INTRODUCTION Hypereosinophilic syndrome is a rare clinical condition, and cardiac involvement confers a poor prognosis. Hypereosinophilic myocarditis is a medical emergency and targeted treatment should be started promptly even before a definitive diagnosis could be made. CASE PRESENTATION A 27-year-old female patient is hospitalized for exertional dyspnea, chest pain, and fatigue for the past 2 weeks. She also describes left leg paresthesias. Clinical examination was in normal limits. ECG showed sinus tachycardia, QS pattern in V1-V4, and diffuse flattened T waves. Laboratory tests revealed increased inflammatory markers, hypereosinophilia, elevated cardiac enzymes, high NT-proBNP. Echocardiography revealed LV dysfunction (EF 31%), while cardiac MRI showed diffuse delayed enhancement with predominant subendocardial disposition. The electromyogram was suggestive of left tibial nerve neuropathy. We interpreted the case as eosinophilic myocarditis with an urgent requirement of therapy and initiated high-dose glucocorticoid therapy and the GDMT 4-pillar heart failure treatment. We excluded common infectious, myeloproliferative syndromes, and frequent associated autoimmune diseases. With prednisone, the eosinophil count rapidly normalized and we gradually tapered the dose by 5 mg per week, however continuing with heart failure therapy. At monthly follow-up visits, there was a significant clinical improvement, with normalization of the eosinophilic count, and a near-normalization of myocardial function. The only symptom that persisted was paresthesias linked to left tibial neuropathy. CONCLUSION The surprisingly rapid and favorable course of the disease offers a high index of suspicion for a toxic or a reactive transitory etiology, however still unidentified. In our case, the cause of eosinophilia remained unknown, although we managed to narrow down the possible etiologies. A surprisingly good clinical response was obtained with non-specific treatment targeting mainly hyperosinophilic myocarditis.
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Affiliation(s)
- Andreea-Cristina Ivănescu
- 1"Carol Davila" University of Medicine, Bucharest, Romania
- 2Colentina University Hospital, Bucharest, Romania
| | | | | | - Elisabeta Bădilă
- 1"Carol Davila" University of Medicine, Bucharest, Romania
- 2Colentina University Hospital, Bucharest, Romania
| | - Gheorghe-Andrei Dan
- 1"Carol Davila" University of Medicine, Bucharest, Romania
- 2Colentina University Hospital, Bucharest, Romania
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Pichler WJ, Thoo L, Yerly D. Drug hypersensitivity and eosinophilia: The decisive role of p-i stimulation. Allergy 2023; 78:2596-2605. [PMID: 37395496 DOI: 10.1111/all.15795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 05/31/2023] [Accepted: 06/16/2023] [Indexed: 07/04/2023]
Abstract
Eosinophilia is a common finding in drug hypersensitivity reactions (DHR). Its cause is unclear, as neither antigen/allergen-driven inflammation nor clonal expansion is involved. Most delayed-DHRs are due to p-i (pharmacologic interaction of drugs with immune receptors). These are off-target activities of drugs with immune receptors that result in various types of T-cell stimulation, some of which involve excessive IL-5 production. Functional and phenotypic studies of T-cell clones and their TCR-transfected hybridoma cell lines revealed that some p-i-induced drug stimulations occur without CD4/ CD8 co-receptor engagement. The CD4/CD8 co-receptors link Lck (lymphocyte-specific protein tyrosine kinase) and LAT (linker for activation of T cells) to the TCR. Alteration of Lck or LAT can result in a TCR signalosome with enhanced IL-5 production. Thus, if a more affine TCR-[drug/peptide/HLA] interaction allows bypassing the CD4 co-receptor, a modified Lck/LAT activation may lead to a TCR signalosome with elevated IL-5 production. This "IL-5-TCR-signalosome" hypothesis could also explain eosinophilia in superantigen or allo-stimulation (graft-versus-host disease), in which evasion of CD4/CD8 co-receptors has also been described. It may open new therapeutic possibilities in certain eosinophilic diseases by directly targeting the IL-5-TCR signalosome.
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Subki AH, Bokhary MI, Alandijani SA, Aljehani MA, Alharbi AW, Alzahrani M, Almuhammadi SS, Albeirouti BT, Abduljabar MA, Danese S. Resolved Hypereosinophilic Syndrome and Immune Thrombocytopenic Purpura in Ulcerative Colitis Patients Post Colectomy: A Case Series and Literature Review. J Inflamm Res 2022; 15:6373-6380. [DOI: 10.2147/jir.s365094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 11/03/2022] [Indexed: 11/22/2022] Open
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Si J, Zhang X, Chen N, Sun F, Du P, Li Z, Tian D, Sun X, Sun G, Cong T, Du X, Liu Y. Case Report: Multimodal Imaging Guides the Management of an Eosinophilic Leukemia Patient With Eosinophilic Myocarditis and Intracardiac Thrombus. Front Cardiovasc Med 2022; 9:903323. [PMID: 35722086 PMCID: PMC9204136 DOI: 10.3389/fcvm.2022.903323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 05/17/2022] [Indexed: 11/23/2022] Open
Abstract
Background Eosinophilic leukemia (EL) is a rare, serious and potentially life-threatening condition characterized by the overproduction of eosinophils leading to tissue eosinophilic infiltration and damage. Although multiple organ systems may be involved, progressive eosinophilic myocarditis (EM) is the most common cause of morbidity and mortality. Early diagnosis and follow-up surveillance combined with multimodal imaging are crucial for appropriate treatment of EM. Case Summary It’s a rare case of EL with EM and intracardiac thrombus in a 59-year-old patient who presented with asthenia for 3 weeks. Full blood count analysis indicated significant eosinophilia. Bone marrow aspirate revealed dysplastic eosinophilia and a FIP1L1-PDGFRA fusion gene (4q12) was detected, confirming EL. Echocardiography revealed EM with intracardiac thrombus. This was later confirmed by cardiac magnetic resonance imaging. The patient was commenced on imatinib and prednisolone and good clinical response was obtained. Through 18F-FAPI PET/CT imaging, we obtained in vivo visualization of fibroblast activation changes in the early stage of cardiac structure remodeling. With anti-fibrotic therapy after heart failure, the patient achieved a good clinical response. Conclusion This case demonstrates in vivo visualization of fibroblast activation after EM. Multimodality imaging can provide early diagnosis and may guide tailored antifibrotic therapy in early stage of EM.
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Affiliation(s)
- Jinping Si
- Department of Cardiology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Xinxin Zhang
- Department of Cardiology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Na Chen
- Department of Cardiology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Fangfang Sun
- Department of Nuclear Medicine, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Ping Du
- Department of Cardiology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Zhiyong Li
- Department of Radiology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Di Tian
- Department of Radiology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Xiuli Sun
- Department of Hematology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Guozhen Sun
- Department of Hematology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Tao Cong
- Department of Ultrasonography, First Affiliated Hospital of Dalian Medical University, Dalian, China
- *Correspondence: Tao Cong,
| | - Xuemei Du
- Department of Nuclear Medicine, First Affiliated Hospital of Dalian Medical University, Dalian, China
- Xuemei Du,
| | - Ying Liu
- Department of Cardiology, First Affiliated Hospital of Dalian Medical University, Dalian, China
- Ying Liu,
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Cardiomyopathies. Cardiovasc Pathol 2022. [DOI: 10.1016/b978-0-12-822224-9.00014-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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8
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Leiva O, Baker O, Jenkins A, Brunner AM, Al-Samkari H, Leaf RK, Rosovsky RP, Fathi AT, Weitzman J, Bornikova L, Nardi V, Hobbs GS. Association of Thrombosis With Hypereosinophilic Syndrome in Patients With Genetic Alterations. JAMA Netw Open 2021; 4:e2119812. [PMID: 34357393 PMCID: PMC8346937 DOI: 10.1001/jamanetworkopen.2021.19812] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
IMPORTANCE Hypereosinophilic syndromes (HESs) are a rare group of disorders that result in overproduction of eosinophils, leading to tissue damage. Thrombotic complications in HES and associated risk factors in this patient population have not been extensively studied. OBJECTIVE To investigate the rates of and risk factors associated with thrombotic events in patients with HES, including markers of clonal hematopoiesis as evidenced by molecular aberrations on next-generation sequencing. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study evaluated patients seen at Brigham and Women's Hospital and Harvard Medical School in Boston, Massachusetts, from January 1, 2015, to January 1, 2020. Patients who had hypereosinophilia with an absolute eosinophil count of 1500 cells/μL or greater on 2 separate occasions at least 1 month apart and who underwent genetic or molecular testing as part of their work-up were included. Patients with secondary eosinophilia were excluded. MAIN OUTCOMES AND MEASURES Symptomatic and asymptomatic arterial and venous thrombotic events after the diagnosis of HES and all-cause death. RESULTS A total of 71 patients (median age, 58 years [interquartile range (IQR), 43-67 years]; 36 women [51%]; 57 White patients [80%]) were included. Patients had a median follow-up time of 29 months (IQR, 19-49 months). Seventeen patients (24%) had 1 or more thrombotic events, including 11 venous thromboembolic events and 11 arterial thrombotic events (8 patients had ≥1 event and 3 patients had recurrent events). Patients with 1 or more thrombotic events had a higher median Eastern Cooperative Oncology Group performance status (median, 1 [IQR, 1-2] vs 0 [IQR, 0-1]; P = .002), had more frequent cardiac involvement (7 of 17 events [41%] vs 6 of 54 events [11%]; P = .01), more frequently received treatment (17 of 17 events [100%] vs 40 of 54 events [74%]; P = .02), and had more molecular aberrations on next-generation sequencing (12 of 17 [71%] vs 12 of 54 [26%]; P = .003) vs patients without thrombosis. After multivariable analysis, the presence of molecular aberration was associated with increased odds of thrombosis (adjusted odds ratio, 5.4; 95% CI, 1.1-27.7). Death occurred more frequently in patients with thrombotic events compared with those without (6 of 17 [35%] vs 2 of 54 [4%]; P = .002) and in patients with molecular aberrations compared with those without (6 of 24 [25%] vs 1 of 40 [3%]; P = .009), although only thrombotic events were significantly associated with increased odds of death after multivariable analysis. CONCLUSIONS AND RELEVANCE In this cohort study, thrombosis was common in patients with HES and was significantly associated with increased risk of death.
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Affiliation(s)
- Orly Leiva
- Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Olesya Baker
- Center for Clinical Investigation, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Andrew Jenkins
- Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Andrew M. Brunner
- Division of Hematology Oncology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston
| | - Hanny Al-Samkari
- Division of Hematology Oncology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston
| | - Rebecca Karp Leaf
- Division of Hematology Oncology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston
| | - Rachel P. Rosovsky
- Division of Hematology Oncology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston
| | - Amir T. Fathi
- Division of Hematology Oncology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston
| | - James Weitzman
- Division of Hematology Oncology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston
| | - Larissa Bornikova
- Division of Hematology Oncology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston
| | - Valentina Nardi
- Division of Hematology Oncology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston
| | - Gabriela S. Hobbs
- Division of Hematology Oncology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston
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Kastin D, Siegel M, Anderson R, Aronsohn A. IgG 4 Autoimmune Hepatitis Presenting as Idiopathic Hypereosinophilia Syndrome. Hepatology 2021; 73:1615-1617. [PMID: 32745283 DOI: 10.1002/hep.31492] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 07/10/2020] [Accepted: 07/19/2020] [Indexed: 12/14/2022]
Affiliation(s)
- Darren Kastin
- Division of Gastroenterology and Hepatology, Edward Hospital, Naperville, IL
| | - Matthew Siegel
- Division of Hematology and Oncology, Edward Hospital, Naperville, IL
| | | | - Andrew Aronsohn
- Section of Gastroenterology, Hepatology and Nutrition, University of Chicago, Chicago, IL
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Mutsuyoshi Y, Hirai K, Morino J, Kaneko S, Minato S, Yanai K, Ishii H, Matsuyama M, Kitano T, Aomatsu A, Miyazawa H, Ito K, Ueda Y, Ookawara S, Morishita Y. Idiopathic hypereosinophilic syndrome in hemodialysis patients: Case reports. Medicine (Baltimore) 2021; 100:e25164. [PMID: 33725918 PMCID: PMC7969317 DOI: 10.1097/md.0000000000025164] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 02/25/2021] [Indexed: 01/05/2023] Open
Abstract
RATIONALE Herein, we report 3 hemodialysis patients with idiopathic hypereosinophilic syndrome who were successfully treated using corticosteroid therapy. PATIENT CONCERNS Case 1 was a 63-year-old man who was undergoing hemodialysis because of bilateral nephrectomy and developed hypereosinophilia with digestive symptoms, myocardial injury, and intradialytic hypotension. Case 2 was an 83-year-old man who was undergoing hemodialysis because of nephrosclerosis and developed hypereosinophilia with pruritus, myocardial injury, and intradialytic hypotension. Case 3 was a 59-year-old man who was undergoing hemodialysis because of diabetic nephropathy and developed hypereosinophilia with pruritus, myocardial injury, and intradialytic hypotension. DIAGNOSES All 3 patients presented with hypereosinophilia (eosinophil count ≥1500 /μL for more than 1 month) and multiple-organ involvement (intradialytic hypotension, cardiac injury, digestive symptoms, and allergic dermatitis). A specific cause for the hypereosinophilia was not identified by systemic computed tomography, electrocardiography, echocardiography, bone marrow examination, or blood tests. Furthermore, Case 2 and 3 had not recently started taking any new drugs and drug-induced lymphocyte stimulation tests were negative in Case 1. Therefore, they were diagnosed with idiopathic hypereosinophilic syndrome. INTERVENTIONS All 3 patients received corticosteroid therapy with prednisolone at a dose of 40 mg/d, 30 mg/d, and 60 mg/d in Case 1, 2, and 3, respectively. OUTCOMES Their digestive symptoms, pruritus, intradialytic hypotension, and serum troponin I concentrations were immediately improved alongside reductions in their eosinophil counts. LESSONS There have been few case reports of idiopathic hypereosinophilic syndrome in patients undergoing hemodialysis. We believe that recording of the clinical findings and treatments of such patients is mandatory to establish the optimal management of idiopathic hypereosinophilic syndrome.
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Hwang JW, Kim H, Cho SW, Shin YC, Kim HS, Cho YJ, Kwak JJ. Idiopathic hypereosinophilic syndrome with intracardiac atypical linear-shaped and floating thrombus presenting as embolic cerebral infarction. J Cardiol Cases 2020; 23:193-197. [PMID: 33995694 DOI: 10.1016/j.jccase.2020.10.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 09/17/2020] [Accepted: 10/10/2020] [Indexed: 11/30/2022] Open
Abstract
Knowledge of the multi-organ involvement in hypereosinophilic syndrome (HES) is important for the diagnosis and care of patients with this condition, even in cases with atypical presentation. This report aims to describe cerebral embolic infarction and intracardiac atypical linear-shaped thrombus in a patient with idiopathic HES and to discuss the approach of appropriate diagnosis and timely interventional management. A 55-year-old man presented with general weakness, including left-sided weakness, mild cognitive dysfunction, and mild exertional dyspnea for about 2 weeks. Initial magnetic resonance imaging for evaluating the brain showed multifocal acute to subacute infarction of both cerebral hemispheres and both cerebellums. Laboratory findings revealed leukocytosis (25,620 cells/mm3) and eosinophilia (54.9%). To evaluate the intracardiac embolic source, the patient underwent echocardiography, and a 1.5 cm linear thread-like and mobile mass was detected. Consequently, the patient was diagnosed with idiopathic HES. After bone marrow biopsy, corticosteroid and hydroxyurea were administered to control the eosinophilia. This case indicates that HES can present as a floating intracardiac atypical linear-shaped thrombus attached to the left ventricle. After appropriate diagnostic approaches, proper treatment could be given for the patient. <Learning objective: Idiopathic hypereosinophilic syndrome (HES) is a disorder characterized by persistent eosinophilia with heterogeneous clinical manifestations. Knowledge of the multi-organ involvement in HES is important for the diagnosis and care of patients with this condition, even in cases with atypical shaped thrombus as clinical presentation. Close monitoring combined with early treatment and diagnosis may help reduce mortality in HES patients.>.
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Affiliation(s)
- Ji-Won Hwang
- Division of Cardiology, Department of Medicine, Ilsan Paik Hospital, Inje University School of Medicine, Goyang, 10380 Republic of Korea
| | - Hakju Kim
- Department of Thoracic and Cardiovascular Surgery, Ilsan Paik Hospital, Inje University School of Medicine, Goyang, Republic of Korea
| | - Sung Woo Cho
- Division of Cardiology, Department of Medicine, Ilsan Paik Hospital, Inje University School of Medicine, Goyang, 10380 Republic of Korea
| | - Yoon Cheol Shin
- Department of Thoracic and Cardiovascular Surgery, Ilsan Paik Hospital, Inje University School of Medicine, Goyang, Republic of Korea
| | - Hye Sook Kim
- Division of Hemato-oncology, Department of Medicine, Ilsan Paik Hospital, Inje University School of Medicine, Goyang, Republic of Korea
| | - Yong-Jin Cho
- Department of Neurology, Ilsan Paik Hospital, Inje University School of Medicine, Goyang, Republic of Korea
| | - Jae-Jin Kwak
- Division of Cardiology, Department of Medicine, Ilsan Paik Hospital, Inje University School of Medicine, Goyang, 10380 Republic of Korea
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Pallesen KAU, Herlin T, Holm M, Høst C, Christiansen M, Ramsing M, Rasmussen MK, Sommerlund M. Idiopathic hypereosinophilic syndrome: A rare diagnosis in children. Clin Case Rep 2020; 8:2013-2016. [PMID: 33088541 PMCID: PMC7563636 DOI: 10.1002/ccr3.3165] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 05/24/2020] [Accepted: 05/28/2020] [Indexed: 11/10/2022] Open
Abstract
Idiopathic hypereosinophilic syndrome (IHES) is one of numerous hypereosinophilic syndromes. The incidence of IHES among children is unknown, but it is considered a rare disease. We report a pediatric case of IHES and the challenges to finding an effective treatment. The patient described here was responsive to prednisolone and thalidomide.
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Affiliation(s)
| | - Troels Herlin
- Department of Paediatrics Aarhus University Hospital Aarhus N Denmark
| | - Mette Holm
- Department of Paediatrics Aarhus University Hospital Aarhus N Denmark
| | - Christian Høst
- Department of Paediatrics Aarhus University Hospital Aarhus N Denmark
| | - Mette Christiansen
- Department of Molecular Medicine Aarhus University Hospital Aarhus N Denmark
| | - Mette Ramsing
- Department of Pathology Regionshospitalet Randers Randers Denmark
| | | | - Mette Sommerlund
- Department of Dermatology Aarhus University Hospital Aarhus N Denmark
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13
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Takeda M, Ueki S, Yamamoto Y, Nara M, Fukuchi M, Nakayama K, Omori Y, Takahashi N, Hirokawa M. Hypereosinophilic syndrome with abundant Charcot-Leyden crystals in spleen and lymph nodes. Asia Pac Allergy 2020; 10:e24. [PMID: 32789109 PMCID: PMC7402945 DOI: 10.5415/apallergy.2020.10.e24] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Accepted: 07/03/2020] [Indexed: 12/31/2022] Open
Abstract
Hypereosinophilic syndrome, which is characterized by eosinophilia in the peripheral blood, often causes various organ disorders. Charcot-Leyden crystals are recognized features of various diseases, such as parasite infection and asthma, and are known to be classic hallmarks of eosinophilic inflammation. Our recent study revealed the mechanism of Charcot-Leyden crystal formation (i.e., galectin-10 crystallization), namely the involvement of eosinophil extracellular trap cell death, a nonapoptotic cell death. Here we report an autopsy case of a 57-year-old man who had died of hypereosinophilic syndrome. We found numerous eosinophil extracellular trap cell death-associated Charcot-Leyden crystals in the spleen and lymph nodes. Observation of abdominal lymph nodes by electron microscopy revealed eosinophil extracellular traps and free extracellular granules, which are characteristic of typical eosinophil extracellular trap cell death. In this case, we observed various sizes of Charcot-Leyden crystals that were stained with anti-galectin-10 immunofluorescent staining. Further studies are required to understand the pathophysiological roles of Charcot-Leyden crystals and these may lead to the development of novel therapeutic modalities for severe eosinophilic inflammation.
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Affiliation(s)
- Masahide Takeda
- Department of Respiratory Medicine, Akita University Graduate School of Medicine, Akita, Japan
| | - Shigeharu Ueki
- Department of General Internal Medicine and Clinical Laboratory Medicine, Akita University Graduate School of Medicine, Akita, Japan
| | - Yohei Yamamoto
- Department of Molecular Pathology and Tumor Pathology, Akita University Graduate School of Medicine, Akita, Japan
| | - Miho Nara
- Department of Hematology, Nephrology, and Rheumatology, Akita University Graduate School of Medicine, Akita, Japan
| | - Mineyo Fukuchi
- Department of General Internal Medicine and Clinical Laboratory Medicine, Akita University Graduate School of Medicine, Akita, Japan
| | - Katsutoshi Nakayama
- Department of Respiratory Medicine, Akita University Graduate School of Medicine, Akita, Japan
| | - Yasufumi Omori
- Department of Molecular Pathology and Tumor Pathology, Akita University Graduate School of Medicine, Akita, Japan
| | - Naoto Takahashi
- Department of Hematology, Nephrology, and Rheumatology, Akita University Graduate School of Medicine, Akita, Japan
| | - Makoto Hirokawa
- Department of General Internal Medicine and Clinical Laboratory Medicine, Akita University Graduate School of Medicine, Akita, Japan
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14
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Abstract
Loeffler's endocarditis and hypereosinophilic syndromes are a unique group of infiltrative disorders characterized by hypereosinophilia, inflammatory thrombotic, and ultimately, fibrotic involvement of the heart leading to multiple complications including valve involvement, thromboembolic phenomena, heart failure. Clinical recognition, comprehensive laboratory and multimodality imaging diagnostic workup, and early initiation of treatment have been shown to slow down the progression and promote remission. This review addresses a detailed analysis of Loeffler's endocarditis and hypereosinophilic syndromes.
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15
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Ishii K, Mizuuchi T, Yamamoto Y, Mori H, Tago M, Kato E, Hayashi H, Tahara K, Sawada T. Development of Eosinophilic Temporal Arteritis and Digital Ischemia in a Patient with Hypereosinophilic Syndrome. Intern Med 2020; 59:1323-1330. [PMID: 32101832 PMCID: PMC7303445 DOI: 10.2169/internalmedicine.3707-19] [Citation(s) in RCA: 4] [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: 12/22/2022] Open
Abstract
We describe a case of eosinophilic temporal arteritis in a 61-year-old woman with hypereosinophilic syndrome, who developed subcutaneous nodules in the temporal areas and digital cyanosis with small nodules on the sides of her fingers. Ultrasound revealed occlusion and corkscrew-like changes of the temporal and digital arteries, respectively. Temporal artery biopsy revealed eosinophilic vasculitis without giant cell formation. Angiography showed occlusion of the ulnar and digital arteries. Administration of low-dose corticosteroid improved the temporal artery swelling and digital cyanosis. More reports of similar cases are required to characterize this type of non-giant cell eosinophilic vasculitis that affects the peripheral arteries.
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Affiliation(s)
- Kayo Ishii
- Department of Rheumatology, Tokyo Medical University Hospital, Japan
| | - Takahiro Mizuuchi
- Department of Rheumatology, Tokyo Medical University Hospital, Japan
| | - Yusuke Yamamoto
- Department of Rheumatology, Tokyo Medical University Hospital, Japan
| | - Hiroaki Mori
- Department of Rheumatology, Tokyo Medical University Hospital, Japan
| | - Mayu Tago
- Department of Rheumatology, Tokyo Medical University Hospital, Japan
| | - Eri Kato
- Department of Rheumatology, Tokyo Medical University Hospital, Japan
| | - Haeru Hayashi
- Department of Rheumatology, Tokyo Medical University Hospital, Japan
| | - Koichiro Tahara
- Department of Rheumatology, Tokyo Medical University Hospital, Japan
| | - Tetsuji Sawada
- Department of Rheumatology, Tokyo Medical University Hospital, Japan
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16
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Cook JR, Rogers HJ, Chandra PK, Prescott JL, Mukherjee S. Myeloid neoplasm with eosinophilia and ETV6-JAK2 fusion. Leuk Lymphoma 2020; 61:213-216. [PMID: 31482743 DOI: 10.1080/10428194.2019.1658105] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 08/04/2019] [Accepted: 08/16/2019] [Indexed: 02/06/2023]
Affiliation(s)
- James R Cook
- Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Heesun J Rogers
- Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH, USA
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17
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Amano E, Horino T, Ichii O, Inotani S, Matsumoto T, Hamada-Ode K, Shimamura Y, Inoue K, Terada Y. Hypereosinophilic syndrome manifested as eosinophilic gastroenteritis and colitis in a patient undergoing hemodialysis. RENAL REPLACEMENT THERAPY 2018. [DOI: 10.1186/s41100-018-0179-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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18
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Hanbali A, Shaheen M, Alfraih F, Al-Otaibi W, El Fakih R, Owaidah T, Ahmed S. A case of T-cell lymphoproliferative disorder associated with hypereosinophilia with excellent response to mycophenolate mofetil. Hematol Oncol Stem Cell Ther 2018; 11:241-244. [DOI: 10.1016/j.hemonc.2016.11.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2016] [Revised: 10/17/2016] [Accepted: 11/14/2016] [Indexed: 11/30/2022] Open
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19
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Socola F, Hawes V, Lobo RH, Sasapu A. Imatinib-Associated Tumor Lysis Syndrome in a Patient With Myeloid Neoplasm With Eosinophilia and PDGFRA Rearrangement: A Case Report and Review of the Literature. J Glob Oncol 2018; 4:1-4. [PMID: 30241197 PMCID: PMC6180791 DOI: 10.1200/jgo.2016.007716] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Francisco Socola
- All authors: University of Arkansas for Medical Sciences, Little Rock, AR
| | - Veronica Hawes
- All authors: University of Arkansas for Medical Sciences, Little Rock, AR
| | | | - Appalanaidu Sasapu
- All authors: University of Arkansas for Medical Sciences, Little Rock, AR
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20
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Sreedharanunni S, Varma N, Sachdeva MUS, Naseem S, Malhotra P, Bansal D, Trehan A, Varma S. The Spectrum of Hypereosinophilia and Associated Clonal Disorders - A Real-World Data Based on Combined Retrospective and Prospective Analysis from a Tropical Setting. Mediterr J Hematol Infect Dis 2018; 10:e2018052. [PMID: 30210745 PMCID: PMC6131107 DOI: 10.4084/mjhid.2018.052] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Accepted: 07/20/2018] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVE To determine the frequency, etiological spectrum and treatment outcome of hypereosinophilia (HE) and hypereosinophilic syndromes (HES) in a tropical setting. METHODS A retrospective analysis of hospital data of five years (January 2009 to December 2013) and a comprehensive prospective evaluation of patients presenting with HE/HES over a period of 33 months (January 2014 to September 2016) was performed. RESULTS HE/HES was diagnosed in a total of 125 patients during the study period with an estimated prevalence of 0.5-1 case per 100,000 population in our hospital settings. 41 patients were excluded from the final analysis due to lack of sufficient data. Infections, especially helminths were the commonest cause (34%) followed by primary/clonal HE/HES (24%) and reactive HE/HES secondary to various clonal disorders (14.3%). A lymphocytic variant of HES and FIP1L1-PDGFRA positive HES were diagnosed in 3.6% each. Imatinib-responsive BCR-ABL1 negative HE/HES constitute 7.1% in our patients. None of the clinical or routine laboratory features including the age of patients, duration of HE, presence or absence of organomegaly, hemoglobin levels, eosinophil %, absolute eosinophil count, total leukocyte count, platelet counts, serum IgE levels or presence of myelofibrosis could predict or exclude malignancy in patients with HE/HES. The absence of blasts in peripheral blood or the absence of >5% blasts in bone marrow does not exclude primary/clonal HES. CONCLUSIONS An underlying malignancy (Primary HE/HES and neoplasms leading to reactive HES; 35.7%) is diagnosed with nearly equal frequency compared to infections (34.5%) in tropical settings. There are no hematological or serological parameters, which can reliably be used to exclude an underlying malignancy, necessitating a thorough follow-up and comprehensive work-up in patients with HE/HES.
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Affiliation(s)
- Sreejesh Sreedharanunni
- Department of Hematology, Postgraduate Institute of Medical Education and Research, Chandigarh, India - 160012
| | - Neelam Varma
- Department of Hematology, Postgraduate Institute of Medical Education and Research, Chandigarh, India - 160012
| | - Man Updesh Singh Sachdeva
- Department of Hematology, Postgraduate Institute of Medical Education and Research, Chandigarh, India - 160012
| | - Shano Naseem
- Department of Hematology, Postgraduate Institute of Medical Education and Research, Chandigarh, India - 160012
| | - Pankaj Malhotra
- Internal Medicine (Clinical Hematology), Postgraduate Institute of Medical Education and Research, Chandigarh, India -160012
| | - Deepak Bansal
- Pediatrics (Hematology/oncology unit), Postgraduate Institute of Medical Education and Research, Chandigarh, India -160012
| | - Amita Trehan
- Pediatrics (Hematology/oncology unit), Postgraduate Institute of Medical Education and Research, Chandigarh, India -160012
| | - Subhash Varma
- Internal Medicine (Clinical Hematology), Postgraduate Institute of Medical Education and Research, Chandigarh, India -160012
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21
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Persistent blood eosinophilia and eosinophil activation marker in a severe case of eosinophilic gastroenteritis associated with multiple food allergies. REV ROMANA MED LAB 2018. [DOI: 10.2478/rrlm-2018-0026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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22
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Eamudomkarn C, Sithithaworn P, Kamamia C, Yakovleva A, Sithithaworn J, Kaewkes S, Techasen A, Loilome W, Yongvanit P, Wangboon C, Saichua P, Itoh M, M. Bethony J. Diagnostic performance of urinary IgG antibody detection: A novel approach for population screening of strongyloidiasis. PLoS One 2018; 13:e0192598. [PMID: 29985913 PMCID: PMC6037348 DOI: 10.1371/journal.pone.0192598] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Accepted: 05/25/2018] [Indexed: 11/18/2022] Open
Abstract
The diagnosis of strongyloidiasis by coprological methods has a low sensitivity, underestimating the prevalence of Strongyloides stercoralis in endemic areas. Serodiagnostic tests for strongyloidiasis have shown robust diagnostic properties. However, these methods require a blood draw, an invasive and labor-intensive sample collection method, especially in the resource-limited settings where S. stercoralis is endemic. Our study examines a urine-based assay for strongyloidiasis and compares its diagnostic accuracy with coprological and serological methods. Receiver operating characteristic (ROC) curve analyses determined the diagnostic sensitivity (D-Sn) and specificity (D-Sp) of the urine ELISA, as well as estimates its positive predictive value and diagnostic risk. The likelihood ratios of obtaining a positive test result (LR+) or a negative test result (LR-) were calculated for each diagnostic positivity threshold. The urine ELISA assay correlated significantly with the serological ELISA assay for strongyloidiasis, with a D-Sn of 92.7% and a D-Sp of 40.7%, when compared to coprological methods. Moreover, the urine ELISA IgG test had a detection rate of 69%, which far exceeds the coprological method (28%). The likelihood of a positive diagnosis of strongyloidiasis by the urine ELISA IgG test increased significantly with increasing units of IgG detected in urine. The urine ELISA IgG assay for strongyloidiasis assay has a diagnostic accuracy comparable to serological assay, both of which are more sensitive than coprological methods. Since the collection of urine is easy and non-invasive, the urine ELISA IgG assay for strongyloidiasis could be used to screen populations at risk for strongyloidiasis in S. stercoralis endemic areas.
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Affiliation(s)
- Chatanun Eamudomkarn
- Department of Parasitology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
- Cholangiocarcinoma Research Institute (CARI), Khon Kaen University, Khon Kaen, Thailand
| | - Paiboon Sithithaworn
- Department of Parasitology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
- Cholangiocarcinoma Research Institute (CARI), Khon Kaen University, Khon Kaen, Thailand
- * E-mail: ,
| | - Christine Kamamia
- Department of Microbiology, Immunology & Tropical Medicine, George Washington University, Washington, D.C., United States of America
| | - Anna Yakovleva
- Department of Microbiology, Immunology & Tropical Medicine, George Washington University, Washington, D.C., United States of America
| | - Jiraporn Sithithaworn
- Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen, Thailand
- Faculty of Medicine, Mahasarakham University, Mahasarakham, Thailand
| | - Sasithorn Kaewkes
- Department of Parasitology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Anchalee Techasen
- Cholangiocarcinoma Research Institute (CARI), Khon Kaen University, Khon Kaen, Thailand
- Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen, Thailand
| | - Watcharin Loilome
- Cholangiocarcinoma Research Institute (CARI), Khon Kaen University, Khon Kaen, Thailand
- Department of Biochemistry, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Puangrat Yongvanit
- Cholangiocarcinoma Research Institute (CARI), Khon Kaen University, Khon Kaen, Thailand
- Department of Biochemistry, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Chompunoot Wangboon
- Biomedical Science Program, Graduate School, Khon Kaen University, Khon Kaen, Thailand
| | - Prasert Saichua
- Tropical Medicine Program, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Makoto Itoh
- Department of Infection and Immunology, Aichi Medical University School of Medicine, Nagakute, Aichi, Japan
| | - Jeffrey M. Bethony
- Department of Microbiology, Immunology & Tropical Medicine, George Washington University, Washington, D.C., United States of America
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23
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Coccaro N, Tota G, Zagaria A, Anelli L, Casieri P, Impera L, Minervini A, Minervini CF, Orsini P, Cumbo C, Parciante E, Delia M, Brunetti C, Specchia G, Albano F. Monitoring minimal residual disease by ddPCR in acute lymphoblastic leukemia associated with the FGFR1 gene rearrangement. Int J Lab Hematol 2018; 40:e117-e120. [DOI: 10.1111/ijlh.12879] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- N. Coccaro
- Hematology Section; Department of Emergency and Organ Transplantation (D.E.T.O.); University of Bari; Bari Italy
| | - G. Tota
- Hematology Section; Department of Emergency and Organ Transplantation (D.E.T.O.); University of Bari; Bari Italy
| | - A. Zagaria
- Hematology Section; Department of Emergency and Organ Transplantation (D.E.T.O.); University of Bari; Bari Italy
| | - L. Anelli
- Hematology Section; Department of Emergency and Organ Transplantation (D.E.T.O.); University of Bari; Bari Italy
| | - P. Casieri
- Hematology Section; Department of Emergency and Organ Transplantation (D.E.T.O.); University of Bari; Bari Italy
| | - L. Impera
- Hematology Section; Department of Emergency and Organ Transplantation (D.E.T.O.); University of Bari; Bari Italy
| | - A. Minervini
- Hematology Section; Department of Emergency and Organ Transplantation (D.E.T.O.); University of Bari; Bari Italy
| | - C. F. Minervini
- Hematology Section; Department of Emergency and Organ Transplantation (D.E.T.O.); University of Bari; Bari Italy
| | - P. Orsini
- Hematology Section; Department of Emergency and Organ Transplantation (D.E.T.O.); University of Bari; Bari Italy
| | - C. Cumbo
- Hematology Section; Department of Emergency and Organ Transplantation (D.E.T.O.); University of Bari; Bari Italy
| | - E. Parciante
- Hematology Section; Department of Emergency and Organ Transplantation (D.E.T.O.); University of Bari; Bari Italy
| | - M. Delia
- Hematology Section; Department of Emergency and Organ Transplantation (D.E.T.O.); University of Bari; Bari Italy
| | - C. Brunetti
- Hematology Section; Department of Emergency and Organ Transplantation (D.E.T.O.); University of Bari; Bari Italy
| | - G. Specchia
- Hematology Section; Department of Emergency and Organ Transplantation (D.E.T.O.); University of Bari; Bari Italy
| | - F. Albano
- Hematology Section; Department of Emergency and Organ Transplantation (D.E.T.O.); University of Bari; Bari Italy
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24
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Abayazeed RM, Abdel-Hay MA, Elfwal S, Hssanein M. A case report of Löffler endocarditis in idiopathic hypereosinophilic syndrome: recovery is possible. Eur Heart J Case Rep 2018; 2:yty030. [PMID: 31020113 PMCID: PMC6177098 DOI: 10.1093/ehjcr/yty030] [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: 10/27/2017] [Accepted: 02/20/2018] [Indexed: 11/16/2022]
Abstract
Introduction Hypereosinophilic syndrome (HES) is a myeloproliferative disorder characterized by persistent eosinophilia that is associated with damage to multiple organs. Case Presentation Herein, we describe a case of left ventricular (LV) Löffler endocarditis on top of idiopathic HES leading to inflow and outflow obstruction. The posterior mitral leaflet was involved in the fibrotic process leading to severe mitral valve regurgitation. There was a mural thrombus in the left ventricle, which resulted in thrombo-embolic complications in the form of lower limb ischaemia. The patient was treated with high-dose corticosteroids and anticoagulants with significant improvement of his cardiac condition. Discussion In patients with persistent hypereosinophilia, thorough workup is recommended to identify any possible primary cause and detect associated end-organ damage. Treatment should be started as early as possible after establishing the diagnosis to reduce morbidity and prevent complications. Corticosteroids are the first-line therapy that usually cause a rapid reduction in the level of the eosinophilia and must be started promptly if cardiac involvement is present to attain rapid reduction in the eosinophil level and reverse the cardiac damage.
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Affiliation(s)
| | | | - Sara Elfwal
- Department of Cardiology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Mahmoud Hssanein
- Department of Cardiology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
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25
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Yılmaz I, Bahçecioğlu SN, Türk M, Tutar N, Oymak FS, Gülmez İ. Last station in the eosinophilic asthma with chronic rhinosinusitis and/or nasal polyposis march: Eosinophilic asthma with radiological findings associated with blood eosinophilia. J Asthma 2018; 56:111-117. [PMID: 29611776 DOI: 10.1080/02770903.2018.1443469] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Eosinophilic asthma with chronic rhinosinusitis and/or nasal polyposis (EA-CRS/NP) is a subphenotype of adult-onset eosinophilic asthma. Blood eosinophil levels are shown to be highly elevated in patients with EA-CRS/NP and have potential for tissue infiltration. We aimed to demonstrate the clinical features of the patients who have a blood eosinophil level above 10% and have thorax computed tomography findings due to blood eosinophilia. METHODS Patients who were followed up in our clinic between 2012 and 2017 were retrospectively evaluated. Inclusion criteria were as follows: 1) Eosinophilic severe asthma, 2) eosinophilia >10%, 3) chronic sinusitis and/or nasal polyps, 4) patients with pathologic findings on thorax computed tomography, 5) regular follow-up for at least 1 year. RESULTS We identified 36 patients who met the above criteria. We defined this group as "Eosinophilic Asthma with chronic Rhinosinusitis and/or nasal polyposis with Radiological findings related to blood eosinophilia" (EARR). The mean age was 44.9 ± 11 years and 64% were females. Nasal polyps, aspirin exacerbated respiratory disease, and atopy, were present in 81%, 47%, and 25% of the patients, respectively. The mean blood eosinophil count was 1828.6 cells/mm3 (19%). The majority of EARR patients had upper lobe dominant ground-glass opacities. The mean follow-up period was 3.2 ± 2.5 years. EARR patients did not evolve into eosinophilic granulomatous polyangiitis in the follow-up. CONCLUSIONS This phenotype is the first eosinophilic asthma sub-phenotype reported in the literature. EARR is the final stage of the allergic march of EA-CRS/NP.
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Affiliation(s)
- Insu Yılmaz
- a Division of Immunology and Allergy, Department of Chest Diseases , Erciyes University School of Medicine , Kayseri , Turkey
| | - Sakine Nazik Bahçecioğlu
- a Division of Immunology and Allergy, Department of Chest Diseases , Erciyes University School of Medicine , Kayseri , Turkey
| | - Murat Türk
- a Division of Immunology and Allergy, Department of Chest Diseases , Erciyes University School of Medicine , Kayseri , Turkey
| | - Nuri Tutar
- b Department of Chest Diseases , Erciyes University School of Medicine , Kayseri , Turkey
| | - Fatma Sema Oymak
- b Department of Chest Diseases , Erciyes University School of Medicine , Kayseri , Turkey
| | - İnci Gülmez
- b Department of Chest Diseases , Erciyes University School of Medicine , Kayseri , Turkey
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26
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Derrieux C, Freynet N, Frayfer J, Delabesse E, Clappier E, Defasque S, Broutier H, Fouillard L. A case of B-cell precursor acute lymphoblastic leukemia with IL3-IGH rearrangement revealed by thromboembolism and marked eosinophilia. Leuk Lymphoma 2018; 59:2489-2492. [PMID: 29424254 DOI: 10.1080/10428194.2018.1430796] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Coralie Derrieux
- a Laboratoire d'Hématologie , Grand Hôpital de l'Est Francilien , Meaux , France
| | - Nicolas Freynet
- b Département d'Hématologie et d'Immunologie Biologiques , Hôpitaux Universitaires Henri Mondor, APHP, Faculté de Médecine UPEC , Créteil , France
| | - Jamile Frayfer
- c Service d'Hématologie Clinique , Grand Hôpital de l'Est Francilien , Meaux , France
| | - Eric Delabesse
- d Laboratoire d'Hématologie , CHU de Toulouse, Institut Universitaire du Cancer Toulouse-Oncopole , Toulouse , France
| | | | | | - Helene Broutier
- a Laboratoire d'Hématologie , Grand Hôpital de l'Est Francilien , Meaux , France
| | - Loïc Fouillard
- c Service d'Hématologie Clinique , Grand Hôpital de l'Est Francilien , Meaux , France
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27
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Nemes A, Marton I, Domsik P, Kalapos A, Pósfai É, Modok S, Kormányos Á, Ambrus N, Borbényi Z, Forster T. The right atrium in idiopathic hypereosinophilic syndrome : Insights from the 3D speckle tracking echocardiographic MAGYAR-Path Study. Herz 2017; 44:405-411. [PMID: 29234843 DOI: 10.1007/s00059-017-4652-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2017] [Revised: 10/17/2017] [Accepted: 11/12/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Idiopathic hypereosinophilic syndrome is characterized by a persistent eosinophil blood count of >1.5 × 109 cells/l and organ damage, independent of the primary and secondary causes of eosinophilia. The purpose of the present study was to assess the three-dimensional speckle tracking echocardiography-derived right atrial volumetric and functional properties between hypereosinophilic syndrome patients and matched controls. METHODS A total of 11 patients with idiopathic hypereosinophilic syndrome and 22 age- and gender-matched healthy controls were enrolled in the study. Three-dimensional speckle tracking echocardiography was used for calculation of right atrial volumes, volume-based functional properties, and strain parameters. RESULTS Significantly increased right atrial maximum (68.7 ± 33.1 ml vs. 40.3 ± 12.1 ml, respectively; p = 0.001) and minimum volumes (48.3 ± 31.0 ml vs. 28.3 ± 9.4 ml, respectively; p = 0.009), as well as right atrial volume before atrial contraction (58.6 ± 27.3 ml vs. 34.5 ± 11.8 ml, respectively; p = 0.001), were found in hypereosinophilic syndrome patients compared with controls. Total and passive right atrial stroke volumes proved to be significantly increased in hypereosinophilic syndrome patients. However, global and mean segmental strain parameters did not differ significantly between the groups. CONCLUSION Increased cyclic right atrial volumes and mild alterations in right atrial functional properties could be demonstrated in idiopathic hypereosinophilic syndrome patients.
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Affiliation(s)
- A Nemes
- 2nd Department of Medicine and Cardiology Centre, Medical Faculty, Albert Szent-Györgyi Clinical Center, University of Szeged, Semmelweis Street 8, P.O. Box 427, 6725, Szeged, Hungary.
| | - I Marton
- Division of Haematology, 2nd Department of Medicine and Cardiology Centre, Medical Faculty, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
| | - P Domsik
- 2nd Department of Medicine and Cardiology Centre, Medical Faculty, Albert Szent-Györgyi Clinical Center, University of Szeged, Semmelweis Street 8, P.O. Box 427, 6725, Szeged, Hungary
| | - A Kalapos
- 2nd Department of Medicine and Cardiology Centre, Medical Faculty, Albert Szent-Györgyi Clinical Center, University of Szeged, Semmelweis Street 8, P.O. Box 427, 6725, Szeged, Hungary
| | - É Pósfai
- Division of Haematology, 2nd Department of Medicine and Cardiology Centre, Medical Faculty, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
| | - S Modok
- Division of Haematology, 2nd Department of Medicine and Cardiology Centre, Medical Faculty, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
| | - Á Kormányos
- 2nd Department of Medicine and Cardiology Centre, Medical Faculty, Albert Szent-Györgyi Clinical Center, University of Szeged, Semmelweis Street 8, P.O. Box 427, 6725, Szeged, Hungary
| | - N Ambrus
- 2nd Department of Medicine and Cardiology Centre, Medical Faculty, Albert Szent-Györgyi Clinical Center, University of Szeged, Semmelweis Street 8, P.O. Box 427, 6725, Szeged, Hungary
| | - Z Borbényi
- Division of Haematology, 2nd Department of Medicine and Cardiology Centre, Medical Faculty, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
| | - T Forster
- 2nd Department of Medicine and Cardiology Centre, Medical Faculty, Albert Szent-Györgyi Clinical Center, University of Szeged, Semmelweis Street 8, P.O. Box 427, 6725, Szeged, Hungary
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28
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Nemes A, Marton I, Domsik P, Kalapos A, Pósfai É, Modok S, Borbényi Z, Forster T. Aortic stiffness is increased in patients with hypereosinophilic syndrome being in early necrotic phase. Quant Imaging Med Surg 2017; 7:636-640. [PMID: 29312868 DOI: 10.21037/qims.2017.12.06] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Persistent eosinophilia and eosinophil-mediated single- or multiple-organ damage are typical features of hypereosinophilic syndrome (HES). Theoretically, eosinophilic infiltration of the ascending aortic wall could not be excluded in HES, therefore the present study aimed to test whether HES is associated with abnormalities in aortic elastic properties. Methods The present study comprised 10 HES patients (mean age: 57.6±10.1 years, 5 males) without known cardiovascular disease, their results were compared to 19 age-, gender- and risk factor-matched controls (59.2±4.2 years, 15 males). Complete two-dimensional Doppler echocardiography with measurement of echocardiographic aortic elastic properties was performed in all HES cases and controls. Results Although neither systolic (30.6±3.4 vs. 30.1±3.6 mm, P=ns), nor diastolic (28.7±3.6 vs. 27.8±3.2 mm, P=ns) aortic diameter differed significantly between HES patients and matched controls, significantly increased aortic stiffness index (11.19±5.65 vs. 7.04±2.97, P<0.05) could be demonstrated in HES patients. Conclusions Increased aortic stiffness could be demonstrated in HES patients in their early necrotic phase.
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Affiliation(s)
- Attila Nemes
- 2nd Department of Medicine and Cardiology Centre, 2nd Department of Medicine and Cardiology Centre, Medical Faculty, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
| | - Imelda Marton
- Division of Haematology, 2nd Department of Medicine and Cardiology Centre, Medical Faculty, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
| | - Péter Domsik
- 2nd Department of Medicine and Cardiology Centre, 2nd Department of Medicine and Cardiology Centre, Medical Faculty, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
| | - Anita Kalapos
- 2nd Department of Medicine and Cardiology Centre, 2nd Department of Medicine and Cardiology Centre, Medical Faculty, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
| | - Éva Pósfai
- Division of Haematology, 2nd Department of Medicine and Cardiology Centre, Medical Faculty, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
| | - Szabolcs Modok
- Division of Haematology, 2nd Department of Medicine and Cardiology Centre, Medical Faculty, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
| | - Zita Borbényi
- 2nd Department of Medicine and Cardiology Centre, 2nd Department of Medicine and Cardiology Centre, Medical Faculty, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
| | - Tamás Forster
- 2nd Department of Medicine and Cardiology Centre, 2nd Department of Medicine and Cardiology Centre, Medical Faculty, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
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30
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Landberg N, Dreimane A, Rissler M, Billström R, Ågerstam H. Primary cells inBCR/FGFR1-positive 8p11 myeloproliferative syndrome are sensitive to dovitinib, ponatinib, and dasatinib. Eur J Haematol 2017; 99:442-448. [DOI: 10.1111/ejh.12957] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/28/2017] [Indexed: 02/06/2023]
Affiliation(s)
- Niklas Landberg
- Department of Clinical Genetics; Lund University; Lund Sweden
| | - Arta Dreimane
- Department of Haematology; Linköping University Hospital; Linköping Sweden
| | | | - Rolf Billström
- Department of Medicine; Central Hospital Skövde; Skövde Sweden
| | - Helena Ågerstam
- Department of Clinical Genetics; Lund University; Lund Sweden
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31
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Jaratlerdsiri W, Chan EKF, Petersen DC, Yang C, Croucher PI, Bornman MSR, Sheth P, Hayes VM. Next generation mapping reveals novel large genomic rearrangements in prostate cancer. Oncotarget 2017; 8:23588-23602. [PMID: 28423598 PMCID: PMC5410329 DOI: 10.18632/oncotarget.15802] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Accepted: 02/15/2017] [Indexed: 12/27/2022] Open
Abstract
Complex genomic rearrangements are common molecular events driving prostate carcinogenesis. Clinical significance, however, has yet to be fully elucidated. Detecting the full range and subtypes of large structural variants (SVs), greater than one kilobase in length, is challenging using clinically feasible next generation sequencing (NGS) technologies. Next generation mapping (NGM) is a new technology that allows for the interrogation of megabase length DNA molecules outside the detection range of single-base resolution NGS. In this study, we sought to determine the feasibility of using the Irys (Bionano Genomics Inc.) nanochannel NGM technology to generate whole genome maps of a primary prostate tumor and matched blood from a Gleason score 7 (4 + 3), ETS-fusion negative prostate cancer patient. With an effective mapped coverage of 35X and sequence coverage of 60X, and an estimated 43% tumor purity, we identified 85 large somatic structural rearrangements and 6,172 smaller somatic variants, respectively. The vast majority of the large SVs (89%), of which 73% are insertions, were not detectable ab initio using high-coverage short-read NGS. However, guided manual inspection of single NGS reads and de novo assembled scaffolds of NGM-derived candidate regions allowed for confirmation of 94% of these large SVs, with over a third impacting genes with oncogenic potential. From this single-patient study, the first cancer study to integrate NGS and NGM data, we hypothesise that there exists a novel spectrum of large genomic rearrangements in prostate cancer, that these large genomic rearrangements are likely early events in tumorigenesis, and they have potential to enhance taxonomy.
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Affiliation(s)
- Weerachai Jaratlerdsiri
- Laboratory for Human Comparative and Prostate Cancer Genomics, Genomics and Epigenetics Division, Garvan Institute of Medical Research, Darlinghurst, Australia
| | - Eva K F Chan
- Laboratory for Human Comparative and Prostate Cancer Genomics, Genomics and Epigenetics Division, Garvan Institute of Medical Research, Darlinghurst, Australia.,St Vincent's Clinical School, University of New South Wales, Randwick, Australia
| | - Desiree C Petersen
- Laboratory for Human Comparative and Prostate Cancer Genomics, Genomics and Epigenetics Division, Garvan Institute of Medical Research, Darlinghurst, Australia.,St Vincent's Clinical School, University of New South Wales, Randwick, Australia
| | - Claire Yang
- Bionano Genomics Inc., San Diego, California, USA
| | - Peter I Croucher
- St Vincent's Clinical School, University of New South Wales, Randwick, Australia.,Bone Biology Division, Garvan Institute of Medical Research, Darlinghurst, Australia.,School of Biotechnology and Biomolecular Sciences, University of New South Wales, Randwick, Australia
| | - M S Riana Bornman
- School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa
| | - Palak Sheth
- Bionano Genomics Inc., San Diego, California, USA
| | - Vanessa M Hayes
- Laboratory for Human Comparative and Prostate Cancer Genomics, Genomics and Epigenetics Division, Garvan Institute of Medical Research, Darlinghurst, Australia.,St Vincent's Clinical School, University of New South Wales, Randwick, Australia.,School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa.,Central Clinical School, University of Sydney, Camperdown, Australia
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32
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Choi MY, Tsigelny IF, Boichard A, Skjevik ÅA, Shabaik A, Kurzrock R. BRAF mutation as a novel driver of eosinophilic cystitis. Cancer Biol Ther 2017; 18:655-659. [PMID: 28829677 DOI: 10.1080/15384047.2017.1360449] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Eosinophilic cystitis is a rare manifestation of hypereosinophilia and a cause of morbidity, including dysuria and hematuria. Although some cases can be attributed to infection or allergy, most cases are assessed to be idiopathic and treated with corticosteroids. However, hypereosinophilia can also be due to actionable clonal molecular alterations in the haematopoietic cells, similar to other myeloproliferative neoplasms. Common mutations associated with eosonophilic syndromes are of platelet-derived growth factor receptor α or β or c-kit, though other pathogenic mutations have been found by next generation sequencing. Determination of a specific mutation may therefore identify clonality and refine treatment of some cases. Here we review the molecular features of eosinophilic disorders. We also describe the use of a liquid biopsy of circulating cell-free DNA in the workup of a case of eosinophilic cystitis in which next generation sequencing of cell-free DNA showed a BRAF I463T mutation. In silico modeling supports the functional impact and potential clinical relevance of BRAF I463T.
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Affiliation(s)
- Michael Y Choi
- a Center for Personalized Cancer Therapy and Division of Hematology and Oncology, UCSD Moores Cancer Center , University of California, San Diego , 3855 Health Sciences Drive #0820, La Jolla , CA
| | - Igor F Tsigelny
- b Center for Personalized Cancer Therapy, Division of Hematology and Oncology, San Diego Supercomputer Center, and Department of Neurosciences , University of California, San Diego , 9500 Gilman Drive #0505, CureMatch Inc., Lusk Blvd., Suite F208, San Diego, La Jolla , CA.,c CureMatch Inc. , 6390 Lusk Blvd., Suite F208, San Diego 92121
| | - Amelie Boichard
- d Center for Personalized Cancer Therapy, Division of Hematology and Oncology, San Diego Supercomputer Center , University of California, San Diego , 3855 Health Sciences Drive #0658, La Jolla , CA
| | - Åge A Skjevik
- e San Diego Supercomputer Center and Department of Biomedicine , University of Bergen , Bergen , Norway
| | - Ahmed Shabaik
- f Department of Pathology, UCSD Medical Center , University of California, San Diego , 200 W. Arbor Drive #8720 San Diego , CA
| | - Razelle Kurzrock
- a Center for Personalized Cancer Therapy and Division of Hematology and Oncology, UCSD Moores Cancer Center , University of California, San Diego , 3855 Health Sciences Drive #0820, La Jolla , CA
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Yılmaz İ, Türk M, Bahçecioğlu SN. Classification of eosinophilic granulomatosis with polyangiitis phenotypes and treatment based on phenotypes. Autoimmun Rev 2017; 16:992-993. [PMID: 28711579 DOI: 10.1016/j.autrev.2017.07.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 06/17/2017] [Indexed: 01/27/2023]
Affiliation(s)
- İnsu Yılmaz
- Erciyes University School of Medicine, Department of Chest Diseases, Division of Immunology and Allergy, Kayseri, Turkey.
| | - Murat Türk
- Erciyes University School of Medicine, Department of Chest Diseases, Division of Immunology and Allergy, Kayseri, Turkey
| | - Sakine Nazik Bahçecioğlu
- Erciyes University School of Medicine, Department of Chest Diseases, Division of Immunology and Allergy, Kayseri, Turkey
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Hernandez CM, Arisha MJ, Ahmad A, Oates E, Nanda NC, Nanda A, Wasan A, Caleti BE, Bernal CLP, Gallardo SM. Usefulness of three-dimensional echocardiography in the assessment of valvular involvement in Loeffler endocarditis. Echocardiography 2017; 34:1050-1056. [PMID: 28600838 DOI: 10.1111/echo.13575] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Loeffler endocarditis is a complication of hypereosinophilic syndrome resulting from eosinophilic infiltration of heart tissue. We report a case of Loeffler endocarditis in which three-dimensional transthoracic and transesophageal echocardiography provided additional information to what was found by two-dimensional transthoracic echocardiography alone. Our case illustrates the usefulness of combined two- and three-dimensional echocardiography in the assessment of Loeffler endocarditis. In addition, a summary of the features of hypereosinophilic syndrome and Loeffler endocarditis is provided in tabular form.
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Affiliation(s)
- Carlos M Hernandez
- National Medical Center (Siglo XXI), Cardiology Hospital, IMSS, Mexico City, Mexico
| | - Mohammed J Arisha
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Amier Ahmad
- Division of Internal Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Ethan Oates
- Division of Internal Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Navin C Nanda
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Anil Nanda
- Asthma and Allergy Center, Lewisville and Flower Mound, TX, USA.,Division of Allergy and Immunology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | | | - Beda E Caleti
- National Medical Center (Siglo XXI), Cardiology Hospital, IMSS, Mexico City, Mexico
| | - Cinthia L P Bernal
- National Medical Center (Siglo XXI), Cardiology Hospital, IMSS, Mexico City, Mexico
| | - Sergio M Gallardo
- National Medical Center (Siglo XXI), Specialties Hospital (Dr. Bernardo Sepulveda), IMSS, Mexico City, Mexico
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35
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Sarthy JF, Reddivalla N, Radhi M, Chastain K. Pediatric 8p11 eosinophilic myeloproliferative syndrome (EMS): A case report and review of the literature. Pediatr Blood Cancer 2017; 64. [PMID: 27808462 DOI: 10.1002/pbc.26310] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Revised: 09/05/2016] [Accepted: 09/21/2016] [Indexed: 01/05/2023]
Abstract
The 8p11 eosinophilic myeloproliferative syndrome (EMS) is an aggressive neoplasm driven by translocation of the fibroblast growth factor receptor 1 and often transforms to leukemias and lymphomas that are refractory to treatment. The first case was identified in 1983, and to date over 70 cases have been reported in the literature. Despite those reports, no consensus exists on management of this condition, and inconsistency in treatment regimens is even more pronounced in the pediatric literature. We report a case of a male infant with the 8p11 EMS, review the published pediatric experience with EMS, and discuss treatment strategies for this enigmatic hematological disorder.
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Affiliation(s)
- Jay F Sarthy
- Children's Mercy Hospitals and Clinics, Kansas City, Missouri 64113
| | | | - Mohamed Radhi
- Children's Mercy Hospitals and Clinics, Kansas City, Missouri 64113
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36
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Nayak VH, Engin NY, Burns JJ, Ameta P. Hypereosinophilic Syndrome With Eosinophilic Gastritis. Glob Pediatr Health 2017; 4:2333794X17705239. [PMID: 28491930 PMCID: PMC5406201 DOI: 10.1177/2333794x17705239] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 03/21/2017] [Indexed: 11/17/2022] Open
Affiliation(s)
| | | | - James Joseph Burns
- Sacred Heart Children Hospital, University of Florida, Pensacola, FL, USA
| | - Priyanka Ameta
- Sacred Heart Children Hospital, University of Florida, Pensacola, FL, USA
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37
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Santos YAP, Silva BRA, Lira PNZBA, Vaz LCA, Mafort TT, Bruno LP, Lopes AJ. Eosinophilic granulomatosis with polyangiitis (formerly known as Churg-Strauss syndrome) as a differential diagnosis of hypereosinophilic syndromes. Respir Med Case Rep 2017; 21:1-6. [PMID: 28337408 PMCID: PMC5352719 DOI: 10.1016/j.rmcr.2017.03.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 03/04/2017] [Accepted: 03/06/2017] [Indexed: 01/01/2023] Open
Abstract
Eosinophilic granulomatosis with polyangiitis (EGPA), formerly known as Churg-Strauss syndrome, is a rare systemic disease situated between primary small vessel vasculitides associated with antineutrophil cytoplasmic antibodies (ANCAs) and hypereosinophilic syndromes (HES). Here, we present a case of EGPA in a 38-year-old male, with a previous diagnosis of asthma, who presented with fever, migratory lung infiltrates and systemic eosinophilia that was refractory to previous courses of antibiotics. This case highlights the importance of the primary care physician understanding the differential diagnosis of pulmonary eosinophilic syndromes.
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Affiliation(s)
- Yuri Albuquerque Pessoa Santos
- Department of Clinical Medicine, University Hospital Pedro Ernesto, State University of Rio de Janeiro, Boulevard 28 de Setembro, 77, 3º andar, Vila Isabel, 20551-030, Rio de Janeiro, Brazil
| | - Bruno Rangel Antunes Silva
- Department of Pneumology, University Hospital Pedro Ernesto, State University of Rio de Janeiro, Boulevard 28 de Setembro, 77, 2º andar, Vila Isabel, 20551-030, Rio de Janeiro, Brazil; Postgraduate Programme in Medical Sciences, School of Medical Sciences, State University of Rio de Janeiro, Av. Prof. Manoel de Abreu, 444, 2º andar, Vila Isabel, 20550-170, Rio de Janeiro, Brazil
| | | | - Luiz Carlos Aguiar Vaz
- Department of Anatomic Pathology, School of Medical Sciences, State University of Rio de Janeiro, Av. Prof. Manoel de Abreu, 444, 3º andar, Vila Isabel, 20550-170, Rio de Janeiro, Brazil
| | - Thiago Thomaz Mafort
- Department of Pneumology, University Hospital Pedro Ernesto, State University of Rio de Janeiro, Boulevard 28 de Setembro, 77, 2º andar, Vila Isabel, 20551-030, Rio de Janeiro, Brazil
| | - Leonardo Palermo Bruno
- Department of Pneumology, University Hospital Pedro Ernesto, State University of Rio de Janeiro, Boulevard 28 de Setembro, 77, 2º andar, Vila Isabel, 20551-030, Rio de Janeiro, Brazil
| | - Agnaldo José Lopes
- Department of Pneumology, University Hospital Pedro Ernesto, State University of Rio de Janeiro, Boulevard 28 de Setembro, 77, 2º andar, Vila Isabel, 20551-030, Rio de Janeiro, Brazil; Postgraduate Programme in Medical Sciences, School of Medical Sciences, State University of Rio de Janeiro, Av. Prof. Manoel de Abreu, 444, 2º andar, Vila Isabel, 20550-170, Rio de Janeiro, Brazil
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38
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Neto MPDQ, Filho FAGG. Idiopathic hypereosinophilic syndrome with 20 years of diagnostic delay. Rev Bras Hematol Hemoter 2017; 39:170-174. [PMID: 28577656 PMCID: PMC5457458 DOI: 10.1016/j.bjhh.2016.11.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Revised: 09/17/2016] [Accepted: 11/04/2016] [Indexed: 01/21/2023] Open
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Butt NM, Lambert J, Ali S, Beer PA, Cross NCP, Duncombe A, Ewing J, Harrison CN, Knapper S, McLornan D, Mead AJ, Radia D, Bain BJ. Guideline for the investigation and management of eosinophilia. Br J Haematol 2017; 176:553-572. [PMID: 28112388 DOI: 10.1111/bjh.14488] [Citation(s) in RCA: 88] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Nauman M Butt
- Royal Liverpool and Broadgreen University Teaching Hospitals NHS Trust, Liverpool, UK
| | - Jonathan Lambert
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Sahra Ali
- Hull and East Yorkshire Hospitals NHS Trust, Hull, UK
| | | | | | - Andrew Duncombe
- Department of Haematology, University Hospital Southampton, Southampton, UK
| | - Joanne Ewing
- Heart of England NHS Foundation Trust, Birmingham, UK
| | | | - Steven Knapper
- Division of Cancer & Genetics, School of Medicine, Cardiff University, Cardiff, UK
| | - Donal McLornan
- King's College Hospital NHS Foundation Trust, London, UK
| | - Adam J Mead
- MRC Molecular Haematology Unit, Weatherall Institute of Molecular Medicine, University of Oxford and BRC Blood Theme, NIHR Oxford Biomedical Centre, Oxford, UK
| | - Deepti Radia
- Guy's and St Thomas' NHS Foundation Trust, London, UK
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Jain A, Malhotra P, Suri V, Agarwal R, Bal A, Varma S. A young man with acute respiratory distress syndrome: eosinophilia is not always “benign”. Blood Res 2017; 52:329-332. [PMID: 29333415 PMCID: PMC5762749 DOI: 10.5045/br.2017.52.4.329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 04/11/2017] [Indexed: 11/23/2022] Open
Affiliation(s)
- Ankur Jain
- Department of Internal Medicine, Nehru Hospital, PGIMER, Chandigarh, India
| | - Pankaj Malhotra
- Department of Internal Medicine, Nehru Hospital, PGIMER, Chandigarh, India
| | - Vikas Suri
- Department of Internal Medicine, Nehru Hospital, PGIMER, Chandigarh, India
| | - Ritesh Agarwal
- Department of Pulmonary Medicine, Nehru Hospital, PGIMER, Chandigarh, India
| | - Amanjit Bal
- Department of Histopathology, Nehru Hospital, PGIMER, Chandigarh, India
| | - Subhash Varma
- Department of Internal Medicine, Nehru Hospital, PGIMER, Chandigarh, India
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Mohammad S, Gotoh A, Morishita S, Komatsu N. Imatinib-sensitive myeloid neoplasm with low allele burden of FIP1L1-PDGFRA fusion gene in an elderly patient. Geriatr Gerontol Int 2016; 16:1346-1348. [PMID: 28028904 DOI: 10.1111/ggi.12733] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Sherwet Mohammad
- Department of Hematology, Juntendo University School of Medicine, Tokyo, Japan.,Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Akihiko Gotoh
- Department of Hematology, Juntendo University School of Medicine, Tokyo, Japan
| | - Soji Morishita
- Department of Transfusion Medicine and Stem Cell Regulation, Juntendo University School of Medicine, Tokyo, Japan
| | - Norio Komatsu
- Department of Hematology, Juntendo University School of Medicine, Tokyo, Japan
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42
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Abstract
Historically, eosinophils have been considered as end-stage cells involved in host protection against parasitic infection and in the mechanisms of hypersensitivity. However, later studies have shown that this multifunctional cell is also capable of producing immunoregulatory cytokines and soluble mediators and is involved in tissue homeostasis and modulation of innate and adaptive immune responses. In this review, we summarize the biology of eosinophils, including the function and molecular mechanisms of their granule proteins, cell surface markers, mediators, and pathways, and present comprehensive reviews of research updates on the genetics and epigenetics of eosinophils. We describe recent advances in the development of epigenetics of eosinophil-related diseases, especially in asthma. Likewise, recent studies have provided us with a more complete appreciation of how eosinophils contribute to the pathogenesis of various diseases, including hypereosinophilic syndrome (HES). Over the past decades, the definition and criteria of HES have been evolving with the progress of our understanding of the disease and some aspects of this disease still remain controversial. We also review recent updates on the genetic and molecular mechanisms of HES, which have spurred dramatic developments in the clinical strategies of diagnosis and treatment for this heterogeneous group of diseases. The conclusion from this review is that the biology of eosinophils provides significant insights as to their roles in health and disease and, furthermore, demonstrates that a better understanding of eosinophil will accelerate the development of new therapeutic strategies for patients.
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Abstract
Eosinophils can regulate local and systemic inflammation, and their presence in higher numbers appears to play an important role in the pathology of various atopic and inflammatory diseases. Eosinophil maturation, recruitment, and survival depend on several cytokine regulators, including interleukin (IL)-5, IL-4, and IL-13 as well as growth factors such as GM-CSF. Over the last decade, the approach to treating eosinophilic diseases has changed greatly. A number of biologic modulators have been developed to target eosinophilic inflammatory pathways, and their usage has resulted in variable clinical improvement in the treatment of eosinophilic-associated conditions. Novel targeted therapies that are safe and effective for treating these disorders are being investigated. This review summarizes the clinical use of biologic agents that have been studied in clinical trials or approved for treating eosinophilic diseases.
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Affiliation(s)
- Panida Sriaroon
- Division of Allergy, Immunology, and Rheumatology, Department of Pediatrics, University of South Florida, 140 7th ave S, CRI 4008, St. Petersburg, FL, 33701, USA.
| | - Mark Ballow
- Division of Allergy, Immunology, and Rheumatology, Department of Pediatrics, University of South Florida, 140 7th ave S, CRI 4008, St. Petersburg, FL, 33701, USA
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Lefèvre G, Ackermann F, Kahn JE. Hypereosinophilia with asthma and systemic (non-vasculitic) manifestations: Eosinophilic granulomatosis with polyangiitis or hypereosinophilic syndrome? Autoimmun Rev 2016; 16:208-209. [PMID: 27915050 DOI: 10.1016/j.autrev.2016.11.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Accepted: 11/25/2016] [Indexed: 10/20/2022]
Affiliation(s)
- Guillaume Lefèvre
- French Eosinophil Network, France; CHU Lille, Institut d'Immunologie, Unité d'Immunologie Clinique, F-59000 Lille, France; Univ. Lille, U995 - LIRIC - Lille Inflammation Research International Center, F-59000 Lille, France.
| | - Félix Ackermann
- French Eosinophil Network, France; Service de Médecine Interne, Hôpital Foch, Suresnes, France
| | - Jean-Emmanuel Kahn
- French Eosinophil Network, France; Univ. Lille, U995 - LIRIC - Lille Inflammation Research International Center, F-59000 Lille, France; Service de Médecine Interne, Hôpital Foch, Suresnes, France
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45
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King B, Lee AI, Choi J. Treatment of Hypereosinophilic Syndrome with Cutaneous Involvement with the JAK Inhibitors Tofacitinib and Ruxolitinib. J Invest Dermatol 2016; 137:951-954. [PMID: 27887955 DOI: 10.1016/j.jid.2016.10.044] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Revised: 10/24/2016] [Accepted: 10/26/2016] [Indexed: 12/11/2022]
Affiliation(s)
- Brett King
- Department of Dermatology, Yale School of Medicine, New Haven, Connecticut, USA.
| | - Alfred Ian Lee
- Department of Medicine, Section of Hematology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Jaehyuk Choi
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
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46
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Immune Profile of Honduran Schoolchildren with Intestinal Parasites: The Skewed Response against Geohelminths. J Parasitol Res 2016; 2016:1769585. [PMID: 27882241 PMCID: PMC5108857 DOI: 10.1155/2016/1769585] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Accepted: 10/10/2016] [Indexed: 01/18/2023] Open
Abstract
Soil-transmitted helminth infections typically induce a type-2 immune response (Th2), but no immunoepidemiological studies have been undertaken in Honduras, an endemic country where the main control strategy is children's annual deworming. We aimed to characterize the immune profile of Honduran schoolchildren harbouring these parasitoses. Demographic and epidemiological data were obtained through a survey; nutritional status was assessed through anthropometry; intestinal parasites were diagnosed by formol-ether and Kato-Katz; and blood samples were collected to determine immunological markers including Th1/Th2 cytokines, IgE, and eosinophil levels. A total of 225 children participated in the study, all of whom had received deworming during the national campaign five months prior to the study. Trichuriasis and ascariasis prevalence were 22.2% and 20.4%, respectively. Stunting was associated with both age and trichuriasis, whereas ascariasis was associated with sex and household conditions. Helminth infections were strongly associated with eosinophilia and hyper-IgE as well as with a Th2-polarized response (increased levels of IL-13, IL-10, and IL4/IFN-γ ratios and decreased levels of IFN-γ). Pathogenic protozoa infections were associated with a Th1 response characterized by elevated levels of IFN-γ and decreased IL10/IFN-γ ratios. Even at low prevalence levels, STH infections affect children's nutrition and play a polarizing role in their immune system.
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Fraticelli P, Kafyeke A, Mattioli M, Martino GP, Murri M, Gabrielli A. Idiopathic hypereosinophilic syndrome presenting with severe vasculitis successfully treated with imatinib. World J Clin Cases 2016; 4:328-332. [PMID: 27803915 PMCID: PMC5067496 DOI: 10.12998/wjcc.v4.i10.328] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Revised: 05/25/2016] [Accepted: 06/29/2016] [Indexed: 02/05/2023] Open
Abstract
Idiopathic hypereosinophilic syndrome (HES) is a rare disorder characterized by peripheral eosinophilia exceeding 1500/mm3, a chronic course, absence of secondary causes, and signs and symptoms of eosinophil-mediated tissue injury. One of the best-characterized forms of HES is the one associated with FIP1L1-PDGFRA gene rearrangement, which was recently demonstrated as responsive to treatment with the small molecule kinase inhibitor drug, imatinib mesylate. Here, we describe the case of a 51-year-old male, whose symptoms satisfied the clinical criteria for HES with cutaneous and cardiac involvement and who also presented with vasculitic brain lesions and retroperitoneal bleeding. Molecular testing, including fluorescence in situ hybridization, of bone marrow and peripheral blood showed no evidence of PDGFR rearrangements. The patient was initially treated with high-dose steroid therapy and then with hydroxyurea, but proved unresponsive to both. Upon subsequent initiation of imatinib mesilate, the patient showed a dramatic improvement in eosinophil count and progressed rapidly through clinical recovery. Long-term follow-up confirmed the efficacy of treatment with low-dose imatinib and with no need of supplemental steroid treatment, notwithstanding the absence of PDGFR rearrangement.
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Skendros P, Papagoras C, Lefaki I, Giatromanolaki A, Kotsianidis I, Speletas M, Bocly V, Theodorou I, Dalla V, Ritis K. Successful response in a case of severe pustular psoriasis after interleukin‐1β inhibition. Br J Dermatol 2016; 176:212-215. [DOI: 10.1111/bjd.14685] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2016] [Indexed: 12/24/2022]
Affiliation(s)
- P. Skendros
- First Department of Internal Medicine Democritus University of Thrace University Hospital of Alexandroupolis, Dragana Alexandroupolis 68100 Greece
| | - C. Papagoras
- First Department of Internal Medicine Democritus University of Thrace University Hospital of Alexandroupolis, Dragana Alexandroupolis 68100 Greece
| | - I. Lefaki
- State Clinic of Dermatology Hospital for Skin and Venereal Diseases Thessaloniki Greece
| | - A. Giatromanolaki
- Department of Pathology Democritus University of Thrace University Hospital of Alexandroupolis, Dragana Alexandroupolis 68100 Greece
| | - I. Kotsianidis
- Department of Haematology Democritus University of Thrace University Hospital of Alexandroupolis, Dragana Alexandroupolis 68100 Greece
| | - M. Speletas
- Department of Immunology and Histocompatibility Faculty of Medicine School of Health Sciences University of Thessaly Larissa Greece
| | - V. Bocly
- UF d'Histocompatibilité et Immunogénétique Département d'Immunologie Groupe Hospitalier Pitié Salpêtrière – Charles Foix Paris France
| | - I. Theodorou
- UF d'Histocompatibilité et Immunogénétique Département d'Immunologie Groupe Hospitalier Pitié Salpêtrière – Charles Foix Paris France
| | - V. Dalla
- First Department of Internal Medicine Democritus University of Thrace University Hospital of Alexandroupolis, Dragana Alexandroupolis 68100 Greece
| | - K. Ritis
- First Department of Internal Medicine Democritus University of Thrace University Hospital of Alexandroupolis, Dragana Alexandroupolis 68100 Greece
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Abstract
The objective of this investigation was to study the gastrointestinal and hepatic
involvement in hypereosinophilic syndrome (HES). Gastrointestinal or hepatic involvement
is estimated to affect up to one-third of patients with HES, although most of the clinical
evidence has been derived from case reports. In literature, HES presenting with hepatitis
and jaundice with subsequent development of colitis is a rare clinicopathologic entity.
Given the clinical implications, physicians should include HES among differentials in
these types of presentations.
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Affiliation(s)
- Faisal Inayat
- Department of Medicine, New York-Presbyterian Hospital, Weill Cornell Medical College, New York City, NY, USA
| | - Abu Hurairah
- Division of Gastroenterology, Department of Medicine, SUNY Downstate Medical Center, Brooklyn, NY, USA
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Vidyadharan S, Joseph B, Nair SP. Chronic Eosinophilic Leukemia Presenting Predominantly with Cutaneous Manifestations. Indian J Dermatol 2016; 61:437-9. [PMID: 27512192 PMCID: PMC4966405 DOI: 10.4103/0019-5154.185716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
A 37-year-old male presented with severe oral and genital mucosal ulcers, lichenoid eruption and twenty-nail dystrophy. Systemic examination was normal, except for anemia. On investigations, he was found to have persistently elevated peripheral eosinophilia, absolute eosinophil count >5000/mm3, bone marrow showing increased eosinophilic precursors, and infiltration by atypical cells. The serum vitamin B12 levels were grossly elevated, and Philadelphia chromosome study was negative. Thus, a diagnosis of chronic eosinophilic leukemia was made. The patient showed excellent response to imatinib mesylate. We are reporting a rare type of leukemia presenting with predominantly cutaneous manifestations.
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Affiliation(s)
- Suja Vidyadharan
- Department of Dermatology and Venereology, Government Medical College, Thiruvananthapuram, Kerala, India
| | - Bebisha Joseph
- Department of Dermatology and Venereology, Government Medical College, Thiruvananthapuram, Kerala, India
| | - Sukumaran Pradeep Nair
- Department of Dermatology and Venereology, Government Medical College, Thiruvananthapuram, Kerala, India
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