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Giardino FR, Cuomo R, Pozzi M, Marcaccini G, Bacchini S, Marzouk El Araby M, Grimaldi L, Nisi G. Erdheim–Chester Disease of the Breast: First Review and First Case of Isolated Severe Gynecomastia. Diagnostics (Basel) 2023; 13:diagnostics13071239. [PMID: 37046457 PMCID: PMC10093613 DOI: 10.3390/diagnostics13071239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 03/11/2023] [Accepted: 03/21/2023] [Indexed: 03/29/2023] Open
Abstract
(1) Introduction: Erdheim–Chester disease (ECD) is a life-threatening condition and often a diagnostic challenge. It has recently been classified as a hematopoietic tumour, and the cases of ECD reported in the literature has dramatically increased during the last 15 years. (2) Methods: We describe the case of a 57-year-old male patient with severe gynecomastia, with a detailed description of his diagnostic iter and consequent surgical operation. We provide the first systematic review of the literature of breast involvement in ECD, following PRISMA guidelines, including 13 studies and 16 patients. (3) Results: Our report resulted to be the first case of gynecomastia as a single clinical and imaging feature of ECD described in English literature. A total of 81.3% of patients included were female. Among them, 76.9% had unilateral and nodular presentation, while male patients presented bilateral heterogeneous breast enlargement. Globally, 87.5% expressed breast alterations as their first manifestations of ECD. Only 50% presented skeletal involvement. (4) Conclusion: The reported case represents a unique addition to the literature. We found two different patterns in ECD-related breast involvement between male and female patients, an unusual M/F ratio, and a lower rate of bone involvement. Breast involvement is frequently the first clinical feature; therefore, breast caregivers should be aware of this dangerous and most likely underestimated condition.
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2
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Salazar LC, Moreno LÁ, Jaramillo LE, Cabrera EV. Erdheim-Chester disease: First pediatric case report in Colombia. BIOMEDICA : REVISTA DEL INSTITUTO NACIONAL DE SALUD 2021; 41:615-624. [PMID: 34936247 PMCID: PMC8715983 DOI: 10.7705/biomedica.5651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Accepted: 06/17/2021] [Indexed: 11/21/2022]
Abstract
The Erdheim-Chester’s disease is extremely rare in children. We present the case of a 12-year-old girl with histological and radiological diagnosis of this disease and mutation of the BRAF gene, who developed multisystemic compromise requiring treatment with dabrafenib. We identified 22 reports of this condition among children worldwide and this is the second pediatric case in Latin America. Diagnostic imaging is critical to confirm Erdheim-Chester disease and for the surgical planning of the biopsy. Additionally, we identified the parasellar dark sign, which has previously been reported on lymphocytic hypophysitis. This report contributes to the current practice as it shows the clinical presentation and the diagnostic workout of this disease in pediatrics.
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Affiliation(s)
- Luis Carlos Salazar
- Departamento de Radiología e Imágenes Diagnósticas, Facultad de Medicina, Universidad Nacional de Colombia, Bogotá, D.C., Colombia.
| | - Luz Ángela Moreno
- Departamento de Radiología e Imágenes Diagnósticas, Facultad de Medicina, Universidad Nacional de Colombia, Bogotá, D.C., Colombia; Unidad Funcional de Imágenes Diagnósticas, Fundación Hospital de La Misericordia, Bogotá, D.C., Colombia.
| | - Lina Eugenia Jaramillo
- Departamento de Patología, Facultad de Medicina, Universidad Nacional de Colombia, Bogotá, D.C., Colombia; Laboratorio de Patología, Fundación Hospital de La Misericordia, Bogotá, D.C., Colombia.
| | - Edgar Vladimir Cabrera
- Servicio de Oncohematología Pediátrica, Fundación Hospital de La Misericordia, Bogotá, D.C., Colombia.
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3
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Kanakis M, Petrou P, Lourida G, Georgalas I. Erdheim-Chester disease: a comprehensive review from the ophthalmologic perspective. Surv Ophthalmol 2021; 67:388-410. [PMID: 34081930 DOI: 10.1016/j.survophthal.2021.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 05/18/2021] [Accepted: 05/24/2021] [Indexed: 01/18/2023]
Abstract
Erdheim-Chester disease (ECD) is a rare clonal histiocytic neoplasm with less than 1200 documented cases to date. The disease is life-threatening and difficult to recognize, although increasing awareness as well as the integration of clinical, imaging, pathology information , and genetic studies have led to a recent exponential increase in new reported cases. ECD affects multiple organs and systems, including skeletal, neurologic, and cardiovascular. Pulmonary, retroperitoneal, and cutaneous lesions have also been reported in various combinations. Until the discovery that more than half of ECD patients harbor the BRAF-V600E mutation or other mutations in the mitogen-activated protein kinase (MAPK) and RAS pathways, Interferon-a was the first-line treatment. Nowadays BRAF and MEK-inhibitors targeted therapies are the mainstay of treatment. Ophthalmologic involvement occurs in 25% -30% of ECD cases, usually in the form of orbital involvement presenting with exophthalmos and ophthalmoplegia. Other ophthalmologic manifestations include palpebral xanthelasmas, anterior uveitis and vitritis, optic disk edema, choroidal infiltration, recurrent serous retinal detachment, retinal drusen-like deposits and retinal pigment epithelial changes. ECD patients can also present with ocular symptoms as a result of adverse effects of the treatment regimens. In some cases with smoldering or protean symptoms, the emergence of eye manifestations triggered the diagnosis. Ophthalmologists have to be aware of the disease, recognize the constellation of ECD symptoms, and contribute to the diagnosis, treatment, and follow-up of ECD patients.
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Affiliation(s)
| | - Petros Petrou
- G. Genimatas General Hospital, National and Kapodistrian University of Athens, 1st University Eye Clinic, Athens, Greece
| | - Giota Lourida
- Department of Internal Medicine and Infectious Disease, Sotiria Hospital, Athens, Greece
| | - Ilias Georgalas
- G. Genimatas General Hospital, National and Kapodistrian University of Athens, 1st University Eye Clinic, Athens, Greece.
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4
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Stefania S, Colia R, Cinzia R, Corrado A, Cantatore FP. Off-label use of anti-IL-1 drugs in rheumatic diseases. Int J Immunopathol Pharmacol 2021; 35:20587384211006584. [PMID: 33855881 PMCID: PMC8056561 DOI: 10.1177/20587384211006584] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Interleukin-1 (IL-1) plays a key role in the pathogenesis of different rheumatic diseases. There are now several agents available on the market capable of blocking IL-1. The proven effectiveness and excellent safety of these drugs makes them a possible therapeutic option in the treatment of IL-1 driven diseases, when previous therapies are contraindicated or ineffective. This article discusses the European wide off-label use of these drugs for the treatment of rheumatic diseases.
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Affiliation(s)
- Silvia Stefania
- Rheumatology Clinic, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Ripalta Colia
- Rheumatology Clinic, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Rotondo Cinzia
- Rheumatology Clinic, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Addolorata Corrado
- Rheumatology Clinic, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Francesco Paolo Cantatore
- Rheumatology Clinic, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
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5
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Abstract
Erdheim-Chester disease (ECD) is a rare but increasingly recognized multi-system disorder. Its diagnosis and treatment require integration of clinical information, imaging studies, and pathology studies. Of note, ECD can now be defined as a clonal myeloid disorder due to mutations which activate mitogen-activated protein kinase (MAPK) pathways and where an inflammatory milieu is important in the pathogenesis and clinical manifestations of the disease. Biopsy demonstrating characteristic histopathologic features in addition to clinical and radiographic features, most often sclerosing long bone involvement, is required to establish a diagnosis. Detection of somatic MAPK pathway mutations can also assist in the differential diagnosis of ECD and related histiocytic neoplasms. Also, genetic analysis establishing BRAF and RAS mutational status is critical in all ECD patients, as these features will impact therapy with MAPK inhibition. Therapy is recommended at diagnosis in all patients, except for those patients with minimally symptomatic disease. Prospective therapeutic trials are essential to furthering therapeutic progress in ECD.
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Affiliation(s)
- Gordon Starkebaum
- University of Washington, Division of Rheumatology, 1959 NE Pacific St., Box 356428, Seattle, WA, 98195-6428, USA.
| | - Paul Hendrie
- Division of Hematology, University of Washington, 1959 NE Pacific St., Box 358081, Seattle, WA, 98195-6428, USA.
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Xia Q, Tao C, Zhu KW, Zhong WY, Li PL, Jiang Y, Mao MZ. Erdheim-Chester disease with asymmetric talus involvement: A case report. World J Clin Cases 2020; 8:614-623. [PMID: 32110674 PMCID: PMC7031838 DOI: 10.12998/wjcc.v8.i3.614] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 12/25/2019] [Accepted: 01/01/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Erdheim-Chester disease (ECD) is a rare multi-system or multi-organ histiocytic proliferative disease with diverse clinical manifestations, and the development of the disease is complex, which makes clinical diagnosis and treatment difficult. The characteristic clinical manifestations include multi-organ involvement, especially in the symmetrical diaphysis and metaphysis of the bilateral extremities. ECD with a unilateral talus lesion is extremely rare. Here, we report an unusual case of ECD invading the asymmetric talus and tibia without involving other organs. The patient had good outcome after surgery.
CASE SUMMARY We report a case of a 67-year-old man who was referred to our outpatient department because of left ankle chronic pain for 5 years, which exacerbated after a foot sprain 6 mo previously. We discovered multiple sclerotic lesions of the tibia and talus on his previous X-ray films, which were initially missed in a local hospital. Therefore, enhanced computer computed tomography (CT) and magnetic resonance imaging were performed. These examinations showed multiple lesions in the bone marrow cavity of the left tibia, and cortical sclerosis and osteonecrosis of the left talus. Specimens were collected via bone puncture from the two lesions, and a final diagnosis of ECD was confirmed by pathological and immunohistochemical examinations. In addition, other auxiliary examinations including head CT, pulmonary CT, spinal CT, abdominal CT, cardiac ultrasound and thyroid ultrasound showed no obvious abnormalities. The patient underwent surgery for the tibia lesion scraping and talus lesion scraping combined with cement casting. The patient started on a progressive rehabilitation at 4 wk, and felt no pain after surgery. During a 2-year follow-up period, the patient exercised normally without pain, and there were no signs of recurrence.
CONCLUSION This study shows that surgery treatment may also achieve good results for ECD patients with only bone involvement.
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Affiliation(s)
- Qin Xia
- Department of Orthopedics, The Second Xiangya Hospital, Central South University, Changsha 410011, Hunan Province, China
| | - Cheng Tao
- Department of Orthopedics, The Second Xiangya Hospital, Central South University, Changsha 410011, Hunan Province, China
| | - Ke-Wei Zhu
- Department of Orthopedics, The Second Xiangya Hospital, Central South University, Changsha 410011, Hunan Province, China
| | - Wei-Ye Zhong
- Department of Orthopedics, The Second Xiangya Hospital, Central South University, Changsha 410011, Hunan Province, China
| | - Peng-Lin Li
- Department of Orthopedics, The Second Xiangya Hospital, Central South University, Changsha 410011, Hunan Province, China
| | - Yi Jiang
- Department of Pathology, The Second Xiangya Hospital, Central South University, Changsha 410011, Hunan Province, China
| | - Min-Zhi Mao
- Department of Orthopedics, The Second Xiangya Hospital, Central South University, Changsha 410011, Hunan Province, China
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Franconieri F, Deshayes S, de Boysson H, Trad S, Martin Silva N, Terrier B, Bienvenu B, Galateau-Sallé F, Emile JF, Johnson AC, Aouba A. Superior efficacy and similar safety of double dose anakinra in Erdheim-Chester disease after single dose treatment. Oncoimmunology 2018; 7:e1450712. [PMID: 30221042 DOI: 10.1080/2162402x.2018.1450712] [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] [Received: 01/02/2018] [Revised: 02/13/2018] [Accepted: 03/03/2018] [Indexed: 10/17/2022] Open
Abstract
Objectives. In Erdheim-Chester disease (ECD), the empirical single dose (SD, 100 mg/day) anakinra sometimes induces only partial responses. Since SD is usually well tolerated, doubling the dose might improve response while maintaining an acceptable safety profile. Methods. A retrospective analysis was performed of outcomes under double-dose (DD) of anakinra in 4 ECD patients who did not exhibit a complete response (CR) under SD treatment. Bone, retroperitoneal, neurologic/orbital, peritoneal, pericardial, right atrium, and pleural involvements were recorded. CR, partial response (PR), stable disease, progressive disease (PD) and tolerance of DD were assessed. Results. SD treatment was a second or third line treatment in three patients after interferon-therapy failure. Two patients, including one with a BRAF mutation, achieved a CR and one patient with a NRAS mutation achieved a PR with DD treatment. The fourth patient, wild-type for both genes, did not respond to a first DD treatment, but then achieved CR under SD associated with a reduced dose of vemurafenib (960 mg/d). Bone and retroperitoneal lesions partially improved on imaging with SD in all patients, but were further improved under DD with two patients achieving CR. With SD treatment, two patients with right atrial masses showed sustained CR. Under DD treatment, two patients with massive serositis refractory to SD, showed PR. Conclusion. DD improved the response to anakinra and lead to two CRs and a PR in three out of four ECD patients, with minor and comparable side-effects to those of SD, while failures were essentially related to massive serositis.
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Affiliation(s)
- Fréderic Franconieri
- CHU de Caen, Department of Internal Medicine and Clinical Immunology, Caen, F-14000, France
| | - Samuel Deshayes
- CHU de Caen, Department of Internal Medicine and Clinical Immunology, Caen, F-14000, France
| | - Hubert de Boysson
- CHU de Caen, Department of Internal Medicine and Clinical Immunology, Caen, F-14000, France
| | - Salim Trad
- CHU Ambroise Paré - Université Paris Ouest, Department of Internal Medicine, Boulogne-Billancourt, France
| | - Nicolas Martin Silva
- CHU de Caen, Department of Internal Medicine and Clinical Immunology, Caen, F-14000, France
| | | | - Boris Bienvenu
- CHU de Caen, Department of Internal Medicine and Clinical Immunology, Caen, F-14000, France
| | - Françoise Galateau-Sallé
- National referent center MESOPATH-Base National Clinicobiologic Databasis MESOBANK Register multicenter MESONAT-Sante public cancer center of Léon Bérard, Department of Biopathology, Lyon, France
| | - Jean-François Emile
- Department of Pathology, Ambroise Paré Hospital & EA4340, Versailles, Boulogne, France
| | - Alison C Johnson
- François Baclesse Cancer Center, Department of Oncology, Caen, France
| | - Achille Aouba
- CHU de Caen, Department of Internal Medicine and Clinical Immunology, Caen, F-14000, France
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8
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Hwang JW, An CH, Lee MK, Hwang PH. Successful Treatment of Erdheim-Chester Disease with Multisystemic Involvement in a 4-year-old Child by Interferon-α and Corticosteroid. CLINICAL PEDIATRIC HEMATOLOGY-ONCOLOGY 2017. [DOI: 10.15264/cpho.2017.24.1.69] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Jung Won Hwang
- Department of Pediatrics, Chonbuk National University Medical School, Jeonju, Korea
| | - Chang Hoon An
- Department of Pediatrics, Chonbuk National University Medical School, Jeonju, Korea
| | - Min Kyung Lee
- Department of Pediatrics, Chonbuk National University Medical School, Jeonju, Korea
| | - Pyoung Han Hwang
- Department of Pediatrics, Chonbuk National University Medical School, Jeonju, Korea
- Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Korea
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9
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Cavalli G, De Luca G, Dagna L. Advances in potential targeted therapies for Erdheim-Chester disease. Expert Opin Orphan Drugs 2017. [DOI: 10.1080/21678707.2017.1285226] [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: 10/20/2022]
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10
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Váradi Z, Bánusz R, Csomor J, Kállay K, Varga E, Kertész G, Csóka M. Effective BRAF inhibitor vemurafenib therapy in a 2-year-old patient with sequentially diagnosed Langerhans cell histiocytosis and Erdheim-Chester disease. Onco Targets Ther 2017; 10:521-526. [PMID: 28182116 PMCID: PMC5279823 DOI: 10.2147/ott.s121615] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Erdheim-Chester disease (ECD) is a rare histiocytic disorder, characterized by the xanthomatous infiltration of tissues by CD68-positive and CD1a-/CD100-negative foamy histiocytes. In childhood, ECD is exceptionally rare, and only a dozen cases have been published so far. The cooccurence of Langerhans cell histiocytosis (LCH) and ECD is even rarer. Here, we report a 2-year-old boy, the youngest patient in the literature so far, who was diagnosed with concomitant BRAF mutation-positive LCH and ECD. In his case, conventional LCH treatment proved to be ineffective, but he is the youngest patient who was successfully treated with the BRAF inhibitor vemurafenib.
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Affiliation(s)
| | | | - Judit Csomor
- First Department of Pathology and Experimental Cancer Research, Semmelweis University
| | - Krisztián Kállay
- Pediatric Hematology and Stem Cell Transplantation Unit, United St István and St László Hospital, Budapest, Hungary
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Erdheim Chester disease with appendicular skeletal, renal and pleural involvement responding to Zelboraf (BRAF inhibitor) treatment: case report. Skeletal Radiol 2016; 45:1397-402. [PMID: 27423231 DOI: 10.1007/s00256-016-2431-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Revised: 06/23/2016] [Accepted: 06/27/2016] [Indexed: 02/02/2023]
Abstract
Erdheim Chester disease is a rare non-Langerhans cell histiocytosis which may involve multiple organs including bone, soft tissue, lungs, cardiovascular system, kidneys (retroperitoneum), skin, and central nervous system. Bone involvement is most common followed by other organs. This case report describes a 58-year-old man who presented with progressive renal dysfunction presumed due to obstruction. The patient failed multiple urinary tract interventions, and clinical course was complicated by recurrent low-grade fevers, and bilateral knee pain. Advanced imaging and histopathological features on bone biopsy were consistent with Erdheim Chester disease. Molecular studies of tissue showed BRAF V600 mutation. This patient was treated with Zelboraf (vemurafenib) BRAF inhibitor with subsequent improvement in renal and pleural dysfunction as well as decreased histiocytic soft tissue masses on CT.
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12
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Anakinra as efficacious therapy for 2 cases of intracranial Erdheim-Chester disease. Blood 2016; 128:1896-1898. [PMID: 27535996 DOI: 10.1182/blood-2016-06-725143] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
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13
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Franconieri F, Martin-Silva N, de Boysson H, Galateau-Salle F, Emile JF, Bienvenu B, Aouba A. Superior efficacy and tolerance of reduced doses of vemurafenib plus anakinra in Erdheim-Chester disease: Towards the paradigm of combined targeting and immune therapies. Acta Oncol 2016; 55:930-2. [PMID: 27031008 DOI: 10.3109/0284186x.2015.1120885] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Fréderic Franconieri
- Department of Internal Medicine and Clinical Immunology, CHU Côte De Nacre, Université Basse Normandie, Caen, France
| | - Nicolas Martin-Silva
- Department of Internal Medicine and Clinical Immunology, CHU Côte De Nacre, Université Basse Normandie, Caen, France
| | - Hubert de Boysson
- Department of Internal Medicine and Clinical Immunology, CHU Côte De Nacre, Université Basse Normandie, Caen, France
| | | | | | - Boris Bienvenu
- Department of Internal Medicine and Clinical Immunology, CHU Côte De Nacre, Université Basse Normandie, Caen, France
| | - Achille Aouba
- Department of Internal Medicine and Clinical Immunology, CHU Côte De Nacre, Université Basse Normandie, Caen, France
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14
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Variability in the efficacy of the IL1 receptor antagonist anakinra for treating Erdheim-Chester disease. Blood 2016; 127:1509-12. [PMID: 26847247 DOI: 10.1182/blood-2015-09-672667] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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15
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Cavalli G, Dinarello CA. Treating rheumatological diseases and co-morbidities with interleukin-1 blocking therapies. Rheumatology (Oxford) 2015. [PMID: 26209330 DOI: 10.1093/rheumatology/kev269] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
The inflammatory cytokines IL-1α and IL-1β orchestrate local and systemic inflammatory responses underlying a broad spectrum of diseases. Three agents for reducing IL-1 activities are currently available. Anakinra is a recombinant form of the naturally occurring IL-1 receptor antagonist. Anakinra binds to the IL-1 receptor and prevents the activity of IL-1α and IL-1β. The soluble decoy receptor rilonacept and the neutralizing mAb canakinumab block IL-1β. A mAb directed against the IL-1 receptor and a neutralizing anti-human IL-1α are in clinical trials. The availability of therapies specifically targeting IL-1 unveiled the pathological role of IL-1-mediated inflammation in a broadening list of diseases. Conditions effectively treated with agents blocking IL-1 range from classic rheumatic diseases, such as RA and gout, to autoinflammatory syndromes, such as systemic JIA and FMF. However, IL-1 antagonism is also effective against highly prevalent inflammatory diseases, namely cardiovascular diseases and type 2 diabetes, conditions that are frequently encountered as co-morbidities in patients with rheumatic diseases. Thereby, IL-1 inhibition has the potential to lift the burden of disease for patients with rheumatic conditions, but also to provide clinical benefits beyond the efficacy on osteoarticular manifestations.
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Affiliation(s)
- Giulio Cavalli
- Department of Medicine, University of Colorado Denver, Aurora, CO, USA, Division of Internal Medicine and Clinical Immunology, IRCCS San Raffaele Scientific Institute, Milan, Italy and
| | - Charles A Dinarello
- Department of Medicine, University of Colorado Denver, Aurora, CO, USA, Department of Internal Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands
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16
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Campochiaro C, Tomelleri A, Cavalli G, Berti A, Dagna L. Erdheim-Chester disease. Eur J Intern Med 2015; 26:223-9. [PMID: 25865950 DOI: 10.1016/j.ejim.2015.03.004] [Citation(s) in RCA: 99] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Revised: 03/09/2015] [Accepted: 03/15/2015] [Indexed: 12/30/2022]
Abstract
Erdheim-Chester disease (ECD) is rare form of non-Langerhans cells histiocytosis with multiorgan involvement. Individuals are more frequently affected in their fifth decade and there is a slight male prevalence. Recent studies have demonstrated that ECD patients bare mutations in the proto-oncogene BRAF (and more rarely in other genes involved in the MAPK activation pathway), suggesting a critical role of this pathway in the pathogenesis and a possible clonal origin of the disease. Clinical manifestations are extremely protean and virtually every organ system can be affected. The most common clinical features include skeletal involvement with typical bilateral osteosclerotic lesions of long bones of the lower limbs, diabetes insipidus, cardiovascular involvement with circumferential thickening of the aorta ("coated aorta"), and retroperitoneal fibrosis ("hairy kidney"). Cardiovascular and central nervous system (CNS) involvement are associated with the worst prognosis. Biopsy is necessary to establish a definite diagnosis with the identification of CD68+/CD1a-/S100- foamy histiocytes. Currently, interferon-α is the first-line treatment in ECD, as it has been clearly demonstrated to increase overall survival. Anakinra and infliximab have also led to encouraging results and should be taken into consideration when treatment with interferon-α fails. More recently, the BRAF-inhibitor vemurafenib has been used in small groups of ECD patients with optimal efficacy in all treated cases. Nevertheless, its adverse effects and the scanty data on its long-term efficacy and safety still discourage its use as a first-line option. Further studies are still warranted to better understand and treat this neglected and overlooked disease.
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Affiliation(s)
- Corrado Campochiaro
- Unit of Medicine and Clinical Immunology, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Alessandro Tomelleri
- Unit of Medicine and Clinical Immunology, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Giulio Cavalli
- Unit of Medicine and Clinical Immunology, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Alvise Berti
- Unit of Medicine and Clinical Immunology, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Lorenzo Dagna
- Unit of Medicine and Clinical Immunology, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy.
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Murakami I, Matsushita M, Iwasaki T, Kuwamoto S, Kato M, Nagata K, Horie Y, Hayashi K, Imamura T, Morimoto A, Imashuku S, Gogusev J, Jaubert F, Takata K, Oka T, Yoshino T. Interleukin-1 loop model for pathogenesis of Langerhans cell histiocytosis. Cell Commun Signal 2015; 13:13. [PMID: 25889448 PMCID: PMC4343072 DOI: 10.1186/s12964-015-0092-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Accepted: 02/10/2015] [Indexed: 12/13/2022] Open
Abstract
We propose Langerhans cell histiocytosis (LCH) is an inflammatory process that is prolonged by mutations. We hypothesize that Merkel cell polyomavirus (MCPyV) infection triggers an interleukin-1 (IL-1) activation loop that underlies the pathogenesis of LCH. Langerhans cells (LCs) are antigen presenting cells in the skin. When LCs encounter exogenous antigens, they migrate from the epidermis into draining lymphoid tissues to initiate T-cell activity. It has been proposed that LC migration-related factors, including E-cadherin, matrix metalloproteinase, and Notch ligand induce LCH activity. We found that the tyrosine phosphatase SHP-1, which binds IL-1 receptor-associated kinase 1, is expressed at a significantly higher level in LCH affecting multiple organ systems (MS-LCH) than in LCH affecting a single organ system (SS-LCH). IL-1 stimulates T helper 17 cells and their signature cytokine IL-17 had been a matter of controversy. We detected higher levels of IL-17A receptor expression in MS-LCH than in SS-LCH and proposed an IL-17 endocrine model that could settle the controversy. IL-1 is the first cytokine secreted in response to sensitizers and promotes LC migration from sentinel tissues. Myeloid differentiation primary response 88 (MyD88), downstream of the IL-1 receptor, has functions in both RAS signaling and inflammation, leading to human cell transformation. In 2010, an activating mutation in the B-rapidly accelerated fibrosarcoma gene (BRAF) V600E was found in LCH. This BRAF mutation induces phosphorylation of the extracellular signal-regulated kinase (ERK) that may play an important role with MyD88 in LCH pathogenesis. However, phosphorylated ERK (pERK) is rapidly dephosphorylated by dual specificity phosphatase 6 (DUSP6), and limited proliferation is predicted in BRAF mutant cells. MyD88 binds pERK via its D-domain, thereby preventing pERK-DUSP6 interaction and maintaining ERK in an active, phosphorylated state. We detected MCPyV-DNA in the peripheral blood cells of two out of three patients with LCH in high-risk organs but not in those of patients with LCH in non-high-risk organs (0/12; P = .029). MCPyV infection can trigger precursor LCH cells with BRAF mutation to produce IL-1; the IL-1 loop is amplified in all LCH subclasses. Our model indicates both BRAF mutation and IL-1 loop regulation as potential therapeutic targets.
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Affiliation(s)
- Ichiro Murakami
- Division of Molecular Pathology, Faculty of Medicine, Tottori University, 86 Nishi-cho, Yonago, 683-8503, Japan.
| | - Michiko Matsushita
- Department of Pathobiological Science and Technology, School of Health Science, Faculty of Medicine, Tottori University, Yonago, 683-8503, Japan.
| | - Takeshi Iwasaki
- Division of Molecular Pathology, Faculty of Medicine, Tottori University, 86 Nishi-cho, Yonago, 683-8503, Japan.
| | - Satoshi Kuwamoto
- Division of Molecular Pathology, Faculty of Medicine, Tottori University, 86 Nishi-cho, Yonago, 683-8503, Japan.
| | - Masako Kato
- Division of Molecular Pathology, Faculty of Medicine, Tottori University, 86 Nishi-cho, Yonago, 683-8503, Japan.
| | - Keiko Nagata
- Division of Molecular Pathology, Faculty of Medicine, Tottori University, 86 Nishi-cho, Yonago, 683-8503, Japan.
| | - Yasushi Horie
- Department of Pathology, Tottori University Hospital, Yonago, 683-8503, Japan.
| | - Kazuhiko Hayashi
- Division of Molecular Pathology, Faculty of Medicine, Tottori University, 86 Nishi-cho, Yonago, 683-8503, Japan.
| | - Toshihiko Imamura
- Department of Pediatrics, Kyoto Prefectural University of Medicine, Kyoto, 602-8566, Japan.
| | - Akira Morimoto
- Department of Pediatrics, Jichi Medical University School of Medicine, Shimotsuke, 329-0498, Japan.
| | - Shinsaku Imashuku
- Division of Pediatrics and Hematology, Takasago-seibu Hospital, Takasago, 676-0812, Japan.
| | - Jean Gogusev
- Inserm U507 and U1016, Institut Cochin, Paris, 75014, France.
| | - Francis Jaubert
- University of Paris Descartes (Paris V), Paris, 75006, France.
| | - Katsuyoshi Takata
- Department of Pathology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, 700-8530, Japan.
| | - Takashi Oka
- Department of Pathology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, 700-8530, Japan.
| | - Tadashi Yoshino
- Department of Pathology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, 700-8530, Japan.
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Clinical considerations and key issues in the management of patients with Erdheim-Chester Disease: a seven case series. BMC Med 2014; 12:221. [PMID: 25434739 PMCID: PMC4248471 DOI: 10.1186/s12916-014-0221-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Accepted: 11/03/2014] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Erdheim-Chester Disease (ECD), a non Langerhans' cell histiocytosis of orphan nature and propensity for multi-systemic presentations, comprises an intricate medical challenge in terms of diagnosis, treatment and complication management. OBJECTIVES The objectives are to report the clinical, radiological and pathological characteristics, as well as cardinal therapeutic approaches to ECD patients and to provide clinical analyses of the medical chronicles of these complex patients. METHODS Patients with biopsy proven ECD were audited by a multi-disciplinary team of specialists who formed a coherent timeline of all the substantial clinical events in the evolution of their patients' illness. RESULTS Seven patients (five men, two women) were recruited to the study. The median age at presentation was 53 years (range: 39 to 62 years). The median follow-up time was 36 months (range: 1 to 72 months). Notable ECD involvement sites included the skeleton (seven), pituitary gland (seven), retroperitoneum (five), central nervous system (four), skin (four), lungs and pleura (four), orbits (three), heart and great vessels (three) and retinae (one). Prominent signs and symptoms were fever (seven), polyuria and polydipsia (six), ataxia and dysarthria (four), bone pain (four), exophthalmos (three), renovascular hypertension (one) and dyspnea (one). The V600E BRAF mutation was verified in three of six patients tested. Interferon-α treatment was beneficial in three of six patients treated. Vemurafenib yielded dramatic neurological improvement in a BRAF mutated patient. Infliximab facilitated pericardial effusion volume reduction. Cladribine improved cerebral blood flow originally compromised by perivenous lesions. CONCLUSIONS ECD is a complex, multi-systemic, clonal entity coalescing both neoplastic and inflammatory elements and strongly dependent on impaired RAS/RAF/MEK/ERK signaling.
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Tran TA, Pariente D, Guitton C, Delwail A, Barat-Houari M, Meinzer U. Treatment of Erdheim–Chester disease with canakinumab. Rheumatology (Oxford) 2014; 53:2312-4. [DOI: 10.1093/rheumatology/keu344] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Munoz J, Janku F, Cohen PR, Kurzrock R. Erdheim-Chester disease: characteristics and management. Mayo Clin Proc 2014; 89:985-96. [PMID: 24814521 DOI: 10.1016/j.mayocp.2014.01.023] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2013] [Revised: 01/27/2014] [Accepted: 01/28/2014] [Indexed: 01/14/2023]
Abstract
Erdheim-Chester disease is a rare CD68(+), CD1a(-) non-Langerhans cell histiocytosis with multiorgan involvement. The etiology of Erdheim-Chester disease is unclear; there are no known associated infectious or hereditary genetic abnormalities. However, somatic BRAF mutations have recently been identified in these patients. Historically, the literature regarding the management of Erdheim-Chester disease consisted of case reports and small case series with anecdotal therapeutic responses to agents including, but not limited to, cytotoxic chemotherapy, bone marrow transplantation, cladribine, corticosteroids, IFN-α, the BCR-ABL/KIT inhibitor imatinib mesylate, the IL-1 receptor antagonist anakinra, the TNF-inhibitor infliximab, and recently the BRAF inhibitor vemurafenib. We performed a search of the literature using PubMed with the terms Erdheim Chester disease, without date limitations, including case reports, case series, original articles, and previous review articles. In the absence of large-scale studies, experience-based management prevails. The present review details our approach to the management of patients with Erdheim-Chester disease.
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Affiliation(s)
- Javier Munoz
- Hematology-Oncology, Banner MD Anderson Cancer Center, Gilbert, AZ.
| | - Filip Janku
- Department of Investigational Cancer Therapeutics (Phase I Clinical Trials Program), University of Texas MD Anderson Cancer Center, Houston
| | - Philip R Cohen
- Division of Dermatology, University of California, San Diego, San Diego
| | - Razelle Kurzrock
- Center for Personalized Cancer Therapy, and Division of Hematology and Oncology, University of California San Diego Moores Cancer Center, San Diego
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21
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Abstract
Erdheim-Chester disease (ECD) is a rare, non-Langerhans histiocytosis. Recent findings suggest that ECD is a clonal disorder, marked by recurrent BRAFV600E mutations in >50% of patients, in which chronic uncontrolled inflammation is an important mediator of disease pathogenesis. Although ∼500 to 550 cases have been described in the literature to date, increased physician awareness has driven a dramatic increase in ECD diagnoses over the last decade. ECD frequently involves multiple organ systems and has historically lacked effective therapies. Given the protean clinical manifestations and the lack of a consensus-derived approach for the management of ECD, we provide here the first multidisciplinary consensus guidelines for the clinical management of ECD. These recommendations were outlined at the First International Medical Symposium for ECD, comprised of a comprehensive group of international academicians with expertise in the pathophysiology and therapy of ECD. Detailed recommendations on the initial clinical, laboratory, and radiographic assessment of ECD patients are presented in addition to treatment recommendations based on critical appraisal of the literature and clinical experience. These formalized consensus descriptions will hopefully facilitate ongoing and future research efforts in this disorder.
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Darstein F, Kirschey S, Heckl S, Rahman F, Schwarting A, Schuchmann M, Galle PR, Zimmermann T. Successful treatment of Erdheim-Chester disease with combination of interleukin-1-targeting drugs and high-dose glucocorticoids. Intern Med J 2014; 44:90-2. [DOI: 10.1111/imj.12329] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Accepted: 07/07/2013] [Indexed: 12/28/2022]
Affiliation(s)
- F. Darstein
- I. Medizinische Klinik; Universitätsmedizin Mainz; Bad Kreuznach Germany
| | - S. Kirschey
- III. Medizinische Klinik; Universitätsmedizin Mainz; Bad Kreuznach Germany
| | - S. Heckl
- I. Medizinische Klinik; Universitätsmedizin Mainz; Bad Kreuznach Germany
| | - F. Rahman
- I. Medizinische Klinik; Universitätsmedizin Mainz; Bad Kreuznach Germany
| | - A. Schwarting
- I. Medizinische Klinik; Universitätsmedizin Mainz; Bad Kreuznach Germany
- Rheumazentrum; Bad Kreuznach Germany
| | - M. Schuchmann
- Zentrum für Innere Medizin; Klinikum Konstanz Konstanz Germany
| | - P. R. Galle
- I. Medizinische Klinik; Universitätsmedizin Mainz; Bad Kreuznach Germany
| | - T. Zimmermann
- I. Medizinische Klinik; Universitätsmedizin Mainz; Bad Kreuznach Germany
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Mazor RD, Manevich-Mazor M, Shoenfeld Y. Strategies and treatment alternatives in the management of Erdheim–Chester disease. Expert Opin Orphan Drugs 2013. [DOI: 10.1517/21678707.2013.847785] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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24
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Mazor RD, Manevich-Mazor M, Shoenfeld Y. Erdheim-Chester Disease: a comprehensive review of the literature. Orphanet J Rare Dis 2013; 8:137. [PMID: 24011030 PMCID: PMC3849848 DOI: 10.1186/1750-1172-8-137] [Citation(s) in RCA: 158] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Accepted: 09/04/2013] [Indexed: 12/15/2022] Open
Abstract
Erdheim-Chester Disease (ECD) is a rare form of non Langerhans' cell histiocytosis. Individuals affected by this disease are typically adults between their 5th and 7th decades of life. Males and females are almost equally affected. The multi systemic form of ECD is associated with significant morbidity, which may arise due to histiocytic infiltration of critical organ systems. Among the more common sites of involvement are the skeleton, central nervous system, cardiovascular system, lungs, kidneys (retroperitoneum) and skin. The most common presenting symptom of ECD is bone pain. The etiology of ECD is unknown yet thought to be associated with an intense TH1 immune response. It may also be associated with the V600E BRAF mutation, as described in as many as half of the patients in recent studies. Bilateral symmetric increased tracer uptake on 99mTc bone scintigraphy affecting the periarticular regions of the long bones is highly suggestive of ECD. However, definite diagnosis of ECD is established only once CD68(+), CD1a(−) histiocytes are identified within a biopsy specimen. At present, this obscure ailment embodies numerous challenges to medical science. Given its rarity, it is diagnostically elusive and requires a high level of clinical suspicion. Therapeutically, it is of limited alternatives. Currently, interferon-α is the most extensively studied agent in the treatment of ECD and serves as the first line of treatment. Treatment with other agents is based on anecdotal case reports and on the basis of biological rationale. Nevertheless, cladribine (2CDA), anakinra and vemurafenib are currently advocated as promising second line treatments for patients whose response to interferon-α is unsatisfactory. Overall, the 5 year survival of ECD is 68%. Herein, the authors mustered and brought about a panoramic consolidation of all the relevant facts regarding ECD. This work highlights the different clinical, radiological and pathological manifestations associated with ECD, the differential diagnoses, the various treatment options and the acknowledged science explaining the disease.
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Affiliation(s)
- Roei D Mazor
- The Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel Hashomer, Israel.
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Courcoul A, Vignot E, Chapurlat R. Successful treatment of Erdheim-Chester disease by interleukin-1 receptor antagonist protein. Joint Bone Spine 2013; 81:175-7. [PMID: 23953221 DOI: 10.1016/j.jbspin.2013.06.013] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Accepted: 06/28/2013] [Indexed: 11/28/2022]
Abstract
Erdheim-Chester disease is a rare non-langerhans systemic histiocytosis of unknown origin, associated with bone diseases and severe visceral complications. Therapies have been disappointing. A recombinant form of interleukin-1 receptor antagonist (anakinra) has been used in a few cases when usual treatment fails. We report a new case of successfully interleukin-1 receptor antagonist treatment in Erdheim-Chester disease.
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Affiliation(s)
- Audrey Courcoul
- Inserm UMR1033, université de Lyon, Hospices Civils de Lyon, Department of rheumatology, Pavillon F, hospital Edouard-Herriot, 5, place d'Arsonval, 69003 Lyon, France
| | - Emmanuelle Vignot
- Inserm UMR1033, université de Lyon, Hospices Civils de Lyon, Department of rheumatology, Pavillon F, hospital Edouard-Herriot, 5, place d'Arsonval, 69003 Lyon, France
| | - Roland Chapurlat
- Inserm UMR1033, université de Lyon, Hospices Civils de Lyon, Department of rheumatology, Pavillon F, hospital Edouard-Herriot, 5, place d'Arsonval, 69003 Lyon, France.
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Kornik RI, Naik HB, Lee CCR, Estrada-Veras J, Gahl WA, Cowen EW. Diabetes insipidus, bone lesions, and new-onset red-brown papules in a 42-year-old man. J Am Acad Dermatol 2013; 68:1034-8. [PMID: 23466246 DOI: 10.1016/j.jaad.2013.01.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2013] [Accepted: 01/09/2013] [Indexed: 11/16/2022]
Affiliation(s)
- Rachel I Kornik
- Dermatology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland 20892, USA
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