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Goulabchand R, Hafidi A, Van de Perre P, Millet I, Maria ATJ, Morel J, Le Quellec A, Perrochia H, Guilpain P. Mastitis in Autoimmune Diseases: Review of the Literature, Diagnostic Pathway, and Pathophysiological Key Players. J Clin Med 2020; 9:jcm9040958. [PMID: 32235676 PMCID: PMC7231219 DOI: 10.3390/jcm9040958] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Revised: 03/24/2020] [Accepted: 03/25/2020] [Indexed: 12/13/2022] Open
Abstract
Mastitis frequently affects women of childbearing age. Of all the pathological breast conditions requiring specific management, autoimmune mastitis is in the third position after infection and breast cancer. The aim of this literature review was to make a comprehensive description of autoimmune diseases targeting the mammary gland. Four main histological patterns of autoimmune mastitis are described: (i) lymphocytic infiltrates; (ii) ductal ectasia; (iii) granulomatous mastitis; and (iv) vasculitis. Our literature search found that all types of autoimmune disease may target the mammary gland: organ-specific diseases (diabetes, thyroiditis); connective tissue diseases (such as systemic erythematosus lupus or Sjögren’s syndrome); vasculitides (granulomatosis with polyangiitis, eosinophilic granulomatosis with polyangiitis, giant cell arteritis, polyarteritis nodosa, Behçet’s disease); granulomatous diseases (sarcoidosis, Crohn’s disease); and IgG4-related disease. Cases of breast-specific autoimmune diseases have also been reported, including idiopathic granulomatous mastitis. These breast-limited inflammatory diseases are sometimes the first symptom of a systemic autoimmune disease. Although autoimmune mastitis is rare, it is probably underdiagnosed or misdiagnosed. Early diagnosis may allow us to detect systemic diseases at an earlier stage, which could help to initiate a prompt, appropriate therapeutic strategy. In case of suspected autoimmune mastitis, we hereby propose a diagnostic pathway and discuss the potential pathophysiological pathways leading to autoimmune breast damage.
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Affiliation(s)
- Radjiv Goulabchand
- St Eloi Hospital, Department of Internal Medicine and Multi-Organic Diseases, Local Referral Center for Systemic and Autoimmune Diseases, 80 Avenue Augustin Fliche, F-34295 Montpellier, France; (R.G.); (A.T.J.M.); (A.L.Q.)
- Internal Medicine Department, Caremeau University Hospital, 30029 Nimes, France
- Montpellier School of Medicine, University of Montpellier, 34967 Montpellier, France (I.M.); (J.M.); (H.P.)
- Inserm U1183, Institute for Regenerative Medicine and Biotherapy, St Eloi Hospital, 80 Avenue Augustin Fliche, 34295 Montpellier, France
| | - Assia Hafidi
- Montpellier School of Medicine, University of Montpellier, 34967 Montpellier, France (I.M.); (J.M.); (H.P.)
- Gui de Chauliac Hospital, Pathology Department, 80 Avenue Augustin Fliche, 34295 Montpellier, France
| | - Philippe Van de Perre
- Pathogenesis and Control of Chronic Infections, Univ Montpellier, INSERM, EFS, Montpellier University Hospital, 34394 Montpellier, France;
| | - Ingrid Millet
- Montpellier School of Medicine, University of Montpellier, 34967 Montpellier, France (I.M.); (J.M.); (H.P.)
- Lapeyronie Hospital, Montpellier University, Medical Imaging Department, 371 Avenue du Doyen Gaston Giraud, 34295 Montpellier, France
| | - Alexandre Thibault Jacques Maria
- St Eloi Hospital, Department of Internal Medicine and Multi-Organic Diseases, Local Referral Center for Systemic and Autoimmune Diseases, 80 Avenue Augustin Fliche, F-34295 Montpellier, France; (R.G.); (A.T.J.M.); (A.L.Q.)
- Montpellier School of Medicine, University of Montpellier, 34967 Montpellier, France (I.M.); (J.M.); (H.P.)
- Inserm U1183, Institute for Regenerative Medicine and Biotherapy, St Eloi Hospital, 80 Avenue Augustin Fliche, 34295 Montpellier, France
| | - Jacques Morel
- Montpellier School of Medicine, University of Montpellier, 34967 Montpellier, France (I.M.); (J.M.); (H.P.)
- Department of Rheumatology, CHU and University of Montpellier, 34295 Montpellier, France
| | - Alain Le Quellec
- St Eloi Hospital, Department of Internal Medicine and Multi-Organic Diseases, Local Referral Center for Systemic and Autoimmune Diseases, 80 Avenue Augustin Fliche, F-34295 Montpellier, France; (R.G.); (A.T.J.M.); (A.L.Q.)
- Montpellier School of Medicine, University of Montpellier, 34967 Montpellier, France (I.M.); (J.M.); (H.P.)
| | - Hélène Perrochia
- Montpellier School of Medicine, University of Montpellier, 34967 Montpellier, France (I.M.); (J.M.); (H.P.)
- Gui de Chauliac Hospital, Pathology Department, 80 Avenue Augustin Fliche, 34295 Montpellier, France
| | - Philippe Guilpain
- St Eloi Hospital, Department of Internal Medicine and Multi-Organic Diseases, Local Referral Center for Systemic and Autoimmune Diseases, 80 Avenue Augustin Fliche, F-34295 Montpellier, France; (R.G.); (A.T.J.M.); (A.L.Q.)
- Montpellier School of Medicine, University of Montpellier, 34967 Montpellier, France (I.M.); (J.M.); (H.P.)
- Inserm U1183, Institute for Regenerative Medicine and Biotherapy, St Eloi Hospital, 80 Avenue Augustin Fliche, 34295 Montpellier, France
- Correspondence: ; Tel.: +33-467-337332
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Ihara K, Kimura M, Yamamuro M, Inoshita S. Microscopic polyangiitis associated with subarachnoid hemorrhage. J Rural Med 2019; 14:125-131. [PMID: 31191777 PMCID: PMC6545428 DOI: 10.2185/jrm.2971] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Accepted: 10/09/2018] [Indexed: 11/27/2022] Open
Abstract
Microscopic polyangiitis (MPA), an anti-neutrophil cytoplasmic antibody (ANCA)-associated
vasculitis, is a systemic disease that damages all organs through predominantly affecting
small vessels. However, few cases of MPA are related to aneurysms on medium-sized muscular
vessels, and whether subarachnoid hemorrhage (SAH) is associated with MPA is still
unclear. An 85-year-old woman with rapid progressive glomerular nephritis caused by MPA
complained of sudden severe headache due to SAH 2 days after admission and subsequently
underwent surgery. Cerebrovascular disease occurring simultaneously with MPA might result
in poor prognosis, and the complications exacerbate the condition and lead to high
mortality; thus, physicians should pay more attention to cerebral aneurysms concurrent
with MPA. Among patients with MPA, it is important to identify priority cases and
investigate the intracranial vessel environment. To the best of our knowledge, this is a
rare report about SAH associated with MPA. We recommend that the presence of
cerebrovascular disease should be considered in patients with MPA to improve their
prognosis.
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Affiliation(s)
- Katsuhito Ihara
- Department of Internal Medicine, Tokyo Metropolitan Bokutoh Hospital, Japan
| | - Makiko Kimura
- Department of Internal Medicine, Tokyo Metropolitan Bokutoh Hospital, Japan
| | - Megumi Yamamuro
- Department of Internal Medicine, Tokyo Metropolitan Bokutoh Hospital, Japan
| | - Seiji Inoshita
- Department of Internal Medicine, Tokyo Metropolitan Bokutoh Hospital, Japan
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Ren J, Liu J, Su J, Zhang J, Zhao J. Systemic vasculitis involving the breast: a case report and literature review. Rheumatol Int 2019; 39:1447-1455. [DOI: 10.1007/s00296-019-04279-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Accepted: 03/09/2019] [Indexed: 10/27/2022]
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Griffiths A, Patel A, Roth MZ. Polyarteritis Nodosum of the Breast in a Patient with History of Bilateral Augmentation Mammoplasty. Aesthetic Plast Surg 2017; 41:560-562. [PMID: 28289826 DOI: 10.1007/s00266-017-0825-z] [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: 04/07/2016] [Accepted: 01/11/2017] [Indexed: 12/26/2022]
Abstract
Polyarteritis nodosum belongs to a group of inflammatory disorders characterized by necrotizing vasculitis of small and medium-sized blood vessels. To date, there are 14 publications that document involvement of the breast. Our publication is the second study documenting polyarteritis nodosum of the breast in a patient who had previously had augmentation mammoplasty. Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Miyawaki Y, Katsuyama T, Sada KE, Taniguchi K, Kakio Y, Wada J. Development of intracerebral hemorrhage in the short-term clinical course of a patient with microscopic polyangiitis without neurological symptoms at diagnosis: an autopsy case. CEN Case Rep 2016; 5:173-178. [PMID: 28508972 DOI: 10.1007/s13730-016-0219-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Accepted: 03/24/2016] [Indexed: 11/30/2022] Open
Abstract
A 77-year-old man with high-grade fever, progressive renal dysfunction, high serum level of C-reactive protein and positive serum myeloperoxidase anti-neutrophil cytoplasmic antibody (MPO-ANCA) was diagnosed with microscopic polyangiitis with rapidly progressive glomerulonephritis, and remission induction treatment with glucocorticoids and intravenous cyclophosphamide was initiated. Although his general condition improved in a short time, intracerebral hemorrhage occurred 12 days after the initiation of treatment and emergent hematoma evacuation was performed. However, he passed away on day 14. Surprisingly, even though no clinical findings for any organs except for renal involvement was detected before his death, autopsy revealed necrotizing vasculitis affecting various systemic organs including kidney, pancreas, liver, myocardium in ventricle, adipose tissue of the left adrenal gland, small intestine, gallbladder, bronchus, prostate, testis and spleen. It is difficult to detect widespread vasculitis without clinical symptoms and signs in patients with ANCA-associated vasculitis. A whole body assessment tool is necessary to detect unexpected vital organ damage, including cerebral vessels.
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Affiliation(s)
- Yoshia Miyawaki
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kitaku, Okayama City, 700-8558, Japan
| | - Takayuki Katsuyama
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kitaku, Okayama City, 700-8558, Japan
| | - Ken-Ei Sada
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kitaku, Okayama City, 700-8558, Japan.
| | - Kohei Taniguchi
- Department of Pathology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Yuki Kakio
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kitaku, Okayama City, 700-8558, Japan
| | - Jun Wada
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kitaku, Okayama City, 700-8558, Japan
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Microscopic Polyangiitis following Silicone Exposure from Breast Implantation. Case Rep Nephrol 2014; 2014:902089. [PMID: 25386372 PMCID: PMC4216669 DOI: 10.1155/2014/902089] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Revised: 09/29/2014] [Accepted: 09/29/2014] [Indexed: 11/17/2022] Open
Abstract
We describe a case of a patient who developed microscopic polyangiitis (MPA) in the setting of exposure to silicone after breast implantation. A 57-year-old Hispanic woman was admitted to our hospital with complaints of fever, cough, and hemoptysis. She had undergone silicone breast implantation two years prior to presentation. She was diagnosed as having microscopic polyangiitis (MPA) based on acute progressive renal failure, hematuria, pulmonary hemorrhage, and positivity for myeloperoxidase-anti-neutrophil cytoplasmic antibody (ANCA). A renal biopsy performed showed focal segmental necrotizing and crescentic glomerulonephritis. The patient received high dose steroids, cyclophosphamide, and plasmapheresis with remarkable clinical response. This case report raises the possibility of the development of MPA after silicone exposure from breast implantation.
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AP-VAS 2012 case report: a case of systemic MPO-ANCA-associated vasculitis that demonstrated brain infarction and immunohistochemically MPO-positive capillaries. CEN Case Rep 2013; 2:148-153. [PMID: 28509289 DOI: 10.1007/s13730-012-0053-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2012] [Accepted: 11/25/2012] [Indexed: 10/27/2022] Open
Abstract
We present a case of an aged male with myeloperoxidase anti-neutrophil cytoplasmic autoantibody (MPO-ANCA)-associated vasculitis with onset of brain infarction that demonstrated immunohistochemically MPO-positive capillaries at autopsy. The patient initially presented with gait difficulty and right-sided weakness. Since an imaging study revealed brain infarction, he was admitted to our hospital and medicated by antiplatelet agents. Continuous fever and elevated serum C-reactive protein (CRP), hematuria of glomerular origin, renal dysfunction, and high serum titer of MPO-ANCA were detected. Systemic toxicoderma appeared, and skin biopsy revealed small-vessel vasculitis; thus, he was diagnosed with MPO-ANCA-associated vasculitis. Steroid therapy (methylprednisolone 30 mg/day) was started, and general status improved. However, he died of shock 6 days after the start of the therapy. Autopsy revealed massive retroperitoneal hemorrhage with necrotizing small-vessel vasculitis in systemic organs including retroperitoneum, skin, brain, testes, and kidneys. Immunohistochemically, infiltration of MPO-positive white blood cells into the capillaries was occasionally observed, along with the features of MPO-positive capillaries. Cerebrovascular involvement of MPO-ANCA-associated vasculitis is rare compared with renal and pulmonary manifestations, having been reported to occur in up to 4 % of patients. Furthermore, as we have recently reported, MPO-immunopositive capillaries may appear only during the hyperacute stage of the disease. Therefore, the present case represents the unique combination of these two rare manifestations.
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Jara LJ, Medina G, Gómez-Bañuelos E, Saavedra MA, Vera-Lastra O. Still's disease, lupus-like syndrome, and silicone breast implants. A case of 'ASIA' (Shoenfeld's syndrome). Lupus 2012; 21:140-5. [PMID: 22235044 DOI: 10.1177/0961203311430970] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In recent years, four conditions, siliconosis, Gulf War syndrome (GWS), macrophagic myofasciitis syndrome (MMF) and post-vaccination phenomena, were linked to a previous exposure to an adjuvant, suggesting a common denominator, and it has been proposed to incorporate comparable conditions under a common syndrome entitled Autoimmune/inflammatory Syndrome Induced by Adjuvants (ASIA). We report a case of a female who at the age of 11 years was diagnosed with Still's disease. At the age of 22 she underwent silicone breast implants and presented with a transient lupus-like syndrome. Then, at 25 years old she had a severe activation of Still's disease in association with rupture of silicone breast implants. When the prostheses were removed, the clinical picture improved. This case fulfills the criteria for ASIA and complements seven previous reports of Still's disease in association with silicone breast implants.
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Affiliation(s)
- L J Jara
- Hospital de Especialidades Centro Medico La Raza, IMSS, Mexico City, Mexico.
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Kotton DN, Muse VV, Nishino M. Case records of the Massachusetts General Hospital. Case 2-2012. A 63-year-old woman with dyspnea and rapidly progressive respiratory failure. N Engl J Med 2012; 366:259-69. [PMID: 22256809 DOI: 10.1056/nejmcpc1109274] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Saline Breast Implant Fluid Collection and Reactive Arthritis in a Patient With Streptococcal Toxic Shock Syndrome. J Clin Rheumatol 2011; 17:89-91. [DOI: 10.1097/rhu.0b013e31820edb9d] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Nagasaka T, Miyamoto J, Ishibashi M, Chen KR. MPO-ANCA- and IgA-positive systemic vasculitis: a possibly overlapping syndrome of microscopic polyangiitis and Henoch-Schoenlein purpura. J Cutan Pathol 2009; 36:871-7. [DOI: 10.1111/j.1600-0560.2008.01145.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Backovic A, Wolfram D, Del-Frari B, Piza H, Huber LA, Wick G. Simultaneous analysis of multiple serum proteins adhering to the surface of medical grade polydimethylsiloxane elastomers. J Immunol Methods 2007; 328:118-27. [PMID: 17920619 DOI: 10.1016/j.jim.2007.08.016] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2007] [Revised: 07/24/2007] [Accepted: 08/29/2007] [Indexed: 11/28/2022]
Abstract
Although polydimethylsiloxane (PDMS, silicone) elastomers are presumed to be chemically inert and of negligible toxicity, they induce a prompt acute inflammatory response with subsequent fibrotic reactions. Since local inflammatory and fibrotic side effects are associated with the proteinaceous film on the surface of silicone implants, the process of protein adherence to silicone is of practical medical relevance, and interesting from theoretical, clinical and biotechnological perspectives. It is hypothesized that the systemic side effects resembling rheumatoid and other connective tissue diseases may be triggered by local immunological changes, but this functional relationship has yet to be defined. Because the proteinaceous film on the surface of silicone has been identified as a key player in the activation of host defense mechanisms, we propose a test system based on a proteomics screen to simultaneously identify proteins adsorbed from serum to the surface of silicone. Herein, we describe protein adsorption kinetics on the surface of silicone implants, correlate the adhesion properties of serum proteins with the occurrence of adverse reactions to silicone, and successfully discriminate their signature on the silicone surface in a blinded study of patients suffering from fibrotic reactions (as determined by Baker scale) to silicone implants.
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Affiliation(s)
- Aleksandar Backovic
- Division for Experimental Pathophysiology and Immunology, Biocenter, Innsbruck Medical University, Fritz-Pregl Str 3/4, A-6020, Innsbruck, Austria.
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