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Shi ML, Guan EQ, Zhang RY. Advances in the diagnosis and treatment of Evans syndrome in children. Asian J Surg 2023; 46:4823-4825. [PMID: 37316342 DOI: 10.1016/j.asjsur.2023.05.121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 05/25/2023] [Indexed: 06/16/2023] Open
Affiliation(s)
- Meng-Li Shi
- Department of Pediatrics, Affiliated Hospital of Weifang Medical University, School of Clinical Medicine, Weifang Medical University, Weifang, 261053, China
| | - En-Qin Guan
- Department of Pediatrics, Qingdao Hospital, University of Health and Rehabilitation Sciences (Qingdao Municipal Hospital), Qingdao, 266011, China
| | - Rui-Yun Zhang
- Department of Pediatrics, Qingdao Hospital, University of Health and Rehabilitation Sciences (Qingdao Municipal Hospital), Qingdao, 266011, China.
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Li JC, Tadros S, Rosser F, Torok KS. Pulmonary Nodules in Juvenile Systemic Sclerosis: A Case-Series from the National Registry for Childhood Onset Scleroderma (NRCOS). Diagnostics (Basel) 2023; 13:2103. [PMID: 37370998 PMCID: PMC10297561 DOI: 10.3390/diagnostics13122103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 06/09/2023] [Accepted: 06/12/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND Juvenile systemic sclerosis (jSSc) is a systemic inflammatory and fibrotic autoimmune disease. Adult guidelines recommend obtaining a screening high-resolution computed tomography scan (CT) at diagnosis. As these recommendations are adopted as standard of care for jSSc, increased screening with CT may lead to increased detection of nodules. The implications of nodules identified in jSSc are unclear and unreported. METHODS A retrospective chart review was performed on the prospectively enrolled National Registry for Childhood-Onset Scleroderma (NRCOS) cohort over an enrollment period of 20 years. Clinical associations with presence of nodules and nodule characteristics were investigated. RESULTS In this jSSc cohort, the prevalence of pulmonary nodules was 31% (n = 17 of 54). Nodule characteristics were heterogeneous, and most displayed stability over time. More participants with nodules had structural esophageal abnormalities, restriction, and reduced diffusing capacity on lung function tests, and follow-up imaging. Most participants had multiple nodules, and although most nodules were <5 mm, most participants had at least one nodule >5 mm. CONCLUSIONS Pulmonary nodules are seen in children with jSSc and may be related to more severe disease and/or esophageal dysfunction. More work is needed to provide guidance on radiologic follow-up and clinical management of pulmonary nodules in jSSc.
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Affiliation(s)
- Jonathan C. Li
- UPMC Internal Medicine and Pediatrics Residency Program, University of Pittsburgh, Pittsburgh, PA 15224, USA
| | - Sameh Tadros
- Department of Pediatrics, Division of Radiology, School of Medicine, University of Pittsburgh, Pittsburgh, PA 15224, USA
| | - Franziska Rosser
- Department of Pediatrics, Division of Pulmonary Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA 15224, USA
| | - Kathryn S. Torok
- Department of Pediatrics, Division of Rheumatology, School of Medicine, University of Pittsburgh, Pittsburgh, PA 15224, USA
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Pincez T, Fernandes H, Leblanc T, Michel G, Barlogis V, Bertrand Y, Neven B, Chahla WA, Pasquet M, Guitton C, Marie-Cardine A, Pellier I, Armari-Alla C, Benadiba J, Blouin P, Jeziorski E, Millot F, Paillard C, Thomas C, Cheikh N, Bayart S, Fouyssac F, Piguet C, Deparis M, Briandet C, Dore E, Picard C, Rieux-Laucat F, Landman-Parker J, Leverger G, Aladjidi N. Long term follow-up of pediatric-onset Evans syndrome: broad immunopathological manifestations and high treatment burden. Haematologica 2021; 107:457-466. [PMID: 33440924 PMCID: PMC8804581 DOI: 10.3324/haematol.2020.271106] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Indexed: 11/12/2022] Open
Abstract
Pediatric-onset Evans syndrome (pES) is defined by both immune thrombocytopenic purpura (ITP) and autoimmune hemolytic anemia (AIHA) before the age of 18 years. There have been no comprehensive long-term studies of this rare disease, which can be associated to various immunopathological manifestations (IM). We report outcomes of the 151 patients with pES and more than 5 years of follow-up from the nationwide French prospective OBS’CEREVANCE cohort. Median age at final follow-up was 18.5 years (range, 6.8–50.0 years) and the median follow-up period was 11.3 years (range, 5.1–38.0 years). At 10 years, ITP and AIHA were in sustained complete remission in 54.5% and 78.4% of patients, respectively. The frequency and number of clinical and biological IM increased with age: at the age of 20 years, 74% had at least one clinical IM (cIM). A wide range of cIM occurred, mainly lymphoproliferation, dermatological, gastrointestinal/hepatic and pneumological IM. The number of cIM was associated with a subsequent increase in the number of second-line treatments received (other than steroids and immunoglobulins; hazard ratio 1.4, 95% Confidence Interval: 1.15–1.60, P=0.0002, Cox proportional hazards method). Survival at 15 years after diagnosis was 84%. Death occurred at a median age of 18 years (range, 1.7–31.5 years), and the most frequent cause was infection. The number of second-line treatments and severe/recurrent infections were independently associated with mortality. In conclusion, long-term outcomes of pES showed remission of cytopenias but frequent IM linked to high second-line treatment burden. Mortality was associated to drugs and/or underlying immunodeficiencies, and adolescents-young adults are a high-risk subgroup.
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Affiliation(s)
- Thomas Pincez
- Centre de Référence National des Cytopénies Auto-immunes de l'Enfant (CEREVANCE), Bordeaux, France; Division of Pediatric Hematology-Oncology, Charles-Bruneau Cancer Center, Department of Pediatrics, Sainte-Justine University Hospital, Université de Montréal, Montréal, Québec
| | - Helder Fernandes
- Centre de Référence National des Cytopénies Auto-immunes de l'Enfant (CEREVANCE), Bordeaux, France; Pediatric Oncology Hematology Unit, University Hospital, Plurithématique CIC (CICP), Centre d'Investigation Clinique (CIC) 1401, INSERM Bordeaux
| | - Thierry Leblanc
- Pediatric Hematology Unit, Robert Debré University Hospital, AP-HP, Paris
| | - Gérard Michel
- Department of Pediatric Hematology, La Timone Hospital, Marseille University Hospital, Marseille
| | - Vincent Barlogis
- Department of Pediatric Hematology, La Timone Hospital, Marseille University Hospital, Marseille
| | - Yves Bertrand
- Institute of Pediatric Hematology and Oncology, Lyon University Hospital, Lyon
| | - Bénédicte Neven
- Pediatric Immuno-Hematology and Rheumatology Department, Necker-Enfants Malades University Hospital, AP-HP, Paris, France; Laboratory of Immunogenetics of Pediatric Autoimmune Diseases, Paris, France; Imagine Institute, UMR 1163 INSERM and Paris University, Paris
| | - Wadih Abou Chahla
- Department of Pediatric Hematology, Jeanne de Flandre Hospital, Lille University Hospital, Lille
| | - Marlène Pasquet
- Pediatric Oncology Immunology Hematology Unit, Children's University Hospital, Toulouse
| | - Corinne Guitton
- Department of Pediatrics, Bicêtre University Hospital, AP-HP, Le Kremlin-Bicêtre
| | - Aude Marie-Cardine
- Department of Pediatric Hematology and Oncology, Rouen University Hospital, Rouen
| | | | | | - Joy Benadiba
- Department of Hemato-Oncology Pediatric, Nice University Hospital, Nice
| | - Pascale Blouin
- Department of Pediatric Hematology-Oncology, Clocheville Hospital, Tours University Hospital, Tours
| | - Eric Jeziorski
- Pediatric Oncology Hematology Unit, Arnaud de Villeneuve University Hospital, Montpellier
| | - Frédéric Millot
- Department of Pediatric Hematology, Poitiers University Hospital, Poitiers
| | - Catherine Paillard
- Department of Pediatric Hematology and Oncology, Hautepierre University Hospital, Strasbourg
| | - Caroline Thomas
- Pediatric Hematology Unit, Nantes University Hospital, Nantes
| | - Nathalie Cheikh
- Department of Pediatric Hematology-Oncology, Besanc_on University Hospital, Besanc_on
| | - Sophie Bayart
- Pediatric Hematology Unit, Rennes University Hospital, Rennes
| | - Fanny Fouyssac
- Pediatric Hematology Unit, Nancy University Hospital, Nancy
| | - Christophe Piguet
- Pediatric Oncology Hematology Unit, Limoges University Hospital, Limoges
| | - Marianna Deparis
- Pediatric Oncology-Hematology Unit Department, Caen University Hospital, Caen
| | | | - Eric Dore
- Pediatric Unit, Clermont-Ferrand University Hospital, Clermont-Ferrand
| | - Capucine Picard
- Imagine Institute, UMR 1163 INSERM and Paris University, Paris, France; Study Center for Primary Immunodeficiencies, Necker-Enfants Malades University Hospital, AP-HP, Paris
| | - Frédéric Rieux-Laucat
- Laboratory of Immunogenetics of Pediatric Autoimmune Diseases, Paris, France; Imagine Institute, UMR 1163 INSERM and Paris University, Paris
| | - Judith Landman-Parker
- Pediatric Oncology Immunology Hematology Unit, Armand-Trousseau University Hospital, AP-HP, Paris
| | - Guy Leverger
- Pediatric Oncology Immunology Hematology Unit, Armand-Trousseau University Hospital, AP-HP, Paris
| | - Nathalie Aladjidi
- Centre de Référence National des Cytopénies Auto-immunes de l'Enfant (CEREVANCE), Bordeaux, France; Pediatric Oncology Hematology Unit, University Hospital, Plurithématique CIC (CICP), Centre d'Investigation Clinique (CIC) 1401, INSERM Bordeaux.
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Salehizadeh S, Naser Moghadasi A, Sahrain MA. The co-occurrence of multiple sclerosis and Evans syndrome: A case report. CASPIAN JOURNAL OF INTERNAL MEDICINE 2020; 11:343-345. [PMID: 32874446 PMCID: PMC7442462 DOI: 10.22088/cjim.11.3.343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 04/24/2019] [Accepted: 04/27/2019] [Indexed: 12/04/2022]
Abstract
BACKGROUND Evans syndrome is an uncommon autoimmune disorder manifested by fatigue, jaundice, pallor, purpura and petechiae. The main characteristics of this rare disease are simultaneous or sequential existence of positive anti-globulin test, immune thrombocytopenia (ITP) and autoimmune hemolytic anemia (AIHA). Evans syndrome as an autoimmune disorder can be associated with other diseases. The concomitancy of Evans syndrome and multiple sclerosis (MS) has not been reported so far. In this case study, a -21-year old male with concomitant Evans syndrome and MS has been reported. CASE PRESENTATION A 21-year-old male of Iranian origin and known case of Evans syndrome, was referred to our hospital for better evaluation. Evans syndrome was presented with acute jaundice, purpura, petechiae, and easy bruising when he was 9.He was under treatment of corticosteroid and cytotoxic agents, and presented with left lower extremity paresis for 5 months before admission to our hospital. According to neuroimaging and pathologic results, multiple sclerosis (MS) was diagnosed. Hence, we decided to treat the patient with rituximab. The patient has been stable without any further exacerbation or increase in disability progression after 2 years from diagnosis. CONCLUSION Evans syndrome can be associated with other autoimmune disorders. For our case, we have reported this association with MS.
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Affiliation(s)
- Saeideh Salehizadeh
- Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Abdorreza Naser Moghadasi
- Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Ali Sahrain
- Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
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Abstract
BACKGROUND Signal Transducer and Activator of Transcription 3 (STAT3) gain-of-function germline mutations are associated with diverse clinical manifestations, including autoimmune cytopenia, lymphadenopathy, immunodeficiency, endocrinopathy, and enteropathy. We describe a new feature: raised intracranial pressure with papilledema. MATERIALS AND METHODS Report of two cases. RESULTS The first patient had a de novo heterozygous c.2144C>T (p.Pro715Leu) mutation in the STAT3 gene. At age 1 she had papilledema with marked sheathing of the proximal vessels on the optic discs. Follow-up 8 years later showed chronic papilledema, cystoid macular edema, and vision loss. The second patient had a de novo heterozygous c.2147C>T (p.Thr716Met) mutation. At age 12 he developed papilledema, which recurred despite treatment. In both patients, repeated sampling of the cerebrospinal fluid demonstrated a lymphocytic pleocytosis. CONCLUSIONS Papilledema can occur as a manifestation of STAT3 gain-of-function mutation, sometimes accompanied by prominent vascular sheathing and cystoid macular edema. The mechanism may be chronic meningeal infiltration by white blood cells, impairing cerebrospinal fluid absorption.
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Affiliation(s)
- Young-Woo Suh
- a Department of Ophthalmology , Korea University College of Medicine , Seoul , South Korea.,b Beckman Vision Center, Program in Neuroscience , University of California , San Francisco , CA , USA
| | - Jonathan C Horton
- b Beckman Vision Center, Program in Neuroscience , University of California , San Francisco , CA , USA
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