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Sherri A, Mortada MM, Makowska J, Lewandowska-Polak A. Primary angiitis of the CNS and ANCA-associated vasculitis: from pathology to treatment. Rheumatol Int 2024; 44:211-222. [PMID: 37777632 PMCID: PMC10796583 DOI: 10.1007/s00296-023-05461-9] [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: 07/26/2023] [Accepted: 09/03/2023] [Indexed: 10/02/2023]
Abstract
Vasculitis of the central nervous system can be a localized process, such as primary angiitis of the central nervous system (PACNS), or systemic vasculitis, such as ANCA-associated vasculitis (AAV). Since both conditions share neurological manifestations, the following review will discuss the neurological aspects of both. This review aims to provide a comprehensive comparison of the pathogenesis, clinical manifestation and assessment, diagnostic workup, and treatment protocol for both PACNS and AAV with central nervous system involvement. To provide a comprehensive comparison and update, a literature review was conducted using PubMed and Ovid databases (Embase and Medline). Then, the references were retrieved, screened, and selected according to the inclusion and exclusion criteria. PACNS and AAV share similarities in clinical presentation and neurological symptoms, especially in terms of headache, focal deficits, and cognitive impairment. Additionally, both conditions may exhibit similarities in laboratory and radiological findings, making brain biopsy the gold standard for differentiation between the two conditions. Moreover, the treatment protocols for PACNS and AAV are nearly identical. Comparing PACNS and AAV with CNS involvement highlights the similarities in clinical presentation, radiological findings, and treatment protocols between the two conditions. Further research should focus on establishing a practical diagnostic protocol.
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Affiliation(s)
- Alaa Sherri
- Department of Rheumatology, Medical University of Lodz, Łódź, Poland.
| | | | - Joanna Makowska
- Department of Rheumatology, Medical University of Lodz, Łódź, Poland
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2
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Calatroni M, Consonni F, Allinovi M, Bettiol A, Jawa N, Fiasella S, Curi D, Abu Rumeileh S, Tomei L, Fortunato L, Gelain E, Gianfreda D, Oliva E, Jeannin G, Salviani C, Emmi G, Bodria M, Sinico RA, Moroni G, Ramirez GA, Bozzolo E, Tombetti E, Monti S, Bracaglia C, Marucci G, Pastore S, Esposito P, Catanoso MG, Crapella B, Montini G, Roperto R, Materassi M, Rossi GM, Badalamenti S, Yeung RS, Romagnani P, Ghiggeri GM, Noone D, Vaglio A. Prognostic Factors and Long-Term Outcome with ANCA-Associated Kidney Vasculitis in Childhood. Clin J Am Soc Nephrol 2021; 16:1043-1051. [PMID: 34039568 PMCID: PMC8425616 DOI: 10.2215/cjn.19181220] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 04/21/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND OBJECTIVES ANCA-associated vasculitis is extremely rare in children. We report the clinicopathologic features, long-term outcomes, and prognostic factors of a large pediatric cohort of patients with ANCA-associated kidney vasculitis. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS This retrospective study included 85 consecutive patients with kidney biopsy specimen-proven ANCA-associated vasculitis from tertiary referral centers in Italy and Canada. Kidney biopsy specimens were categorized as focal, crescentic, sclerotic, or mixed, according to the Berden classification. The prognostic significance of baseline clinical, laboratory, and histologic findings was analyzed with respect to kidney failure or CKD stage 3-5/kidney failure. RESULTS A total of 53 patients had microscopic polyangiitis (62%), and 32 had granulomatosis with polyangiitis (38%). Rapidly progressive GN was the most frequent presentation (39%); a third of the patients also had nephrotic-range proteinuria. Kidney biopsy specimens were classified as focal in 21% of the patients, crescentic in 51%, sclerotic in 15%, and mixed in 13%. Remission-induction therapies included cyclophosphamide in 78% of patients. A total of 25 patients (29%) reached kidney failure. The median (interquartile range) time to kidney failure or last follow-up was 35 (6-89) months in the whole cohort, and 73 (24-109) months among the patients who did not reach this outcome. Patients whose biopsy specimens showed sclerotic histology had significantly shorter kidney survival (hazard ratio, 11.80; 95% confidence interval, 2.49 to 55.99) and survival free of CKD stage 3-5 (hazard ratio, 8.88; 95% confidence interval, 2.43 to 32.48), as compared with those with focal/mixed histology. Baseline eGFR, low serum albumin, hypertension, central nervous system complications, and sclerotic histology, which reflected severe kidney involvement, were associated with both kidney failure and CKD stage 3-5/kidney failure at unadjusted analysis; no independent prognostic factors emerged at multivariable analysis. CONCLUSIONS Children with ANCA-associated kidney vasculitis often have aggressive presentation; a third of such children progress to kidney failure and this usually occurs early during follow-up. A severe clinical presentation is associated with the development of CKD or kidney failure.
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Affiliation(s)
- Marta Calatroni
- Nephrology Unit, Humanitas Clinical and Research Center, Rozzano, Italy
| | - Filippo Consonni
- Department of Health Sciences, University of Florence, Florence, Italy
| | | | - Alessandra Bettiol
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Natasha Jawa
- Division of Nephrology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Susanna Fiasella
- Nephrology and Dialysis Unit, Meyer Children’s Hospital, Florence, Italy
| | - Dritan Curi
- Nephrology and Dialysis Unit, Meyer Children’s Hospital, Florence, Italy
| | | | - Leonardo Tomei
- Department of Health Sciences, University of Florence, Florence, Italy
| | - Laura Fortunato
- Nephrology and Dialysis Unit, Meyer Children’s Hospital, Florence, Italy
| | - Elena Gelain
- Nephrology and Dialysis Unit, Meyer Children’s Hospital, Florence, Italy
| | | | - Elena Oliva
- Nephrology Unit, Riuniti Hospital Marche, Ancona, Italy
| | - Guido Jeannin
- Nephrology Unit, Spedali Civili Hospital, Brescia, Italy
| | | | - Giacomo Emmi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Monica Bodria
- Laboratory of Molecular Nephrology and Division of Nephrology and Transplantation, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Giannina Gaslini Institute, Genoa, Italy
| | - Renato A. Sinico
- Laboratory of Molecular Nephrology and Division of Nephrology and Transplantation, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Giannina Gaslini Institute, Genoa, Italy
| | | | - Giuseppe A. Ramirez
- Nephrology Unit, IRCCS Ca 'Granda Foundation Maggiore Policlinico Hospital, Milan, Italy
| | - Enrica Bozzolo
- Nephrology Unit, IRCCS Ca 'Granda Foundation Maggiore Policlinico Hospital, Milan, Italy
| | - Enrico Tombetti
- Nephrology Unit, IRCCS Ca 'Granda Foundation Maggiore Policlinico Hospital, Milan, Italy
| | - Sara Monti
- Unit of Immunology, Allergy, Rheumatology and Rare Disease, San Raffaele Hospital, Milan, Italy
| | - Claudia Bracaglia
- Department of Rheumatology, IRCCS Policlinico S. Matteo Foundation, University of Pavia, Pavia, Italy
| | - Giulia Marucci
- Department of Rheumatology, IRCCS Policlinico S. Matteo Foundation, University of Pavia, Pavia, Italy
| | - Serena Pastore
- Division of Rheumatology, IRCCS Bambino Gesù Children’s Hospital, Rome, Italy
| | - Pasquale Esposito
- Institute for Maternal and Child Health, IRCCS Burlo Garofolo Hospital, Trieste, Italy
| | - Maria G. Catanoso
- Unit of Nephrology, Dialysis and Transplantation, Department of Internal Medicine, University of Genoa and Ospedale Policlinico San Martino–IRCCS, Genoa, Italy
| | - Barbara Crapella
- Rheumatology Unit, IRCCS Reggio Emilia Hospital, Reggio Emilia, Italy
| | - Giovanni Montini
- Rheumatology Unit, IRCCS Reggio Emilia Hospital, Reggio Emilia, Italy
| | - Rosa Roperto
- Pediatric Nephrology, Dialysis and Transplant Unit, IRCCS Ca 'Granda Foundation Maggiore Policlinico Hospital, Milan, Italy
| | - Marco Materassi
- Pediatric Nephrology, Dialysis and Transplant Unit, IRCCS Ca 'Granda Foundation Maggiore Policlinico Hospital, Milan, Italy
| | - Giovanni M. Rossi
- Department of Biomedical, Experimental and Clinical Sciences “Mario Serio,” University of Florence, Florence, Italy
| | | | - Rae S.M. Yeung
- Nephrology Unit, Parma University Hospital, Parma, Italy
| | - Paola Romagnani
- Nephrology and Dialysis Unit, Meyer Children’s Hospital, Florence, Italy
- Department of Biomedical, Experimental and Clinical Sciences “Mario Serio,” University of Florence, Florence, Italy
| | - Gian M. Ghiggeri
- Laboratory of Molecular Nephrology and Division of Nephrology and Transplantation, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Giannina Gaslini Institute, Genoa, Italy
| | - Damien Noone
- Division of Nephrology, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Augusto Vaglio
- Nephrology and Dialysis Unit, Meyer Children’s Hospital, Florence, Italy
- Pediatric Translational Research Chair, University of Toronto, Toronto, Ontario, Canada
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3
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Fukuchi M, Kamide Y, Ueki S, Miyabe Y, Konno Y, Oka N, Takeuchi H, Koyota S, Hirokawa M, Yamada T, Melo RCN, Weller PF, Taniguchi M. Eosinophil ETosis-Mediated Release of Galectin-10 in Eosinophilic Granulomatosis With Polyangiitis. Arthritis Rheumatol 2021; 73:1683-1693. [PMID: 33750029 DOI: 10.1002/art.41727] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 03/04/2021] [Indexed: 01/02/2023]
Abstract
OBJECTIVE Eosinophils are tissue-dwelling immune cells. Accumulating evidence indicates that a type of cell death termed ETosis is an important cell fate involved in the pathophysiology of inflammatory diseases. Although the critical role of eosinophils in eosinophilic granulomatosis with polyangiitis (EGPA; formerly Churg-Strauss syndrome) is well established, the presence of eosinophil ETosis (EETosis) is poorly understood. We undertook this study to better understand the characteristics of EETosis. METHODS In vitro studies using blood-derived eosinophils were conducted to characterize EETosis. The occurrence of EETosis in tissues from patients with EGPA was studied by immunostaining and electron microscopy. Serum concentrations of eosinophil-derived proteins in healthy controls, patients with asthma, and EGPA patients with active disease or with disease in remission (n = 15 per group) were examined. RESULTS EETosis was reliant on reactive oxygen species and peptidylarginine deiminase type 4-dependent histone citrullination, resulting in the cytolytic release of net-like eosinophil extracellular traps, free galectin-10, and membrane-bound intact granules. The signature of EETosis, including loss of cytoplasmic galectin-10 and deposition of granules, was observed in eosinophils infiltrating various tissues from EGPA patients. Serum eosinophil granule proteins and galectin-10 levels were increased in EGPA and positively correlated with disease activity as assessed by the Birmingham Vasculitis Activity Score (r = 0.8531, P < 0.0001 for galectin-10). When normalized to blood eosinophil counts, this correlation remained for galectin-10 (r = 0.7168, P < 0.0001) but not for granule proteins. Galectin-10 levels in active EGPA positively correlated with serum interleukin-5 levels. CONCLUSION Eosinophils infiltrating diseased tissues in EGPA undergo EETosis. Considering the exclusive expression and large pool of cytoplasmic galectin-10 in eosinophils, elevated serum galectin-10 levels in patients with EGPA might reflect the systemic occurrence of cytolytic EETosis.
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Affiliation(s)
| | | | | | | | | | - Nobuyuki Oka
- Kyoto Konoe Rehabilitation Hospital, Kyoto, Japan
| | | | | | | | | | - Rossana C N Melo
- Federal University of Juiz de Fora, Juiz de Fora, Brazil, and Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, United States
| | - Peter F Weller
- Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, United States
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4
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de Moreuil C, Rouvière B, Rezig S, Le Duc-Pennec A, Quintin-Roué I, Bressollette L, Hoffmann C. An atypical lower limb pain revealing a possible systemic venous vasculitis. JOURNAL OF CLINICAL ULTRASOUND : JCU 2021; 49:164-166. [PMID: 32329519 DOI: 10.1002/jcu.22853] [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: 02/23/2020] [Revised: 04/10/2020] [Accepted: 04/12/2020] [Indexed: 06/11/2023]
Abstract
We describe a possible systemic vasculitis involving electively large veins. The patient presented with severe febrile lower limb pain. Diagnosis was made by color Doppler ultrasound (CDU) and confirmed by anatomopathological examination of the long saphenous vein, but not by examination of the temporal artery which was normal. CDU found a unilateral halo sign of one temporal artery and a major wall swelling of the lower limb proximal deep veins. The etiology of this possible vasculitis is still unknown. It could be an unusual clinical presentation of giant cell arteritis with vein involvement but without proven arterial involvement. To confirm this hypothesis, it would be interesting to look systematically for lower limb vein thickening with CDU in patients newly diagnosed with giant cell arteritis who have lower limb pain.
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Affiliation(s)
- Claire de Moreuil
- Département de médecine vasculaire, médecine interne et pneumologie, CHU de Brest, Hôpital La Cavale Blanche, Brest Cedex, France
- EA 3878, GETBO, Université Bretagne Loire, Brest Cedex, France
| | - Bénédicte Rouvière
- Département de médecine vasculaire, médecine interne et pneumologie, CHU de Brest, Hôpital La Cavale Blanche, Brest Cedex, France
| | - Schéhérazade Rezig
- Service de Maladies infectieuses et tropicales, CHU de Brest, Hôpital La Cavale Blanche, Brest Cedex, France
| | - Alexandra Le Duc-Pennec
- Département de médecine nucléaire, CHU de Brest, Hôpital La Cavale Blanche, Brest Cedex, France
| | | | - Luc Bressollette
- Département de médecine vasculaire, médecine interne et pneumologie, CHU de Brest, Hôpital La Cavale Blanche, Brest Cedex, France
- EA 3878, GETBO, Université Bretagne Loire, Brest Cedex, France
| | - Clément Hoffmann
- Département de médecine vasculaire, médecine interne et pneumologie, CHU de Brest, Hôpital La Cavale Blanche, Brest Cedex, France
- EA 3878, GETBO, Université Bretagne Loire, Brest Cedex, France
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5
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Alberici F, Bonatti F, Adorni A, Daminelli G, Sinico RA, Gregorini G, Marvisi C, Fenaroli P, Peyronel F, Maritati F, Palmisano A, Urban ML, Percesepe A, Emmi G, Martorana D, Vaglio A. FCGR3B polymorphism predicts relapse risk in eosinophilic granulomatosis with polyangiitis. Rheumatology (Oxford) 2021; 59:3563-3566. [PMID: 32375167 DOI: 10.1093/rheumatology/keaa134] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 02/19/2020] [Accepted: 02/24/2020] [Indexed: 12/29/2022] Open
Affiliation(s)
- Federico Alberici
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia.,Nephrology Unit, ASST Spedali Civili, Brescia
| | | | - Alessia Adorni
- Hematology and Clinical Immunology, Department of Medicine, University of Perugia, Perugia
| | - Giulia Daminelli
- Department of Biomedical and Clinical Sciences "L. Sacco", University of Milano, Milano
| | - Renato A Sinico
- Department of Medicine and Surgery, University of Milano Bicocca, ASST Monza, Milano/Monza
| | | | - Chiara Marvisi
- Rheumatology Unit, University of Modena and Reggio Emilia, Reggio Emilia
| | | | | | - Federica Maritati
- Nephrology, Dialysis and Renal Transplantation Unit, University Hospital "Ospedali Riuniti" of Ancona, Ancona
| | | | - Maria Letizia Urban
- Department of Experimental and Clinical Medicine, University of Florence, Florence
| | | | - Giacomo Emmi
- Department of Experimental and Clinical Medicine, University of Florence, Florence
| | - Davide Martorana
- Unit of Medical Genetics, University Hospital of Parma, Parma.,CoreLab, Research Common Center, University Hospital of Parma, Parma
| | - Augusto Vaglio
- Department of Biomedical, Experimental and Clinical Sciences, University of Firenze.,Nephrology and Dialysis Unit, Meyer Children's Hospital, Firenze, Italy
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6
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Li C, Zou Y, Lu X, Wang G, Shu X. Pituitary dysfunction in patients with ANCA associated vasculitis: prevalence, presentation, and outcomes. Ther Adv Chronic Dis 2020; 11:2040622320930636. [PMID: 32566116 PMCID: PMC7285954 DOI: 10.1177/2040622320930636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 04/22/2020] [Indexed: 11/23/2022] Open
Abstract
Background: The antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) are rare multisystem autoimmune diseases characterized by inflammatory cell infiltration causing necrosis of small blood vessels. Pituitary involvement in AAV is poorly described. This study aimed to describe the prevalence, clinical characteristics, and outcomes of pituitary involvement in patients with AAV. Methods: A total of 150 patients diagnosed with AAV and hospitalized in the China–Japan Friendship Hospital between 2009 and 2019 were enrolled in this retrospective study. Patients diagnosed with pituitary involvement in AAV were selected for inclusion. Results: Three patients (2%) were identified with pituitary involvement. Two patients had positive ANCA titers, one with proteinase 3 positive and one with myeloperoxidase positive antibodies. Pituitary dysfunction presented as an initial symptom in one patient and developed over the course of the diseases in the other two patients. All three patients had abnormal hormones. Among them, two patients had an enlarged pituitary, shown by magnetic resonance images (MRIs), and one patient had a normal sized pituitary, shown by MRI, but presented with increased linear radioactivity uptake in the pituitary fossa by positron emission tomography-computed tomography. All patients were treated with corticosteroid and immunosuppressive therapy. Both pituitary dysfunction and vasculitis were in remission. Conclusion: Pituitary involvement is uncommon in AAV and it can occur at any point during AAV. The main clinical manifestations are central diabetes insipidus and panhypopituitarism. Immunosuppressive therapy could significantly alleviate clinical symptoms as well as pituitary imaging.
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Affiliation(s)
- Chunjia Li
- Department of Rheumatology, China-Japan Friendship Hospital, Beijing, China
| | - Yu Zou
- Department of Rheumatology, China-Japan Friendship Hospital, Beijing, China
| | - Xin Lu
- Department of Rheumatology, China-Japan Friendship Hospital, Beijing, China
| | - Guochun Wang
- Department of Rheumatology, China-Japan Friendship Hospital, Beijing, China
| | - Xiaoming Shu
- Department of Rheumatology, China-Japan Friendship Hospital, Yinghua East Road, Chaoyang District, Beijing, 100029, China
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7
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Daher A, Sauvetre G, Girszyn N, Verspyck E, Levesque H, Le Besnerais M. Granulomatosis with polyangiitis and pregnancy: A case report and review of the literature. Obstet Med 2020; 13:76-82. [PMID: 32714439 PMCID: PMC7359661 DOI: 10.1177/1753495x18822581] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 12/10/2018] [Indexed: 12/24/2022] Open
Abstract
The association of granulomatosis with polyangiitis and pregnancy is rare and therapeutic options are limited by the risk of teratogenicity and fetotoxicity. There is a paucity of published literature to guide clinical decision-making in these cases. We report the case of a 26-year-old woman with no medical history who presented at 21 weeks of gestation with a bilateral sudden loss of hearing and erosive rhinitis. The diagnosis of granulomatosis with polyangiitis was confirmed radiologically and biologically. Corticosteroids were not enough to stabilize the disease and she received intravenous immunoglobulins with remission. A successful delivery of a healthy male newborn was done at 36 weeks. A review of all published literature on granulomatosis with polyangiitis in pregnancy between 1970 and 2017 is presented. Trial registration: Not applicable.
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Affiliation(s)
- A Daher
- Internal Medicine Department, CHU de Rouen, Rouen, France
| | - G Sauvetre
- Internal Medicine Department, CHU de Rouen, Rouen, France
| | - N Girszyn
- Internal Medicine Department, CHU de Rouen, Rouen, France
| | - E Verspyck
- Obstetric and Gynecology Department, CHU de Rouen, Rouen, France
| | - H Levesque
- Internal Medicine Department, CHU de Rouen, Rouen, France
| | - M Le Besnerais
- Internal Medicine Department, CHU de Rouen, Rouen, France
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8
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Ma TT, Li ZY, Geng YS, Chen M, Zhao MH. Central nervous system involvement in patients with antineutrophil cytoplasmic antibody-associated vasculitis: a study of 29 cases in a single Chinese center. Clin Rheumatol 2020; 39:2185-2193. [PMID: 32062770 DOI: 10.1007/s10067-020-04975-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 12/22/2019] [Accepted: 02/07/2020] [Indexed: 01/01/2023]
Abstract
BACKGROUND In antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV), central nervous system (CNS) involvement is relatively uncommon. The current study retrospectively investigated the clinical features and outcomes of AAV patients with CNS involvement. METHODS A total of 497 AAV patients were retrospectively recruited in our center, twenty-nine of which had CNS involvement. Clinical and radiological manifestations and the outcomes of these patients were analyzed. RESULTS The predominant symptom was sensorimotor impairment. According to the MRI findings, twenty-four patients had cerebral ischemic lesions, four patients had hemorrhagic lesions, and one patient had pituitary mass. With a median follow-up of 25 (range 9-45) months, 23 of 24 patients with cerebral ischemic lesions responded to induction therapy, and symptoms were ameliorated. The remaining one died from acute myocardial infarction 2 months after the diagnosis of cerebral ischemic lesions. Compared with patients without CNS involvement, patients with CNS involvement had significantly higher level of Birmingham Vasculitis Activity Score (23.5 ± 5.3 versus 18.8 ± 6.5, P < 0.01) and significantly higher proportion of peripheral nervous system involvement (58.6% versus 14.6%, P < 0.01). However, we did not found significant difference of patients' survival between those with and without CNS involvement. CONCLUSION CNS involvement in Chinese patients with AAV was mainly manifested as cerebral ischemic lesions. Compared with patients without CNS involvement, patients with CNS involvement had a significantly more active disease of AAV, and significantly higher proportion of peripheral nervous system involvement.Key Points• CNS involvement in Chinese patients with AAV was mainly manifested as cerebral ischemic lesions.• Patients with CNS involvement had a significantly more active disease of AAV.
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Affiliation(s)
- Tian-Tian Ma
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, 100034, China.,Peking University Institute of Nephrology, Beijing, 100034, China.,Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, 100034, China.,Key Laboratory of Chronic Kidney Disease Prevention and Treatment (Peking University), Ministry of Education, Beijing, 100034, China
| | - Zhi-Ying Li
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, 100034, China.,Peking University Institute of Nephrology, Beijing, 100034, China.,Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, 100034, China.,Key Laboratory of Chronic Kidney Disease Prevention and Treatment (Peking University), Ministry of Education, Beijing, 100034, China
| | - Yu-Shan Geng
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, 100034, China.,Peking University Institute of Nephrology, Beijing, 100034, China.,Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, 100034, China.,Key Laboratory of Chronic Kidney Disease Prevention and Treatment (Peking University), Ministry of Education, Beijing, 100034, China
| | - Min Chen
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, 100034, China. .,Peking University Institute of Nephrology, Beijing, 100034, China. .,Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, 100034, China. .,Key Laboratory of Chronic Kidney Disease Prevention and Treatment (Peking University), Ministry of Education, Beijing, 100034, China.
| | - Ming-Hui Zhao
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, 100034, China.,Peking University Institute of Nephrology, Beijing, 100034, China.,Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, 100034, China.,Key Laboratory of Chronic Kidney Disease Prevention and Treatment (Peking University), Ministry of Education, Beijing, 100034, China
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9
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Marvisi C, Sinico RA, Salvarani C, Jayne D, Prisco D, Terrier B, Emmi G, Vaglio A. New perspectives in eosinophilic granulomatosis with polyangiitis (EGPA): report of the first meeting of the European EGPA Study Group. Intern Emerg Med 2019; 14:1193-1197. [PMID: 31388893 DOI: 10.1007/s11739-019-02166-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 07/29/2019] [Indexed: 01/16/2023]
Abstract
The European Eosinophilic Granulomatosis with Polyangiitis (EGPA) study group first gathered in Firenze in December 2018. The discussion was centred around the clinical and therapeutic needs in EGPA which still remain unmet. Indeed, EGPA is a puzzling and rare disease which shares clinical features with other anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAVs) and hypereosinophilic syndromes (HESs). Some of the recommendations published in 2015 are based on data derived from EGPA-related diseases, rather than from EGPA itself, and therefore need to be updated. Thus, the aim of the meeting was to stimulate ongoing research, to promote collaborative European studies and to define the main issues on which future studies should be focused. Current fields of research on EGPA include potential serological biomarkers of disease activity and of specific organ involvement, possible links between different genetic variants and clinical phenotypes, and new therapeutic perspectives. Herein, we give an overview of the meeting with the goal to stimulate an international collaboration and new points of discussion.
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Affiliation(s)
- Chiara Marvisi
- University of Modena and Reggio Emilia, and Azienda USL-IRCCS, Reggio Emilia, Italy
| | - Renato Alberto Sinico
- Department of Medicine and Surgery, University of Milano-Bicocca and ASST Monza, Monza, Italy
| | - Carlo Salvarani
- University of Modena and Reggio Emilia, and Azienda USL-IRCCS, Reggio Emilia, Italy
| | - David Jayne
- Department of Medicine, University of Cambridge, Cambridge, UK
| | - Domenico Prisco
- Dipartimento Di Medicina Sperimentale e Clinica, Università Di Firenze, Largo Brambilla 3, 50134, Florence, Italy
| | - Benjamin Terrier
- Department of Internal Medicine, National Referral Center for Rare Systemic and Autoimmune Diseases, Hôpital Cochin, Paris, France
- Assistance Publique-Hôpitaux de Paris, Université Paris Descartes, Paris, France
| | - Giacomo Emmi
- Dipartimento Di Medicina Sperimentale e Clinica, Università Di Firenze, Largo Brambilla 3, 50134, Florence, Italy.
| | - Augusto Vaglio
- SOC Nefrologia E Dialisi, Azienda Ospedaliero-Universitaria Meyer, e Dipartimento Di Scienze Biomediche, Sperimentali e Cliniche "Mario Serio", Università Di Firenze, Viale Pieraccini 6, 50139, Florence, Italy.
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10
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Kolitz T, Tanay A, Biro A, Zandman-Goddard G. Rituximab induction without maintenance for granulomatosis with polyangiitis and dialysis - Case report and literature review. Best Pract Res Clin Rheumatol 2019; 32:535-540. [PMID: 31174822 DOI: 10.1016/j.berh.2019.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
ANCA-associated vasculitis (AAV) may lead to irreversible organ damage, particularly end-stage renal disease (ESRD) requiring dialysis. The chances of renal recovery diminish with prolonged dialysis. We describe a case of a 32-year-old woman admitted for pulmonary infiltrates and acute renal failure. Autoimmune workup revealed an elevated titer of proteinase 3-antineutrophil cytoplasmic antibody (PR3-ANCA). The diagnosis of granulomatosis with polyangiitis (GPA) was confirmed by renal biopsy. The patient received induction therapy with IV rituximab (375 mg/m2 per week for 4 weeks) along with systemic high-dose IV corticosteroids and one pulse of IV cyclophosphamide (1000 mg). Rapid deterioration of her kidney function led to pulmonary edema requiring intensive care (ICU) hospitalization. Dialysis and plasmapheresis were initiated. Significant clinical improvement ensued, but the patient remained dialysis dependent. No immunosuppressive maintenance therapy other than prednisone was given. Chronic dialysis was discontinued successfully after eight months. At a follow-up of 30 months since her hospitalization, the patient is in complete remission without relapses. We suggest that rituximab induction without maintenance therapy for GPA ESRD may be adequate.
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Affiliation(s)
- T Kolitz
- Departments of Medicine C, Wolfson Medical Center, Israel
| | - A Tanay
- Departments of Rheumatology, Wolfson Medical Center, Israel; Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - A Biro
- Departments of Nephrology, Wolfson Medical Center, Israel
| | - G Zandman-Goddard
- Departments of Medicine C, Wolfson Medical Center, Israel; Sackler Faculty of Medicine, Tel Aviv University, Israel.
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Ma TT, Liu YR, Chen M, Zhao MH. Late restoration of renal function in patients with severe ANCA-associated glomerulonephritis who were dialysis-dependent at presentation. Clin Rheumatol 2018; 37:2143-2150. [DOI: 10.1007/s10067-018-4100-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 03/19/2018] [Accepted: 04/10/2018] [Indexed: 10/17/2022]
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Abstract
Sarcoidosis is a systemic granulomatous lung disease of unknown origin affecting people of any age, mainly young adults. The disease is extremely heterogeneous with an unpredictable clinical course. Different phenotypes have been identified: an acute syndrome can be distinguished from subacute and chronic variants. About 20% of patients are chronically progressive and may develop lung fibrosis. Sarcoidosis usually involves the lungs and thoracic lymph nodes, although the skin, eyes, bones, liver, spleen, heart, upper respiratory tract and nervous system can also be affected. No reliable indicators of clinical outcome are available, and there is no single serological biomarker with demonstrated unequivocal diagnostic and prognostic value. Diagnosis requires histological confirmation although a presumptive diagnosis may be acceptable in special conditions. This review examines the diagnostic approach to sarcoidosis involving a multidisciplinary team of specialists in which the internist has the task of identifying all pulmonary and extrapulmonary localizations of the disease and of managing complications and comorbidities.
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Affiliation(s)
- Elena Bargagli
- Respiratory Medicine, Department of Clinical and Experimental Medicine, Department of Clinical and Experimental Biomedical Sciences, University Hospital Careggi (AOUC), Largo Brambilla 1, 50134, Florence, Italy.
| | - Antje Prasse
- Medizinische Hochschule Hannover, Abteilung für Pneumologie Carl-Neuberg-Straße 1, 30625, Hannover, Germany
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