1
|
Kawaguchi R, Usagawa H, Miyawaki Y, Oiwa H. A case of eosinophilic granulomatosis with polyangiitis associated with diffuse alveolar haemorrhage: A case report and case-based review. Mod Rheumatol Case Rep 2024; 8:398-403. [PMID: 38676913 DOI: 10.1093/mrcr/rxae019] [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: 02/22/2024] [Revised: 03/05/2024] [Accepted: 03/27/2024] [Indexed: 04/29/2024]
Abstract
A 76-year-old man with bronchial asthma was admitted for respiratory failure and bloody sputum. A significant drop in haemoglobin and multiple consolidations supported clinical diagnosis of diffuse alveolar haemorrhage (AH). Myeloperoxidase-antineutrophil cytoplasmic antibody (MPO-ANCA) was positive and urinalysis suggested glomerulonephritis. Based on eosinophilia, sinusitis, peripheral nerve involvement, and leukocytoclastic vasculitis, he was diagnosed with eosinophilic granulomatosis with polyangiitis (EGPA) associated with AH. Our case-based review suggested that male predominance (65%), high positivity for ANCA (88%), and a high frequency of renal involvement (45%) may be characteristic of AH in EGPA. Although AH is rare in EGPA, we should be aware of this life-threatening complication.
Collapse
Affiliation(s)
- Rira Kawaguchi
- Department of Rheumatology, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Hirohisa Usagawa
- Department of Rheumatology, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Yoshia Miyawaki
- Center for Innovative Clinical Medicine, Okayama University Hospital, Okayama, Japan
| | - Hiroshi Oiwa
- Department of Rheumatology, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| |
Collapse
|
2
|
Shafique Ur Rehman M, Subhan M, Gulraiz S, Bibi R, Waqas M, Ishfaq A, Siddiq Muhammad S, Gapizov A, Fayyaz F. Overlapping Autoimmune Diseases: A Case Report and Review of Eosinophilic Granulomatosis With Polyangiitis and Mixed Connective Tissue Disease. Cureus 2023; 15:e43584. [PMID: 37719589 PMCID: PMC10503782 DOI: 10.7759/cureus.43584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2023] [Indexed: 09/19/2023] Open
Abstract
We describe a rare case of concurrent eosinophilic granulomatosis with polyangiitis and mixed connective tissue disease in a 27-year-old man who presented with pulmonary, renal, cardiac, and skin manifestations. We confirmed the diagnosis based on clinical, histopathological, and serological criteria. We treated the patient with corticosteroids, methotrexate, cyclophosphamide, and hydroxychloroquine, achieving early remission. The coexistence of both conditions in the same patient is extremely rare and has only been reported in a few cases worldwide. We also review the literature on these two rare autoimmune diseases' coexistence, pathogenesis, diagnosis, and management. Our case emphasizes recognizing overlapping autoimmune conditions in patients with complex clinical features and employing a comprehensive diagnostic approach and tailored treatment strategies. Further research is needed to understand these patients' epidemiology, prognosis, and optimal therapy. Early diagnosis and aggressive immunosuppression are crucial for achieving remission and preventing organ damage. We also identified the knowledge gaps and research needs in this field.
Collapse
Affiliation(s)
| | - Muhammad Subhan
- Internal Medicine, Jinnah Hospital, Allama Iqbal Medical College, Lahore, PAK
- Internal Medicine, Al Barkat Health Care and Collection Centre, Lahore, PAK
- Editorial Department, International Journal of Clinical and Molecular Oncology, Lahore, PAK
| | - Shaina Gulraiz
- Emergency Medicine, Allama Iqbal Medical College, Lahore, PAK
| | - Ruqiya Bibi
- Medicine and Surgery, Jinnah Hospital, Lahore, PAK
- Internal Medicine, Allama Iqbal Medical College, Lahore, PAK
| | - Muhammad Waqas
- Internal Medicine, Jinnah Sindh Medical University, Karachi, PAK
| | | | | | | | - Faris Fayyaz
- Surgery, Dow University of Health Sciences, Karachi, PAK
| |
Collapse
|
3
|
Zhao B, Zheng H, Yang T, Zheng R. Eosinophilic granulomatosis with polyangiitis in allergic asthma: Efforts to make early diagnosis possible. Allergy Asthma Proc 2023; 44:59-63. [PMID: 36719697 DOI: 10.2500/aap.2023.44.220072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Background: Eosinophilic granulomatosis with polyangiitis (EGPA) is a rare autoimmune disease that can affect multiple organ systems in the body. A majority of patients with EGPA present with asthma-like symptoms and may be misdiagnosed with refractory asthma. It is necessary to distinguish EGPA from asthma and provide a theoretical basis for effective future prevention and treatment. Objective: This study aimed to compare the clinical features of EGPA and the clinical features of allergic asthma in an effort to make an early diagnosis possible. Methods: We reviewed the basic information, test results, pre-onset conditions, and prognosis of 44 adult patients with EGPA who were admitted to our hospital between January 2013 and June 2021, and conducted a 1:1 matched case-control study to compare patients with EGPA and patients with allergic asthma. Results: The 44 patients with EGPA were older than those with allergic asthma, but more than half of the patients with EGPA had been diagnosed with bronchial asthma, with a history of 10 months to 40 years, and had previously used inhalers or systemic steroids. The proportion of male-to-female cases was ∼1:1, with seven antineutrophil cytoplasmic antibodies (ANCA) positive cases (15.9%), 20 limited EGPA cases (45.45%), and 24 systemic EGPA cases (54.55%). Although the peripheral blood eosinophil count and percentage were lower in the male patients than in the female patients, male patients with higher five-factor scores might indicate worse prognosis. The fractional exhaled nitric oxide (FeNO) level, eosinophil percentage and count, and total immunoglobulin E (IgE) level were higher in the EGPA group than in the allergic asthma group. Unlike in allergic asthma, the FeNO level is not correlated with the blood eosinophil count or percentage in EGPA. Seven patients received cardiac emission computed tomography (ECT) tests, with abnormalities suggested in six patients. Results of an electrocardiogram, color-Doppler echocardiography, myocardial enzyme level, and troponin level suggested no obvious abnormality. Conclusion: The proportion of patients with EGPA who tested positive for ANCA is not high, and patients with high eosinophil counts should be alert to the possibility of having EGPA. For patients with infiltration of eosinophils into the airway, a diagnosis should not be based on peripheral blood eosinophil counts. It is recommended that the FeNO level and pulmonary function should also be monitored for patients who present with symptoms in other body systems. The sensitivity of cardiac ECT tests is higher than routine tests, so timely screening by cardiac ECT is recommended for all patients with EGPA.
Collapse
Affiliation(s)
- Bo Zhao
- From the Department of Pulmonary and Critical Care Medicine, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, China and
| | - Haiming Zheng
- From the Department of Pulmonary and Critical Care Medicine, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, China and
| | - Tengfei Yang
- Department of Health Management, Shengjing Hospital of China Medical University, Shenyang, China
| | - Rui Zheng
- From the Department of Pulmonary and Critical Care Medicine, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, China and
| |
Collapse
|
4
|
Can Bostan O, Duran E, Tuncay G, Cihanbeylerden M, Karadag O, Damadoglu E, Karakaya G, Kalyoncu AF. Sinonasal and respiratory outcomes of eosinophilic granulomatosis with polyangiitis patients receiving 100 mg mepolizumab in real-life clinical practice: 1-year follow up study. J Asthma 2022; 60:931-937. [PMID: 35912568 DOI: 10.1080/02770903.2022.2109165] [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: 10/16/2022]
Abstract
Background: Mepolizumab 300 mg is an approved treatment option for patients with eosinophilic granulomatosis with polyangiitis (EGPA), yet, the adequacy of 100 mg of mepolizumab in disease control is controversial.Objective: To evaluate the sinonasal and respiratory outcomes of EGPA patients treated with 100 mg mepolizumab for one year.Methods: Evaluations of 11 patients were made of the sinonasal outcome test (SNOT-22) (nasal, otologic, sleep, and emotional domains), asthma control test (ACT), forced expiratory volume in 1s (FEV1), blood eosinophil counts and oral steroid doses before mepolizumab treatment (T0) and at the 6th (T6) and 12th (T12) months.Results: A significant decrease was observed in the total SNOT-22 scores in the 6th month, after which the scores continued to be stable until the 12th month. (SNOT-22 median (IQR); T0: 70(53-82); T6: 19(4-35); T12: 11(6-40); T0-T6, p = 0.02; T6-T12, p = 0.85). In the subdomains of SNOT-22, nasal and sleep-related domains improved significantly in the first 6 months, and the otologic and emotional domains only improved from baseline in the 12th month. There was a significant decrease in blood eosinophil counts in the 6th month and oral steroid dose in the 12th month (eosinophils, median(IQR), T0: 1000(700-1800), T6: 100(0-200), p = 0.02; OCS dose, median(IQR), T0: 16(8-16); T6: 4(0-4); T12: 0(0-4); T0-T12, p = 0.002). A significant improvement was observed in ACT values in the 6th month (ACT median (IQR); T0:16(8-18); T6: 22(21-25); p = 0.01).Conclusion: Mepolizumab 100 mg provided a significant decrease in SNOT-22 values, especially in nasal and sleep domains, eosinophil counts and OCS dose in the 6th month.
Collapse
Affiliation(s)
- Ozge Can Bostan
- Hacettepe University School of Medicine, Department of Chest Diseases, Division of Allergy and Clinical Immunology, Ankara, Turkey
| | - Emine Duran
- Hacettepe University School of Medicine, Department of Internal Medicine, Division of Rheumatology, Ankara, Turkey.,Hacettepe University School of Medicine, Vasculitis Research Centre, Ankara, Turkey
| | - Gulseren Tuncay
- Hacettepe University School of Medicine, Department of Chest Diseases, Division of Allergy and Clinical Immunology, Ankara, Turkey
| | - Melek Cihanbeylerden
- Hacettepe University School of Medicine, Department of Chest Diseases, Division of Allergy and Clinical Immunology, Ankara, Turkey
| | - Omer Karadag
- Hacettepe University School of Medicine, Department of Internal Medicine, Division of Rheumatology, Ankara, Turkey.,Hacettepe University School of Medicine, Vasculitis Research Centre, Ankara, Turkey
| | - Ebru Damadoglu
- Hacettepe University School of Medicine, Department of Chest Diseases, Division of Allergy and Clinical Immunology, Ankara, Turkey
| | - Gul Karakaya
- Hacettepe University School of Medicine, Department of Chest Diseases, Division of Allergy and Clinical Immunology, Ankara, Turkey
| | - Ali F Kalyoncu
- Hacettepe University School of Medicine, Department of Chest Diseases, Division of Allergy and Clinical Immunology, Ankara, Turkey
| |
Collapse
|