1
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Wang RX, Newman SA. Urticarial Vasculitis. Immunol Allergy Clin North Am 2024; 44:483-502. [PMID: 38937011 DOI: 10.1016/j.iac.2024.03.006] [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] [Indexed: 06/29/2024]
Abstract
Urticarial vasculitis is a rare autoimmune disorder characterized by persistent edematous papules and plaques on the skin that last longer than 24 hours, often accompanied by systemic symptoms such as joint pain and fever. Unlike common urticaria, this condition involves inflammation of small blood vessels, leading to more severe and long-lasting skin lesions with a tendency to leave a bruiselike appearance. Diagnosis is challenging and may require a skin biopsy. Associated with underlying autoimmune diseases, treatment involves managing symptoms with medications such as antihistamines and corticosteroids, addressing the immune system's dysfunction, and treating any concurrent autoimmune conditions.
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Affiliation(s)
- Ruth X Wang
- Department of Internal Medicine, University of Colorado School of Medicine, Anschutz Medical Campus, 13001 East 17th Place, Aurora, CO 80045, USA
| | - Sabrina A Newman
- Department of Dermatology, University of Colorado School of Medicine, Anschutz Medical Campus, 12801 East 17th Avenue, Mail Stop 8127, Aurora, CO 80045, USA.
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2
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Bruschi M, Angeletti A, Prunotto M, Meroni PL, Ghiggeri GM, Moroni G, Sinico RA, Franceschini F, Fredi M, Vaglio A, Cavalli A, Scapozza L, Patel JJ, Tan JC, Lo KC, Cavagna L, Petretto A, Pratesi F, Migliorini P, Locatelli F, Pazzola G, Pesce G, Giannese D, Manfredi A, Ramirez GA, Esposito P, Murdaca G, Negrini S, Bui F, Trezzi B, Emmi G, Cavazzana I, Binda V, Fenaroli P, Pisan I, Montecucco C, Santoro D, Scolari F, Mescia F, Volpi S, Mosca M, Tincani A, Ravelli A, Murtas C, Candiano G, Caridi G, La Porta E, Verrina E. A critical view on autoantibodies in lupus nephritis: Concrete knowledge based on evidence. Autoimmun Rev 2024; 23:103535. [PMID: 38552995 DOI: 10.1016/j.autrev.2024.103535] [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: 01/02/2024] [Revised: 03/22/2024] [Accepted: 03/23/2024] [Indexed: 04/07/2024]
Abstract
Deposition of autoantibodies in glomeruli is a key factor in the development of lupus nephritis (LN). For a long time, anti-dsDNA and anti-C1q antibodies were thought to be the main cause of the kidney damage. However, recent studies have shown that the list of autoantibidies that have renal tropism and deposit in the kidney in LN is increasing and the link between anti-dsDNA and renal pathology is weak due to potential confounders. Aspecific bindings of dsDNA with cationic antibodies and of anti-dsDNA with several renal antigens such as actinin, laminin, entactin, and annexinA2 raised doubts about the specific target of these antibodies in the kidney. Moreover, the isotype of anti-dsDNA in SLE and LN has never received adequate interest until the recent observation that IgG2 are preponderant over IgG1, IgG3 and IgG4. Based on the above background, recent studies investigated the involvement of anti-dsDNA IgG2 and of other antibodies in LN. It was concluded that circulating anti-dsDNA IgG2 levels do not distinguish between LN versus non-renal SLE, and, in patients with LN, their levels do not change over time. Circulating levels of other antibodies such as anti-ENO1 and anti-H2 IgG2 were, instead, higher in LN vs non-renal SLE at the time of diagnosis and decreased following therapies. Finally, new classes of renal antibodies that potentially modify the anti-inflammatory response in the kidney are emerging as new co-actors in the pathogenetic scenario. They have been defined as 'second wave antibodies' for the link with detoxifying mechanisms limiting the oxidative stress in glomeruli that are classically stimulated in a second phase of inflammation. These findings have important clinical implications that may modify the laboratory approach to LN. Serum levels of anti-ENO1 and anti-H2 IgG2 should be measured in the follow up of patients for designing the length of therapies and identify those patients who respond to treatments. Anti-SOD2 could help to monitor and potentiate the anti-inflammatory response in the kidney.
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Affiliation(s)
- Maurizio Bruschi
- Laboratory of Molecular Nephrology, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Andrea Angeletti
- Division of Nephrology, Dialysis and Transplantation, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Marco Prunotto
- Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, Geneva, Switzerland
| | - Pier Luigi Meroni
- Experimental Laboratory of Immunological and Rheumatologic Researches, Istituto Auxologico Italiano-Istituto di Ricovero e Cura a Carattere Scientifico, Milano, Italy.
| | - Gian Marco Ghiggeri
- Laboratory of Molecular Nephrology, IRCCS Istituto Giannina Gaslini, Genoa, Italy; Division of Nephrology, Dialysis and Transplantation, IRCCS Istituto Giannina Gaslini, Genoa, Italy.
| | - Gabriella Moroni
- Department of Biomedical Sciences, Humanitas University and IRCCS Humanitas Research Hospital, Milan, Italy
| | | | - Franco Franceschini
- Rheumatology and Clinical Immunology, ASST SpedaliCivili and Università of Brescia, Italy
| | - Micaela Fredi
- Rheumatology and Clinical Immunology, ASST SpedaliCivili and Università of Brescia, Italy
| | - Augusto Vaglio
- Department of Biomedical, Experimental and Clinical Sciences "Mario Serio", University of Firenze, and Nephrology and Dialysis Unit, Meyer Children's Hospital, Firenze, Italy
| | - Andrea Cavalli
- Institute for Research in Biomedicine, Università della Svizzera Italiana, Bellinzona, Switzerland; Swiss Institute of Bioinformatics, Lausanne, Switzerland
| | - Leonardo Scapozza
- Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, Geneva, Switzerland
| | | | | | - Ken C Lo
- Nimble Therapeutics, Madison, WI, USA
| | - Lorenzo Cavagna
- Division of Rheumatology, University and IRCCS Policlinico S. Matteo, Pavia, Italy
| | - Andrea Petretto
- Core Facilities-Proteomics Laboratory, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Federico Pratesi
- Clinical Immunology Unit, Department of Internal Medicine, University of Pisa, Italy
| | - Paola Migliorini
- Clinical Immunology Unit, Department of Internal Medicine, University of Pisa, Italy
| | - Francesco Locatelli
- Division of Rheumatology, University and IRCCS Policlinico S. Matteo, Pavia, Italy
| | - Giulia Pazzola
- Nephrology and Dialysis, Arciospedale Santa Maria nuova, Reggio Emilia, Italy
| | - Giampaola Pesce
- Nephrology and Dialysis, Arciospedale Santa Maria nuova, Reggio Emilia, Italy
| | | | - Angelo Manfredi
- Unit of Internal Medicine and Immunology, IRCCS Ospedale San Raffaele, Milano, Italy
| | - Giuseppe A Ramirez
- Unit of Internal Medicine and Immunology, IRCCS Ospedale San Raffaele, Milano, Italy
| | - Pasquale Esposito
- Division of Nephrology, University of Genoa and Policlinico San Martino, Genova, Italy
| | | | - Simone Negrini
- Department of Internal Medicine, University of Genoa, Italy
| | - Federica Bui
- Division of Nephrology, University of Genoa and Policlinico San Martino, Genova, Italy
| | - Barbara Trezzi
- Swiss Institute of Bioinformatics, Lausanne, Switzerland
| | - Giacomo Emmi
- Lupus Clinic Department of biomedicine, University of Florence, University Hospital Careggi, Florence, Italy
| | - Ilaria Cavazzana
- Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, Geneva, Switzerland
| | - Valentina Binda
- Department of Biomedical, Experimental and Clinical Sciences "Mario Serio", University of Firenze, and Nephrology and Dialysis Unit, Meyer Children's Hospital, Firenze, Italy
| | - Paride Fenaroli
- Nephrology Unit, University Hospital, University of Parma, Parma, Italy
| | - Isabella Pisan
- Nephrology Unit, University Hospital, University of Parma, Parma, Italy
| | | | - Domenico Santoro
- Nephrology and Dialysis Unit, University of Messina and G Martino Hospital, Messina, Italy
| | - Francesco Scolari
- Division of Nephrology and Dialysis, ASST SpedaliCivili and Università of Brescia, Brescia, Italy
| | - Federica Mescia
- Division of Nephrology and Dialysis, ASST SpedaliCivili and Università of Brescia, Brescia, Italy
| | - Stefano Volpi
- Division of Paediatric Rheumatology and Scientific Institute for Research and Health Care, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Marta Mosca
- Rheumatologu Unit, Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - Angela Tincani
- Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, Geneva, Switzerland
| | - Angelo Ravelli
- Division of Paediatric Rheumatology and Scientific Institute for Research and Health Care, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Corrado Murtas
- Nephrology and Dialysis Unit, Ospedale Belcolle, 01100 Viterbo, Italy
| | - Giovanni Candiano
- Laboratory of Molecular Nephrology, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Gianluca Caridi
- Laboratory of Molecular Nephrology, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Edoardo La Porta
- Division of Nephrology, Dialysis and Transplantation, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Enrico Verrina
- Division of Nephrology, Dialysis and Transplantation, IRCCS Istituto Giannina Gaslini, Genoa, Italy
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Velasco-Amador JP, Prados-Carmona Á, Navarro-Triviño FJ. Wenn es kein Angioödem ist, was dann? Diagnostisches Vorgehen bei Gesichtsödemen. J Dtsch Dermatol Ges 2024; 22:501-512. [PMID: 38574029 DOI: 10.1111/ddg.15336_g] [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: 06/14/2023] [Accepted: 11/16/2023] [Indexed: 04/06/2024]
Abstract
ZusammenfassungGesichtsödeme sind ein relativ häufiges Symptom bei Patienten allergologischer und dermatologischer Kliniken. Die Differentialdiagnose ist breit gefächert und die endgültige Diagnose kann manchmal eine Herausforderung für den Kliniker sein. Das faziale Angioödem selbst umfasst verschiedene Ätiopathologien (histaminerg, bradykinininduziert und weitere), die von anderen Ursachen des Gesichtsödems differenziert werden sollten, etwa allergischer Kontaktdermatitis, granulomatösen Erkrankungen, inflammatorischen Ursachen, Infektionen, Neoplasmen oder paraneoplastischen Syndromen, Autoimmunerkrankungen und anderen Entitäten, die hier als „Sonstige“ bezeichnet werden. Um die richtigen Untersuchungen anzuordnen und eine gezielte Therapie zu verordnen, ist ein angemessener diagnostischer Ansatz ausschlaggebend. Diese Übersicht konzentriert sich auf Entitäten, die mit Gesichtsödem einhergehen, und fasst ihre klinischen Charakteristika zusammen.
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Affiliation(s)
| | | | - Francisco José Navarro-Triviño
- Departamento de Eczema de Contacto e Inmunoalergia, Servicio de Dermatología Médico-Quirúrgica y Venereología, Hospital Universitario San Cecilio, Granada, Spanien
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4
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Velasco-Amador JP, Prados-Carmona Á, Navarro-Triviño FJ. If not angioedema, what is it? Diagnostic approach to facial edema. J Dtsch Dermatol Ges 2024; 22:501-512. [PMID: 38483055 DOI: 10.1111/ddg.15336] [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: 06/14/2023] [Accepted: 11/16/2023] [Indexed: 04/05/2024]
Abstract
Facial edema is a relatively frequent clinical presentation encountered in patients seen in allergology and dermatology clinics. The differential diagnosis is broad, and sometimes the definitive diagnosis can be a challenge for the clinician. Facial angioedema itself encompasses different etiopathologies (histaminergic, bradykinergic, etc.) that must be distinguished from other causes of facial edema, such as allergic contact dermatitis, granulomatous conditions, inflammatory causes, infections, neoplasms or paraneoplastic syndromes, autoimmune diseases, among other entities hereby referred as miscellanea. A proper diagnostic approach is essential to order the appropriate tests, as well as to prescribe a targeted treatment. This review focuses on entities that present with facial edema and summarize their characteristic clinical features.
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Affiliation(s)
| | | | - Francisco José Navarro-Triviño
- Departamento de Eczema de Contacto e Inmunoalergia, Servicio de Dermatología Médico-Quirúrgica y Venereología, Hospital Universitario San Cecilio, Granada, Spain
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5
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Saha MK. Overview of Vasculitides in Adults. Neuroimaging Clin N Am 2024; 34:1-12. [PMID: 37951696 DOI: 10.1016/j.nic.2023.07.007] [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] [Indexed: 11/14/2023]
Abstract
Vasculitis is characterized by the inflammation of blood vessels. Vasculitides refers to the different forms of vasculitis, often classified according to the size of the blood vessel that is involved. Vasculitis may occur as a primary process or secondary to many systemic diseases. This topic provides an overview of the clinical features, diagnosis, and classification of the different forms of vasculitides.
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Affiliation(s)
- Manish K Saha
- Division of Nephrology, University of North Carolina, Chapel Hill, NC, USA.
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Sekerel BE, Ilgun Gurel D, Sahiner UM, Soyer O, Kocaturk E. The many faces of pediatric urticaria. FRONTIERS IN ALLERGY 2023; 4:1267663. [PMID: 38026129 PMCID: PMC10655015 DOI: 10.3389/falgy.2023.1267663] [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] [Received: 07/26/2023] [Accepted: 10/11/2023] [Indexed: 12/01/2023] Open
Abstract
Urticaria is a common disease that can affect individuals of all age groups, with approximately one-quarter of the population experiencing it at least once in their lifetime. Lesions characterized by erythema and itchy hives can appear anywhere on the body. These can vary in size ranging from millimeters to centimeters, and typically clear within 24 h. About 40% of patients with urticaria have accompanying angioedema, which involves localized deep tissue swelling. Urticaria usually occurs spontaneously and is classified into acute and chronic forms, with the latter referring to a condition that lasts for more than 6 weeks. The prevalence of chronic urticaria in the general population ranges from 0.5% to 5%, and it can either be inducible or spontaneous. The most common form of pediatric urticaria is acute and is usually self-limiting. However, a broad differential diagnosis should be considered in children with urticaria, particularly if they also have accompanying systemic complaints. Differential diagnoses of pediatric urticaria include chronic spontaneous urticaria, chronic inducible urticaria, serum sickness-like reaction, urticarial vasculitis, and mast cell disorders. Conditions that can mimic urticaria, including but not limited to cryopyrinopathies, hyper IgD syndrome, Periodic Fever, Aphthous Stomatitis, Pharyngitis and Adenitis (PFAPA), Tumor Necrosis Factor Receptor Associated Periodic Syndrome (TRAPs), and Schnitzler syndrome should also be considered. The many faces of pediatric urticaria can be both easy and confusing. A pragmatic approach relies on clinical foresight and understanding the various forms of urticaria and their potential mimickers. This approach can pave the way for an accurate and optimized diagnostic approach in children with urticaria.
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Affiliation(s)
- Bulent Enis Sekerel
- Department of Pediatric Allergy, Hacettepe University School of Medicine, Ankara, Türkiye
| | - Deniz Ilgun Gurel
- Department of Pediatric Allergy, Hacettepe University School of Medicine, Ankara, Türkiye
| | - Umit Murat Sahiner
- Department of Pediatric Allergy, Hacettepe University School of Medicine, Ankara, Türkiye
| | - Ozge Soyer
- Department of Pediatric Allergy, Hacettepe University School of Medicine, Ankara, Türkiye
| | - Emek Kocaturk
- Department of Allergology, Charite University School of Medicine, Berlin, Germany
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Ouchene L, Muntyanu A, Assayag D, Veilleux È, Abril A, Ferrara G, Yacyshyn E, Pineau CA, O'Brien E, Baron M, Osman M, Gniadecki R, Netchiporouk E. Skin disorders and interstitial lung disease: Part II-The spectrum of cutaneous diseases with lung disease association. J Am Acad Dermatol 2023; 88:767-782. [PMID: 36228940 DOI: 10.1016/j.jaad.2022.09.051] [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: 06/30/2022] [Revised: 08/30/2022] [Accepted: 09/07/2022] [Indexed: 11/06/2022]
Abstract
Part 2 of this 2-part CME introduces dermatologists to noninfectious inflammatory skin diseases associated with pulmonary involvement. In many cases, dermatologists may be the first physicians recognizing respiratory complications associated with these diagnoses. Because pulmonary involvement is often the leading cause of morbidity and mortality, dermatologists should be comfortable screening and monitoring for lung disease in high-risk patients, recognizing cutaneous stigmata of lung disease in these patients and referring to pulmonary specialists, when appropriate, for prompt treatment initiation. Some treatments used for skin disease may not be appropriate in the context of lung disease and hence, choosing a holistic approach is important. Interstitial lung disease and pulmonary hypertension are the most common pulmonary complications and a significant cause of mortality in autoimmune connective tissue diseases, especially systemic sclerosis, dermatomyositis, and mixed connective tissue disease. Pulmonary complications, notably interstitial lung disease, are also common and life-threatening in sarcoidosis and vasculitis, while they are variable in neutrophilic and autoimmune blistering diseases.
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Affiliation(s)
- Lydia Ouchene
- Division of Dermatology, McGill University Health Centre, Montréal, Québec, Canada
| | - Anastasiya Muntyanu
- Division of Dermatology, McGill University Health Centre, Montréal, Québec, Canada
| | - Deborah Assayag
- Division of Pulmonary Medicine, McGill University Health Centre, Montréal, Québec, Canada
| | - Èvicka Veilleux
- Department of Medicine, McGill University, Montreal, Québec, Canada
| | - Andy Abril
- Division of Rheumatology, Mayo Clinic, Jacksonville, Florida
| | - Giovanni Ferrara
- Division of Pulmonary Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Elaine Yacyshyn
- Division of Rheumatology, University of Alberta, Edmonton, Alberta, Canada
| | - Christian A Pineau
- Division of Rheumatology, McGill University Health Centre, Montréal, Québec, Canada
| | - Elizabeth O'Brien
- Division of Dermatology, McGill University Health Centre, Montréal, Québec, Canada
| | - Murray Baron
- Division of Rheumatology, McGill University Health Centre, Montréal, Québec, Canada
| | - Mohammed Osman
- Division of Rheumatology, University of Alberta, Edmonton, Alberta, Canada
| | - Robert Gniadecki
- Division of Dermatology, University of Alberta, Edmonton, Alberta, Canada
| | - Elena Netchiporouk
- Division of Dermatology, McGill University Health Centre, Montréal, Québec, Canada.
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Hutchison E, Vincent R. Nonpruritic urticaria - a sign of serious systemic disease. Int J Dermatol 2023; 62:e325-e327. [PMID: 36866787 DOI: 10.1111/ijd.16631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 01/19/2023] [Accepted: 02/16/2023] [Indexed: 03/04/2023]
Affiliation(s)
- Eliza Hutchison
- Department of Dermatology, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Rosie Vincent
- Department of Dermatology, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
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9
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Ishizu A, Kawakami T, Kanno H, Takahashi K, Miyazaki T, Ikeda E, Oharaseki T, Ogawa Y, Onimaru M, Kurata M, Nakazawa D, Muso E, Harigai M. Expert perspectives on pathological findings in vasculitis. Mod Rheumatol 2023; 33:1-11. [PMID: 35535676 DOI: 10.1093/mr/roac043] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 04/30/2022] [Accepted: 05/03/2022] [Indexed: 01/05/2023]
Abstract
Pathological findings are important in the diagnosis of vasculitis. However, due to the rarity of the disease, standard textbooks usually devote only a few pages to this topic, and this makes it difficult for clinicians not specializing in vasculitis to fully understand the pathological findings in vasculitis. To address the paucity of information, we present representative pathological findings in vasculitis classified in the 2012 Revised International Chapel Hill Consensus Conference Nomenclature of Vasculitides (CHCC2012). The CHCC2012 classifies 26 vasculitides into seven categories: (1) large-vessel vasculitis, (2) medium-vessel vasculitis, (3) small-vessel vasculitis, including antineutrophil cytoplasmic antibody-associated vasculitis and immune complex small-vessel vasculitis, (4) variable-vessel vasculitis, (5) single-organ vasculitis, (6) vasculitis associated with systemic disease, and (7) vasculitis associated with probable aetiology. Moreover, representative pathological findings of vasculitis-related diseases and non-inflammatory vasculopathy not mentioned in the CHCC2012 are also presented. This will be useful for clinicians to refer to typical pathological findings of vasculitis in daily practice.
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Affiliation(s)
- Akihiro Ishizu
- Department of Medical Laboratory Science, Faculty of Health Sciences, Hokkaido University, Sapporo, Japan
| | - Tamihiro Kawakami
- Division of Dermatology, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Hiroyuki Kanno
- Department of Pathology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Kei Takahashi
- Department of Pathology, Toho University Ohashi Medical Center, Tokyo, Japan
| | | | - Eiji Ikeda
- Department of Pathology, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Toshiaki Oharaseki
- Department of Pathology, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Yayoi Ogawa
- Hokkaido Renal Pathology Center, Sapporo, Japan
| | - Mitsuho Onimaru
- Division of Pathophysiological and Experimental Pathology, Department of Pathology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Mie Kurata
- Department of Analytical Pathology, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Daigo Nakazawa
- Department of Rheumatology, Endocrinology, and Nephrology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Eri Muso
- Department of Nephrology and Dialysis, Kitano Hospital, Tazuke Kofukai Medical Research Institute, Osaka, Japan
| | - Masayoshi Harigai
- Division of Rheumatology, Department of Internal Medicine, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
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10
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Nouha BM, Meriem BS, Khaled TS, Manel BS, Insaf H, Mouna H, Ahmed L, Sabra A, Abdelfatteh Z, Habib S. Hypocomplementemic Urticarial Vasculitis Syndrome with Crescentic Glomerulonephritis. Indian J Pediatr 2023; 90:102. [PMID: 36447067 DOI: 10.1007/s12098-022-04405-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 11/03/2022] [Indexed: 12/05/2022]
Affiliation(s)
- Ben Mahmoud Nouha
- Department of Nephrology, Dialysis and Kidney Transplantation, Fattouma Bourguiba University Hospital of Monastir, Avenue Farhat Hached, 5000, Monastir, Tunisia.
| | - Ben Salem Meriem
- Department of Nephrology, Dialysis and Kidney Transplantation, Fattouma Bourguiba University Hospital of Monastir, Avenue Farhat Hached, 5000, Monastir, Tunisia
| | - Taieb Sahbi Khaled
- Department of Nephrology, Dialysis and Kidney Transplantation, Fattouma Bourguiba University Hospital of Monastir, Avenue Farhat Hached, 5000, Monastir, Tunisia
| | - Ben Saleh Manel
- Department of Nephrology, Dialysis and Kidney Transplantation, Fattouma Bourguiba University Hospital of Monastir, Avenue Farhat Hached, 5000, Monastir, Tunisia
| | - Handous Insaf
- Department of Nephrology, Dialysis and Kidney Transplantation, Fattouma Bourguiba University Hospital of Monastir, Avenue Farhat Hached, 5000, Monastir, Tunisia
| | - Hamouda Mouna
- Department of Nephrology, Dialysis and Kidney Transplantation, Fattouma Bourguiba University Hospital of Monastir, Avenue Farhat Hached, 5000, Monastir, Tunisia
| | - Letaief Ahmed
- Department of Nephrology, Dialysis and Kidney Transplantation, Fattouma Bourguiba University Hospital of Monastir, Avenue Farhat Hached, 5000, Monastir, Tunisia
| | - Aloui Sabra
- Department of Nephrology, Dialysis and Kidney Transplantation, Fattouma Bourguiba University Hospital of Monastir, Avenue Farhat Hached, 5000, Monastir, Tunisia
| | - Zakhama Abdelfatteh
- Department of Pathological Anatomy, Fattouma Bourguiba University Hospital of Monastir, Monastir, Tunisia
| | - Skhiri Habib
- Department of Nephrology, Dialysis and Kidney Transplantation, Fattouma Bourguiba University Hospital of Monastir, Avenue Farhat Hached, 5000, Monastir, Tunisia
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11
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Barata R, Damas J, Pereira TA, Góis M, Sousa H, Ribeiro F, Sousa J, Nolasco F. Kidney Disease in a Patient With a Chronic Rash: A Quiz. Am J Kidney Dis 2023; 81:A16-A18. [PMID: 36543413 DOI: 10.1053/j.ajkd.2022.08.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 08/09/2022] [Indexed: 12/23/2022]
Affiliation(s)
- Rui Barata
- Nephrology Department, Hospital Curry Cabral, Lisbon, Portugal.
| | - Juliana Damas
- Nephrology Department, Hospital Curry Cabral, Lisbon, Portugal
| | | | - Mário Góis
- Nephrology Department, Hospital Curry Cabral, Lisbon, Portugal
| | - Helena Sousa
- Nephrology Department, Hospital Curry Cabral, Lisbon, Portugal
| | | | - João Sousa
- Nephrology Department, Hospital Curry Cabral, Lisbon, Portugal
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12
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Papara C, Karsten CM, Ujiie H, Schmidt E, Schmidt-Jiménez LF, Baican A, Freire PC, Izumi K, Bieber K, Peipp M, Verschoor A, Ludwig RJ, Köhl J, Zillikens D, Hammers CM. The relevance of complement in pemphigoid diseases: A critical appraisal. Front Immunol 2022; 13:973702. [PMID: 36059476 PMCID: PMC9434693 DOI: 10.3389/fimmu.2022.973702] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 07/26/2022] [Indexed: 11/13/2022] Open
Abstract
Pemphigoid diseases are autoimmune chronic inflammatory skin diseases, which are characterized by blistering of the skin and/or mucous membranes, and circulating and tissue-bound autoantibodies. The well-established pathomechanisms comprise autoantibodies targeting various structural proteins located at the dermal-epidermal junction, leading to complement factor binding and activation. Several effector cells are thus attracted and activated, which in turn inflict characteristic tissue damage and subepidermal blistering. Moreover, the detection of linear complement deposits in the skin is a diagnostic hallmark of all pemphigoid diseases. However, recent studies showed that blistering might also occur independently of complement. This review reassesses the importance of complement in pemphigoid diseases based on current research by contrasting and contextualizing data from in vitro, murine and human studies.
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Affiliation(s)
- Cristian Papara
- Department of Dermatology, University of Lübeck, Lübeck, Germany
- Department of Dermatology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Christian M. Karsten
- Institute of Systemic Inflammation Research, University of Lübeck, Lübeck, Germany
| | - Hideyuki Ujiie
- Department of Dermatology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Enno Schmidt
- Department of Dermatology, University of Lübeck, Lübeck, Germany
- Lübeck Institute of Experimental Dermatology (LIED), University of Lübeck, Lübeck, Germany
| | | | - Adrian Baican
- Department of Dermatology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Patricia C. Freire
- Institute of Systemic Inflammation Research, University of Lübeck, Lübeck, Germany
| | - Kentaro Izumi
- Department of Dermatology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Katja Bieber
- Lübeck Institute of Experimental Dermatology (LIED), University of Lübeck, Lübeck, Germany
| | - Matthias Peipp
- Division of Antibody-Based Immunotherapy, Department of Medicine II, Christian-Albrechts-University of Kiel and University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Admar Verschoor
- Department of Dermatology, University of Lübeck, Lübeck, Germany
- Department of Otorhinolaryngology, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Ralf J. Ludwig
- Department of Dermatology, University of Lübeck, Lübeck, Germany
- Lübeck Institute of Experimental Dermatology (LIED), University of Lübeck, Lübeck, Germany
| | - Jörg Köhl
- Institute of Systemic Inflammation Research, University of Lübeck, Lübeck, Germany
- Division of Immunobiology, Cincinnati Children’s Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Detlef Zillikens
- Department of Dermatology, University of Lübeck, Lübeck, Germany
| | - Christoph M. Hammers
- Department of Dermatology, University of Lübeck, Lübeck, Germany
- Lübeck Institute of Experimental Dermatology (LIED), University of Lübeck, Lübeck, Germany
- *Correspondence: Christoph M. Hammers,
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13
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Urticarial vasculitis: Clinical and laboratory findings with a particular emphasis on differential diagnosis. J Allergy Clin Immunol 2022; 149:1137-1149. [PMID: 35396080 DOI: 10.1016/j.jaci.2022.02.007] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 02/02/2022] [Accepted: 02/15/2022] [Indexed: 12/22/2022]
Abstract
Urticarial vasculitis (UV) is a rare cutaneous vasculitis of small vessels characterized by recurrent episodes of wheal-like lesions that tend to last more than 24 hours, healing with a residual ecchymotic postinflammatory hyperpigmentation. The histopathologic pattern of UV is that of leukocytoclastic vasculitis, consisting of fibrinoid necrosis of dermal vessels' walls and neutrophil-rich perivascular inflammatory infiltrates. Although its etiopahogenesis remains still undefined, UV is now regarded as an immune complex-driven disease with activation of the complement cascade, leading to exaggerated production of anaphylatoxins that are responsible for neutrophil recruitment and activation. This condition can be categorized into 2 main entities according to serum complement levels: normocomplementemic UV and hypocomplementemic UV, the latter being associated with circulating anti-C1q autoantibodies and possible extracutaneous manifestations. Systemic multiorgan involvement may be seen particularly in syndromic hypocomplementemic UV, also known as McDuffie syndrome. This review summarizes the clinicopathological and laboratory features as well as the underlying pathophysiological mechanisms of UV. A focus on its main differential diagnoses is provided, that is, chronic spontaneous urticaria, bullous pemphigoid, IgA (Henoch-Schönlein purpura) and IgM/IgG immune complex vasculitis, lupus erythematous tumidus, Wells syndrome, erythema multiforme, cutaneous mastocytosis, cryopyrin-associated periodic syndromes, and coronavirus disease 2019-associated and anti-severe acute respiratory syndrome coronavirus 2-vaccine-associated urticarial eruptions.
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14
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Kesarwani V, Phachu D, Trivedi R. Hypocomplementemic Urticarial Vasculitis Syndrome or Systemic Lupus Erythematosus in Evolution? Cureus 2022; 14:e23429. [PMID: 35481300 PMCID: PMC9033644 DOI: 10.7759/cureus.23429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/23/2022] [Indexed: 11/05/2022] Open
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15
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Chan M, Hanna MG, Willard N, Treece A, Dixon BP. Hypocomplementemic Atypical IgA Vasculitis: A Case Report. Front Pediatr 2022; 10:886371. [PMID: 35757129 PMCID: PMC9218267 DOI: 10.3389/fped.2022.886371] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 05/13/2022] [Indexed: 12/02/2022] Open
Abstract
IgA vasculitis (IgAV, also known as Henoch-Schönlein purpura or HSP) is a vasculitis of small vessels involving multiple organs, particularly of the joints, gastrointestinal tract, skin, and kidneys. Growing laboratory evidence has shown that complement plays a key role in the pathogenesis of IgAV, although direct evidence of this association in patients is lacking. We report a child with IgAV associated with clinical features of hypertension, nephrotic range proteinuria, acute kidney injury, and low serum C3, with histopathologic findings on renal biopsy of membranoproliferative glomerulonephritis with C3 and IgA co-dominance, and extensive complement derangements. This case report suggests that complement modifies the pathogenesis of IgAV, and further investigation into complement-targeted therapy in cases of refractory IgAV may be beneficial.
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Affiliation(s)
- Melvin Chan
- Department of Pediatric Nephrology, Children's Hospital Colorado, Aurora, CO, United States
| | - Melisha Gayle Hanna
- Department of Pediatric Nephrology, Children's Hospital Colorado, Aurora, CO, United States
| | - Nicholas Willard
- Department of Pathology, School of Medicine, University of Colorado, Aurora, CO, United States
| | - Amy Treece
- Department of Pathology, School of Medicine, University of Colorado, Aurora, CO, United States
| | - Bradley Patton Dixon
- Department of Pediatric Nephrology, Children's Hospital Colorado, Aurora, CO, United States
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16
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Angeletti A, Volpi S, Bruschi M, Lugani F, Vaglio A, Prunotto M, Gattorno M, Schena F, Verrina E, Ravelli A, Ghiggeri GM. Neutrophil Extracellular Traps-DNase Balance and Autoimmunity. Cells 2021; 10:cells10102667. [PMID: 34685647 PMCID: PMC8534732 DOI: 10.3390/cells10102667] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 09/26/2021] [Accepted: 10/02/2021] [Indexed: 12/12/2022] Open
Abstract
Neutrophil extracellular traps (NETs) are macromolecular structures programmed to trap circulating bacteria and viruses. The accumulation of NETs in the circulation correlates with the formation of anti-double-stranded (ds) DNA antibodies and is considered a causative factor for systemic lupus erythematosus (SLE). The digestion of DNA by DNase1 and DNases1L3 is the rate- limiting factor for NET accumulation. Mutations occurring in one of these two DNase genes determine anti-DNA formation and are associated with severe Lupus-like syndromes and lupus nephritis (LN). A second mechanism that may lead to DNase functional impairment is the presence of circulating DNase inhibitors in patients with low DNase activity, or the generation of anti-DNase antibodies. This phenomenon has been described in a relevant number of patients with SLE and may represent an important mechanism determining autoimmunity flares. On the basis of the reviewed studies, it is tempting to suppose that the blockade or selective depletion of anti-DNase autoantibodies could represent a potential novel therapeutic approach to prevent or halt SLE and LN. In general, strategies aimed at reducing NET formation might have a similar impact on the progression of SLE and LN.
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Affiliation(s)
- Andrea Angeletti
- Division of Nephrology, Dialysis and Transplantation, IRCCS Istituto Giannina Gaslini, GenoaLargo Gaslini, 16148 Genoa, Italy; (A.A.); (E.V.)
- Laboratory of Molecular Nephrology, IRCCS Istituto Giannina Gaslini, GenoaLargo Gaslini, 16148 Genoa, Italy; (M.B.); (F.L.)
| | - Stefano Volpi
- Center for Autoinflammatory Diseases and Immunodeficiencies, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy; (S.V.); (M.G.); (F.S.); (A.R.)
- Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno Infantili, University of Genoa, 16132 Genoa, Italy
| | - Maurizio Bruschi
- Laboratory of Molecular Nephrology, IRCCS Istituto Giannina Gaslini, GenoaLargo Gaslini, 16148 Genoa, Italy; (M.B.); (F.L.)
| | - Francesca Lugani
- Laboratory of Molecular Nephrology, IRCCS Istituto Giannina Gaslini, GenoaLargo Gaslini, 16148 Genoa, Italy; (M.B.); (F.L.)
| | - Augusto Vaglio
- Department of Biomedical, Experimental and Clinical Sciences “Mario Serio”, University of Firenze, 50121 Firenze, Italy;
| | - Marco Prunotto
- Institute of Pharmaceutical Sciences of Western Switzerland, School of Pharmaceutical Sciences, University of Geneva, 1205 Geneva, Switzerland;
| | - Marco Gattorno
- Center for Autoinflammatory Diseases and Immunodeficiencies, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy; (S.V.); (M.G.); (F.S.); (A.R.)
- Clinics of Pediatrics and Rheumatology, IRCCS Istituto Giannina Gaslini, 16147 Genova, Italy
| | - Francesca Schena
- Center for Autoinflammatory Diseases and Immunodeficiencies, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy; (S.V.); (M.G.); (F.S.); (A.R.)
| | - Enrico Verrina
- Division of Nephrology, Dialysis and Transplantation, IRCCS Istituto Giannina Gaslini, GenoaLargo Gaslini, 16148 Genoa, Italy; (A.A.); (E.V.)
- Laboratory of Molecular Nephrology, IRCCS Istituto Giannina Gaslini, GenoaLargo Gaslini, 16148 Genoa, Italy; (M.B.); (F.L.)
| | - Angelo Ravelli
- Center for Autoinflammatory Diseases and Immunodeficiencies, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy; (S.V.); (M.G.); (F.S.); (A.R.)
| | - Gian Marco Ghiggeri
- Division of Nephrology, Dialysis and Transplantation, IRCCS Istituto Giannina Gaslini, GenoaLargo Gaslini, 16148 Genoa, Italy; (A.A.); (E.V.)
- Laboratory of Molecular Nephrology, IRCCS Istituto Giannina Gaslini, GenoaLargo Gaslini, 16148 Genoa, Italy; (M.B.); (F.L.)
- Correspondence:
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17
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Bastelica P, Labetoulle M, Noel N, Barreau E, Matonti F, Jourde Chiche N, Rousseau A, Benichou J. [Retinal involvement in hypocomplementemic urticarial vasculitis (McDuffie syndrome): Report of two cases]. J Fr Ophtalmol 2021; 44:e587-e590. [PMID: 34452765 DOI: 10.1016/j.jfo.2021.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 01/16/2021] [Accepted: 02/01/2021] [Indexed: 11/29/2022]
Affiliation(s)
- P Bastelica
- Service d'ophtalmologie, hôpital Bicêtre, université Paris-Sud, 78, rue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France
| | - M Labetoulle
- Service d'ophtalmologie, hôpital Bicêtre, université Paris-Sud, 78, rue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France; Department of Immunology of viral and auto-immune disease (IMVA DSV, iMETI, IDMIT), UMR1184, CEA, 18, route du Panorama, 92260 Fontenay-aux-Roses, France
| | - N Noel
- Department of Immunology of viral and auto-immune disease (IMVA DSV, iMETI, IDMIT), UMR1184, CEA, 18, route du Panorama, 92260 Fontenay-aux-Roses, France; Service d'immunologie clinique, hôpital Bicêtre, université Paris-Sud, 78, rue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France
| | - E Barreau
- Service d'ophtalmologie, hôpital Bicêtre, université Paris-Sud, 78, rue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France
| | - F Matonti
- Centre Monticelli Paradis, 433bis rue Paradis, 13008 Marseille, France; Université Aix-Marseille, CNRS, INT, Institut de neurosciences de la Timone, 27, boulevard Jean-Moulin, 13385 Marseille cedex 05, France
| | - N Jourde Chiche
- Université Aix-Marseille, C2VN, Inserm, INRA ; centre de néphrologie et transplantation rénale, hôpital de la Conception, 147, boulevard Baille, 13005 Marseille, France
| | - A Rousseau
- Service d'ophtalmologie, hôpital Bicêtre, université Paris-Sud, 78, rue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France; Department of Immunology of viral and auto-immune disease (IMVA DSV, iMETI, IDMIT), UMR1184, CEA, 18, route du Panorama, 92260 Fontenay-aux-Roses, France
| | - J Benichou
- Service d'ophtalmologie, hôpital Bicêtre, université Paris-Sud, 78, rue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France.
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18
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Gu SL, Jorizzo JL. Urticarial vasculitis. Int J Womens Dermatol 2021; 7:290-297. [PMID: 34222586 PMCID: PMC8243153 DOI: 10.1016/j.ijwd.2021.01.021] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Revised: 12/23/2020] [Accepted: 01/21/2021] [Indexed: 01/19/2023] Open
Abstract
Urticarial vasculitis is a rare clinicopathologic entity that is characterized by chronic or recurrent episodes of urticarial lesions. Skin findings of this disease can be difficult to distinguish visually from those of chronic idiopathic urticaria but are unique in that individual lesions persist for ≥24 hours and can leave behind dusky hyperpigmentation. This disease is most often idiopathic but has been linked to certain drugs, infections, autoimmune connective disease, myelodysplastic disorders, and malignancies. More recently, some authors have reported associations between urticarial vasculitis and COVID-19, as well as influenza A/H1N1 infection. Urticarial vasculitis can extend systemically as well, most often affecting the musculoskeletal, renal, pulmonary, gastrointestinal, and ocular systems. Features of leukocytoclastic vasculitis seen on histopathologic examination are diagnostic of this disease, but not always seen. In practice, antibiotics, dapsone, colchicine, and hydroxychloroquine are popular first-line therapies, especially for mild cutaneous disease. In more severe cases, immunosuppressives, including methotrexate, mycophenolate mofetil, azathioprine, and cyclosporine, as well as corticosteroids, may be necessary for control. More recently, select biologic therapies, including rituximab, omalizumab, and interleukin-1 inhibitors have shown promise for the treatment of recalcitrant or refractory cases.
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Affiliation(s)
- Stephanie L. Gu
- Department of Dermatology, Weill Cornell Medicine, New York, NY, United States
- Corresponding author.
| | - Joseph L. Jorizzo
- Department of Dermatology, Weill Cornell Medicine, New York, NY, United States
- Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, NC, United States
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19
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Berry EC, Wells J, Morey A, Anantharajah A. Hypocomplementemic urticarial vasculitis syndrome presenting with bilateral scleritis. BMJ Case Rep 2021; 14:14/5/e240041. [PMID: 33972296 PMCID: PMC8112411 DOI: 10.1136/bcr-2020-240041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Hypocomplementemic urticarial vasculitis syndrome (HUVS) is a rare autoimmune disorder characterised by recurrent urticarial lesions and acquired hypocomplementemia with systemic manifestations. The authors present the case of a 70-year-old man who presented to the ophthalmology clinic with bilateral scleritis and ocular hypertension. He was diagnosed with HUVS after a 6-month period of bilateral scleritis, vestibulitis, significant weight loss, mononeuritis multiplex and recurrent urticarial vasculitis with pronounced persistent hypocomplementemia and the presence of anti-C1q antibodies. Disease control was eventually obtained with mycophenolate and prednisolone.
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Affiliation(s)
- Ella Claire Berry
- Canberra Health Services Library, ACT Government, Garren, Australian Capital Territory, Australia .,Ophthalmology Unit, Canberra Health Services, Garran, Australian Capital Territory, Australia
| | - Jane Wells
- Ophthalmology Unit, Canberra Health Services, Garran, Australian Capital Territory, Australia.,Department of Ophthalmology, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
| | - Adrienne Morey
- ACT Pathology, Canberra Health Services, Garran, Australian Capital Territory, Australia.,Australian National University Medical School, Garran, Australian Capital Territory, Australia
| | - Anthea Anantharajah
- Department of Immunology, Canberra Health Services, Garran, Australian Capital Territory, Australia.,John Curtin School of Medical Research, Canberra, Australian Capital Territory, Australia
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20
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Hartl J, Serpas L, Wang Y, Rashidfarrokhi A, Perez OA, Sally B, Sisirak V, Soni C, Khodadadi-Jamayran A, Tsirigos A, Caiello I, Bracaglia C, Volpi S, Ghiggeri GM, Chida AS, Sanz I, Kim MY, Belmont HM, Silverman GJ, Clancy RM, Izmirly PM, Buyon JP, Reizis B. Autoantibody-mediated impairment of DNASE1L3 activity in sporadic systemic lupus erythematosus. J Exp Med 2021; 218:e20201138. [PMID: 33783474 PMCID: PMC8020718 DOI: 10.1084/jem.20201138] [Citation(s) in RCA: 68] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 12/18/2020] [Accepted: 02/10/2021] [Indexed: 12/12/2022] Open
Abstract
Antibodies to double-stranded DNA (dsDNA) are prevalent in systemic lupus erythematosus (SLE), particularly in patients with lupus nephritis, yet the nature and regulation of antigenic cell-free DNA (cfDNA) are poorly understood. Null mutations in the secreted DNase DNASE1L3 cause human monogenic SLE with anti-dsDNA autoreactivity. We report that >50% of sporadic SLE patients with nephritis manifested reduced DNASE1L3 activity in circulation, which was associated with neutralizing autoantibodies to DNASE1L3. These patients had normal total plasma cfDNA levels but showed accumulation of cfDNA in circulating microparticles. Microparticle-associated cfDNA contained a higher fraction of longer polynucleosomal cfDNA fragments, which bound autoantibodies with higher affinity than mononucleosomal fragments. Autoantibodies to DNASE1L3-sensitive antigens on microparticles were prevalent in SLE nephritis patients and correlated with the accumulation of cfDNA in microparticles and with disease severity. DNASE1L3-sensitive antigens included DNA-associated proteins such as HMGB1. Our results reveal autoantibody-mediated impairment of DNASE1L3 activity as a common nongenetic mechanism facilitating anti-dsDNA autoreactivity in patients with severe sporadic SLE.
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Affiliation(s)
- Johannes Hartl
- Department of Pathology, New York University Grossman School of Medicine, New York, NY
| | - Lee Serpas
- Department of Pathology, New York University Grossman School of Medicine, New York, NY
| | - Yueyang Wang
- Department of Pathology, New York University Grossman School of Medicine, New York, NY
| | - Ali Rashidfarrokhi
- Department of Pathology, New York University Grossman School of Medicine, New York, NY
| | - Oriana A. Perez
- Department of Pathology, New York University Grossman School of Medicine, New York, NY
| | - Benjamin Sally
- Department of Pathology, New York University Grossman School of Medicine, New York, NY
| | - Vanja Sisirak
- Department of Pathology, New York University Grossman School of Medicine, New York, NY
- Le Centre national de la recherche scientifique - unité mixte de recherche 5164, ImmunoConcEpt, Universite ´de Bordeaux, Bordeaux, France
| | - Chetna Soni
- Department of Pathology, New York University Grossman School of Medicine, New York, NY
| | - Alireza Khodadadi-Jamayran
- Department of Pathology, New York University Grossman School of Medicine, New York, NY
- Applied Bioinformatics Laboratories, New York University School of Medicine, New York, NY
| | - Aristotelis Tsirigos
- Department of Pathology, New York University Grossman School of Medicine, New York, NY
- Applied Bioinformatics Laboratories, New York University School of Medicine, New York, NY
| | - Ivan Caiello
- Division of Rheumatology, Istituto di Ricovero e Cura a Carattere Scientifico, Ospedale Pediatrico Bambino Gesù, Rome, Italy
| | - Claudia Bracaglia
- Division of Rheumatology, Istituto di Ricovero e Cura a Carattere Scientifico, Ospedale Pediatrico Bambino Gesù, Rome, Italy
| | - Stefano Volpi
- Centro per le Malattie Autoinfiammatorie e Immunodeficienze, Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Giannina Gaslini, Genoa, Italy
- Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili, Università degli Studi di Genova, Genoa, Italy
| | - Gian Marco Ghiggeri
- Division of Nephrology, Dialysis and Transplantation, Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Giannina Gaslini, Genoa, Italy
| | - Asiya Seema Chida
- Division of Rheumatology, Department of Medicine, Lowance Center for Human Immunology, Emory University, Atlanta, GA
| | - Ignacio Sanz
- Division of Rheumatology, Department of Medicine, Lowance Center for Human Immunology, Emory University, Atlanta, GA
| | - Mimi Y. Kim
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY
| | - H. Michael Belmont
- Division of Rheumatology, Department of Medicine, New York University Grossman School of Medicine, New York, NY
| | - Gregg J. Silverman
- Division of Rheumatology, Department of Medicine, New York University Grossman School of Medicine, New York, NY
| | - Robert M. Clancy
- Division of Rheumatology, Department of Medicine, New York University Grossman School of Medicine, New York, NY
| | - Peter M. Izmirly
- Division of Rheumatology, Department of Medicine, New York University Grossman School of Medicine, New York, NY
| | - Jill P. Buyon
- Division of Rheumatology, Department of Medicine, New York University Grossman School of Medicine, New York, NY
| | - Boris Reizis
- Department of Pathology, New York University Grossman School of Medicine, New York, NY
- Division of Rheumatology, Department of Medicine, New York University Grossman School of Medicine, New York, NY
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21
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Dominguez B, Vigo R. Hypocomplementemic urticarial vasculitis syndrome associated with rapidly progressive glomerulonephritis: lessons for the clinical nephrologist. J Nephrol 2021; 34:953-957. [PMID: 33433859 DOI: 10.1007/s40620-020-00942-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 11/30/2020] [Indexed: 11/28/2022]
Affiliation(s)
| | - Ronald Vigo
- Delray Medical Center, Delray Beach, Florida, USA
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22
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Moroni G, Ponticelli C. Secondary Membranous Nephropathy. A Narrative Review. Front Med (Lausanne) 2020; 7:611317. [PMID: 33344486 PMCID: PMC7744820 DOI: 10.3389/fmed.2020.611317] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 11/13/2020] [Indexed: 12/16/2022] Open
Abstract
Membranous nephropathy (MN) is a common cause of proteinuria and nephrotic syndrome all over the world. It can be subdivided into primary and secondary forms. Primary form is an autoimmune disease clinically characterized by nephrotic syndrome and slow progression. It accounts for ~70% cases of MN. In the remaining cases MN may be secondary to well-defined causes, including infections, drugs, cancer, or autoimmune diseases, such as systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), urticarial vasculitis, sarcoidosis, thyroiditis, Sjogren syndrome, systemic sclerosis, or ankylosing spondylitis. The clinical presentation is similar in primary and secondary MN. However, the outcome may be different, being often related to that of the original disease in secondary MN. Also, the treatment may be different, being targeted to the etiologic cause in secondary MN. Thus, the differential diagnosis between primary and secondary MN is critical and should be based not only on history and clinical features of the patient but also on immunofluorescence and electron microscopy analysis of renal biopsy as well as on the research of circulating antibodies. The identification of the pathologic events underlying a secondary MN is of paramount importance, since the eradication of the etiologic factors may be followed by remission or definitive cure of MN. In this review we report the main diseases and drugs responsible of secondary MN, the outcome and the pathogenesis of renal disease in different settings and the possible treatments.
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Affiliation(s)
- Gabriella Moroni
- Nephrology Unit Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca' Granda Ospedale Maggiore, Milan, Italy
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23
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Balasubramaniam D, Gottwald L, Dominiak N, Rettig N, Bedford‐Lyon N, Ahmed M. Hypocomplementemic urticarial vasculitis syndrome: a rare autoimmune entity. Int J Dermatol 2020; 59:e480-e481. [DOI: 10.1111/ijd.15061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 06/17/2020] [Accepted: 06/18/2020] [Indexed: 11/26/2022]
Affiliation(s)
| | - Lorie Gottwald
- University of Toledo College of Medicine and Life Sciences Toledo OH USA
| | - Nicole Dominiak
- University of Toledo College of Medicine and Life Sciences Toledo OH USA
| | - Nina Rettig
- University of Toledo College of Medicine and Life Sciences Toledo OH USA
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Kidney Involvement in Hypocomplementemic Urticarial Vasculitis Syndrome-A Case-Based Review. J Clin Med 2020; 9:jcm9072131. [PMID: 32640739 PMCID: PMC7408727 DOI: 10.3390/jcm9072131] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 06/25/2020] [Accepted: 07/03/2020] [Indexed: 11/16/2022] Open
Abstract
Hypocomplementemic urticarial vasculitis syndrome (HUVS), or McDuffie syndrome, is a rare small vessel vasculitis associated with urticaria, hypocomplementemia and positivity of anti-C1q antibodies. In rare cases, HUVS can manifest as an immune-complex mediated glomerulonephritis with a membranoproliferative pattern of injury. Due to the rarity of this disorder, little is known about the clinical manifestation, pathogenesis, treatment response and outcome of such patients. We describe here three cases of HUVS with severe renal involvement. These patients had a rapidly progressive form of glomerulonephritis with severe nephrotic syndrome against a background of a membranoproliferative pattern of glomerular injury with extensive crescent formation. Therefore, these patients required aggressive induction and maintenance immunosuppressive therapy, with a clinical and renal response in two patients, while the third patient progressed to end-stage renal disease. Because of the rarity of this condition, there are few data regarding the clinical presentation, pathology and outcome of such patients. Accordingly, we provide an extensive literature review of cases reported from 1976 until 2020 and place them in the context of the current knowledge of HUVS pathogenesis. We identified 60 patients with HUVS and renal involvement that had adequate clinical data reported, out of which 52 patients underwent a percutaneous kidney biopsy. The most frequent renal manifestation was hematuria associated with proteinuria (70% of patients), while one third had abnormal kidney function on presentation (estimated glomerular filtration (GFR) below 60 mL/min/1.73 m2). The most frequent glomerular pattern of injury was membranoproliferative (35%), followed by mesangioproliferative (21%) and membranous (19%). Similar to other systemic vasculitis, renal involvement carries a poorer prognosis, but the outcome can be improved by aggressive immunosuppressive treatment.
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Ralli M, Campo F, Angeletti D, Minni A, Artico M, Greco A, Polimeni A, de Vincentiis M. Pathophysiology and therapy of systemic vasculitides. EXCLI JOURNAL 2020; 19:817-854. [PMID: 32665772 PMCID: PMC7355154 DOI: 10.17179/excli2020-1512] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 06/15/2020] [Indexed: 12/14/2022]
Abstract
Systemic vasculitides represent uncommon conditions characterized by the inflammation of blood vessels that can lead to different complex disorders limited to one organ or potentially involving multiple organs and systems. Systemic vasculitides are classified according to the diameter of the vessel that they mainly affect (small, medium, large, or variable). The pathogenetic mechanisms of systemic vasculitides are still partly unknown, as well as their genetic basis. For most of the primary systemic vasculitides, a single gold standard test is not available, and diagnosis is often made after having ruled out other mimicking conditions. Current research has focused on new management protocol and therapeutic strategies aimed at improving long-term patient outcomes and avoiding progression to multiorgan failure with irreversible damage. In this narrative review, authors describe different forms of systemic vasculitides through a review of the literature, with the aim of highlighting the current knowledge and recent findings on etiopathogenesis, diagnosis and therapy.
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Affiliation(s)
- Massimo Ralli
- Department of Sense Organs, Sapienza University of Rome, Italy
| | - Flaminia Campo
- Department of Sense Organs, Sapienza University of Rome, Italy
| | | | - Antonio Minni
- Department of Sense Organs, Sapienza University of Rome, Italy
| | - Marco Artico
- Department of Sense Organs, Sapienza University of Rome, Italy
| | - Antonio Greco
- Department of Sense Organs, Sapienza University of Rome, Italy
| | - Antonella Polimeni
- Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Italy
| | - Marco de Vincentiis
- Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Italy
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Boyer A, Gautier N, Comoz F, Hurault de Ligny B, Aouba A, Lanot A. [Nephropathy associated with hypocomplementemic urticarial vasculitis: A case report and literature review]. Nephrol Ther 2020; 16:124-135. [PMID: 31928955 DOI: 10.1016/j.nephro.2019.09.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 08/08/2019] [Accepted: 09/01/2019] [Indexed: 11/25/2022]
Abstract
Hypocomplementemic urticarial vasculitis is a rare systemic vasculitis, affecting small vessels, characterised by chronicle urticaria, hypocomplementemia, and systemic manifestations. Renal involvement, whose prevalence varies between 9% and 60%, is mainly glomerular. We here report the case of a 59 years old woman presenting kidney failure, associated with chronicle urticaria and arthralgias. Laboratory investigation showed haematuria, proteinuria, hypocomplementemia and anti-SSa antibody positivity. A percutaneous kidney biopsy revealed focal and segmental glomerulonephritis associated with an acute interstitial nephritis. Hypocomplementemic urticarial vasculitis diagnosis was established after identifying anti-C1q antibodies. The lack of a dry syndrome, the negativity of a Schirmer test and the lack of sialadenitis on a salivary gland biopsy excluded an associated Gougerot-Sjögren Syndrome. The patient was treated with hydroxychloroquine and low-dose steroids, enabling a clinical and biological recovery. Of the 82 cases in the literature describing hypocomplementemic urticarial vasculitis associated nephropathies, 72 (88%) were a glomerular impairment, most frequently secondary to membranoproliferative glomerulonephritis. Only 6 (7%) tubulo-interstitial nephritis have been reported, 4 of them being associated with a glomerulonephritis. Patients were more likely to be women, aged in their third decade. The most frequent renal manifestations were haematuria (60%), and proteinuria (52%). Kidney failure was rarely observed (22%), with a fairly good renal prognosis. Hypocomplementemic urticarial vasculitis was associated with a systemic disease in 11 (13%) patients. In the absence of recommendations, the treatment strategy remains to be defined.
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Affiliation(s)
- Annabel Boyer
- Centre universitaire des maladies rénales, CHU de Caen, avenue de la côte de Nacre, 14033 Caen cedex 9, France; Unicaen, UFR de médecine, Normandie Université, 2, rue des Rochambelles, 14032 Caen cedex, France
| | - Nicolas Gautier
- Centre universitaire des maladies rénales, CHU de Caen, avenue de la côte de Nacre, 14033 Caen cedex 9, France; Unicaen, UFR de médecine, Normandie Université, 2, rue des Rochambelles, 14032 Caen cedex, France
| | - François Comoz
- Service d'anatomopathologie, CHU de Caen, avenue de la côte de Nacre, 14033 Caen cedex 9, France
| | - Bruno Hurault de Ligny
- Centre universitaire des maladies rénales, CHU de Caen, avenue de la côte de Nacre, 14033 Caen cedex 9, France; Unicaen, UFR de médecine, Normandie Université, 2, rue des Rochambelles, 14032 Caen cedex, France
| | - Achille Aouba
- Service de médecine interne, CHU de Caen, avenue de la côte de Nacre, 14033 Caen cedex 9, France
| | - Antoine Lanot
- Centre universitaire des maladies rénales, CHU de Caen, avenue de la côte de Nacre, 14033 Caen cedex 9, France; Unicaen, UFR de médecine, Normandie Université, 2, rue des Rochambelles, 14032 Caen cedex, France.
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27
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Liong RW, Salonga‐Reyes A, Morris S. Hypocomplementaemic urticarial vasculitis syndrome presenting as unilateral dacryoadenitis. Clin Exp Ophthalmol 2019; 47:1097-1101. [DOI: 10.1111/ceo.13600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Accepted: 07/06/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Rebecca W. Liong
- Gold Coast University Hospital Southport Queensland Australia
- Griffith University School of Medicine Southport Queensland Australia
| | | | - Sharon Morris
- Gold Coast University Hospital Southport Queensland Australia
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Caffarelli C, Paravati F, El Hachem M, Duse M, Bergamini M, Simeone G, Barbagallo M, Bernardini R, Bottau P, Bugliaro F, Caimmi S, Chiera F, Crisafulli G, De Ranieri C, Di Mauro D, Diociaiuti A, Franceschini F, Gola M, Licari A, Liotti L, Mastrorilli C, Minasi D, Mori F, Neri I, Pantaleo A, Saretta F, Tesi CF, Corsello G, Marseglia GL, Villani A, Cardinale F. Management of chronic urticaria in children: a clinical guideline. Ital J Pediatr 2019; 45:101. [PMID: 31416456 PMCID: PMC6694633 DOI: 10.1186/s13052-019-0695-x] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 08/01/2019] [Indexed: 12/12/2022] Open
Abstract
The aim of this guidance is to provide recommendations to clinicians and other interested parties on chronic urticaria in children. The Italian Society for Pediatrics (SIP), the Italian Society for Allergy and Immunology (SIAIP), the Italian Society for Pediatric dermatology (SIDerP) convened a multidisciplinary panel that prepared clinical guidelines for diagnosis and management of chronic urticaria in childhood. Key questions on epidemiology, natural history, diagnosis, and management were developed. The literature was systematically searched and evaluated, recommendations were rated and algorithms for diagnosis and treatment were developed. The recommendations focus on identification of diseases and comorbidities, strategies to recognize triggering factors, improvement of treatment by individualized care.
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Affiliation(s)
- Carlo Caffarelli
- Clinica Pediatrica, Dipartimento Medicina e Chirurgia, Università di Parma, Parma, Italy
| | - Francesco Paravati
- Pediatric Unit, Maternal Infant Department, Azienda Sanitaria Provinciale Crotone, Crotone, Italy
| | - Maya El Hachem
- Dermatology Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Marzia Duse
- Department of Pediatrics, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | | | - Giovanni Simeone
- Primary care Pediatrician, Local Health Unit of Brindisi, Brindisi, Italy
| | - Massimo Barbagallo
- Pediatric Unit, Azienda di rilievo nazionale ARNAS "GARIBALDI", Catania, Italy
| | | | - Paolo Bottau
- Pediatric and Neonatology Unit, Imola Hospital, Imola, BO, Italy
| | - Filomena Bugliaro
- FEDERASMA e Allergie Onlus - Federazione Italiana Pazienti, Prato, Italy
| | - Silvia Caimmi
- Pediatric Clinic, Foundation IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Fernanda Chiera
- Pediatric Unit, Maternal Infant Department, Azienda Sanitaria Provinciale Crotone, Crotone, Italy
| | - Giuseppe Crisafulli
- UO Allergologia, Dipartimento di Pediatria, Università di Messina, Messina, Italy
| | | | - Dora Di Mauro
- Clinica Pediatrica, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Andrea Diociaiuti
- Dermatology Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | | | - Massimo Gola
- Allergological and Pediatric Dermatology Unit, AUTC and University of Florence, Florence, Italy
| | - Amelia Licari
- Pediatric Clinic, Foundation IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Lucia Liotti
- Department of Pediatrics, Senigallia Hospital, Senigallia, Italy
| | - Carla Mastrorilli
- Department of Pediatrics and Emergency, Pediatric Allergy and Pulmunology Unit, Azienda Ospedaliera-Universitaria "Consorziale-Policlinico", Ospedale Pediatrico Giovanni XXIII, Bari, Italy
| | - Domenico Minasi
- UOC di Pediatria Azienda Ospedaliera "Bianchi-Melacrino-Morelli", Reggio Calabria, Italy
| | - Francesca Mori
- Allergy Unit, Department of Pediatric Medicine, Anna Meyer Children's University Hospital, Florence, Italy
| | - Iria Neri
- Dermatology Unit, University of Bologna, Bologna, Italy
| | - Aurelia Pantaleo
- Clinica Pediatrica, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Francesca Saretta
- Pediatric Department, AAS2 Bassa Friulana-Isontina, Palmanova-Latisana, Italy.,Pediatric Allergy Unit, Department of Medicine, Udine, Italy
| | - Carlo Filippo Tesi
- FEDERASMA e Allergie Onlus - Federazione Italiana Pazienti, Prato, Italy
| | - Giovanni Corsello
- Clinica Pediatrica Università degli Studi di Palermo, Palermo, Italy
| | - Gian Luigi Marseglia
- Pediatric Clinic, Foundation IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Alberto Villani
- UOC di Pediatria Generale e Malattie Infettive, Ospedale Pediatrico Bambino Gesù, Rome, Italy
| | - Fabio Cardinale
- Department of Pediatrics and Emergency, Pediatric Allergy and Pulmunology Unit, Azienda Ospedaliera-Universitaria "Consorziale-Policlinico", Ospedale Pediatrico Giovanni XXIII, Bari, Italy.
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Alomari M, Al Momani L, Khazaaleh S, Almomani S, Yaseen K, Alhaddad B. Exceptional association of hypocomplementemic urticarial vasculitis syndrome (HUVS) and symptomatic pulmonary histoplasmosis: a case-based literature review. Clin Rheumatol 2019; 38:1691-1697. [PMID: 30980192 DOI: 10.1007/s10067-019-04548-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 04/02/2019] [Accepted: 04/04/2019] [Indexed: 12/01/2022]
Abstract
Hypocomplementemic urticarial vasculitis syndrome (HUVS) is a rare type III hypersensitivity disorder characterized by urticarial vasculitis and prolonged hypocomplementemia. Individuals with HUVS may also have joint involvement, pulmonary manifestations, ocular disease, kidney inflammation, or any other form of organ involvement. Hypocomplementemia, the presence of C1q antibody in the serum, and urticarial vasculitis are the keys to the diagnosis of HUVS. It has been reported to accompany certain infections such as hepatitis B, hepatitis C, infectious mononucleosis, and coxsackie group A. However, it has never been reported to be linked to histoplasmosis in the literature. To the best of our knowledge, we report the first case of HUVS presenting concurrently with pulmonary histoplasmosis.
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Affiliation(s)
- Mohammad Alomari
- Department of Internal Medicine, Cleveland Clinic Foundation, 18101 Lorain Ave, Cleveland, OH, 44111, USA.
| | - Laith Al Momani
- Department of Internal Medicine, East Tennessee State University, Johnson City, TN, USA
| | - Shrouq Khazaaleh
- Department of Internal Medicine, Cleveland Clinic Foundation, 18101 Lorain Ave, Cleveland, OH, 44111, USA
| | - Shaden Almomani
- Department of Internal Medicine, Jordanian Royal Medical Services, Irbid, Jordan
| | - Kinanah Yaseen
- Department of Rheumatic and Immunologic Diseases, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Bassam Alhaddad
- Departments of Medicine and Rheumatology, MetroHealth Medical Center, Cleveland, OH, USA
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Abstract
The vasculitides are diseases characterized by inflammation of blood vessels and inflammatory leukocytes in vessel walls. There is an increased propensity for ischemic stroke, resulting from compromise of vessel lumina with distal tissue ischemia; and hemorrhagic or nonhemorrhagic stroke, and aneurysmal formation and bleeding, due to loss of vessel integrity.
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Affiliation(s)
- David S Younger
- Department of Neurology, Division of Neuro-Epidemiology, New York University School of Medicine, New York, NY, USA; School of Public Health, City University of New York, New York, NY, USA.
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31
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DeQuattro K, Urisman A, Margaretten M. A 36-Year-Old Man With Renal Failure, Fever, and Hypocomplementemia. Arthritis Care Res (Hoboken) 2018; 71:449-455. [PMID: 30295438 DOI: 10.1002/acr.23770] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 09/25/2018] [Indexed: 01/05/2023]
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Urticaria, Urticarial Vasculitis, Angioedema, and Related Diseases. CURRENT DERMATOLOGY REPORTS 2018. [DOI: 10.1007/s13671-018-0223-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Jachiet M, Flageul B, Bouaziz JD, Bagot M, Terrier B. Les vascularites urticariennes hypocomplémentémiques. Rev Med Interne 2018; 39:90-98. [DOI: 10.1016/j.revmed.2017.03.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Revised: 01/29/2017] [Accepted: 03/04/2017] [Indexed: 01/21/2023]
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Honda D, Ohsawa I, Sato N, Inoshita H, Mano S, Tomino Y, Suzuki Y. Diminished capacity of opsonization and immune complex solubilization, and detection of anti-C1q antibodies in sera from patients with hereditary angioedema. Allergol Int 2017; 66:603-609. [PMID: 28433622 DOI: 10.1016/j.alit.2017.03.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Revised: 03/01/2017] [Accepted: 03/14/2017] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Hereditary angioedema (HAE) is an autosomal dominant disease caused by deficiency of C1 esterase inhibitor. Symptoms of HAE include edema, which can potentially cause suffocation. Some patients with HAE exhibit immunological abnormalities, which could prevent an accurate diagnosis. Low levels of complement components are characteristic of HAE and in other settings are thought to reduce elimination of apoptotic cells and immune complex (IC). Thus, we aimed to experimentally clarify the mechanism of immunological abnormalities using sera from HAE patients. METHODS Serum samples from 18 patients with HAE were collected when free from angioedema attack and compared with normal human pooled sera (NHPS) from 20 healthy volunteers. Opsonization was measured as the rate of phagocytosis of apoptotic Jurkat cells by macrophages differentiated from THP-1 cells incubated with serum. IC solubilization in serum was analyzed by quantifying peroxidase released from a synthetic IC composed of peroxidase and anti-peroxidase antibodies. Anti-C1q antibody levels were detected using an enzyme-linked immunosorbent assay. RESULTS Serological immunological abnormalities were detected in 12 patients. Opsonization in serum samples from each patient with HAE was lower than that in NHPS (∼20% versus 70%, respectively). The rate of IC solubilization was lower in serum from HAE patients than NHPS. Some patients had high serum anti-C1q antibody levels with increased serum IC levels. CONCLUSIONS Sera from patients with HAE exhibit anti-C1q antibodies, with a lower capacity for opsonization and IC solubilization. This may be associated with immunological abnormalities and should be investigated further to facilitate accurate diagnosis of HAE.
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Lopalco G, Rigante D, Venerito V, Emmi G, Anelli MG, Lapadula G, Iannone F, Cantarini L. Management of Small Vessel Vasculitides. Curr Rheumatol Rep 2017; 18:36. [PMID: 27118389 DOI: 10.1007/s11926-016-0580-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Inflammation mediated by cells of the immune system and necrosis are the most striking features observed at the histologic level in patients with vasculitides, clinical entities classified according to pathologic findings involving different organs, to etiology, or to size of vessels involved. Small vessel vasculitides (SVV) are a peculiar group of systemic disorders electively involving small intraparenchymal arteries, arterioles, capillaries, or venules and leading to different levels of vascular obstruction, tissue ischemia and risk of infarction; they can be divided into anti-neutrophil cytoplasmic antibody-associated vasculitides and immune complex vasculitides. Despite the significant advances in understanding the whole disease process and pathophysiology of SVV, strong efforts are still needed to draft, share and spread guidelines in the therapeutic management of these protean disorders. After an accurate evaluation of different open or double-blind trials and cohort studies in this review, we analyze the actual medical tools suggested for treating granulomatosis with polyangiitis, microscopic polyangiitis, eosinophilic granulomatosis with polyangiitis, Henoch-Schönlein purpura, cryoglobulinemic vasculitis, anti-glomerular basement membrane disease and hypocomplementemic urticarial vasculitis.
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Affiliation(s)
- Giuseppe Lopalco
- Interdisciplinary Department of Medicine, Rheumatology Unit, University of Bari, Bari, Italy
| | - Donato Rigante
- Institute of Pediatrics, Fondazione Policlinico Universitario A. Gemelli, Università Cattolica Sacro Cuore, Rome, Italy
| | - Vincenzo Venerito
- Interdisciplinary Department of Medicine, Rheumatology Unit, University of Bari, Bari, Italy
| | - Giacomo Emmi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Maria Grazia Anelli
- Interdisciplinary Department of Medicine, Rheumatology Unit, University of Bari, Bari, Italy
| | - Giovanni Lapadula
- Interdisciplinary Department of Medicine, Rheumatology Unit, University of Bari, Bari, Italy
| | - Florenzo Iannone
- Interdisciplinary Department of Medicine, Rheumatology Unit, University of Bari, Bari, Italy
| | - Luca Cantarini
- Research Center of Systemic Autoinflammatory Diseases and Behçet's Disease Clinic, Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Siena, Italy. .,Rheumatology Unit, Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Policlinico Le Scotte, Viale Bracci 1, 53100, Siena, Italy.
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Abstract
Systemic vasculitides are a group of rare diseases characterized by inflammation of the arterial or venous vessel wall, causing stenosis or thrombosis. Clinical symptoms may be limited to skin or to other organs or may include multiple manifestations as systemic conditions. The pathogenesis is related to the presence of leukocytes in the vessels and to the IC deposition, which implies the activation of the complement system (CS) and then the swelling and damage of vessel mural structures. The complement system (CS) is involved in the pathogenesis of several autoimmune diseases, including systemic vasculitides. This enzymatic system is a part of the innate immune system, and its function is linked to the modulation of the adaptive immunity and in bridging innate and adaptive responses. Its activation is also critical for the development of natural antibodies and T cell response and for the regulation of autoreactive B cells. Complement triggering contributes to inflammation-driven tissue injury, which occurs during the ischemia/reperfusion processes, vasculitides, nephritis, arthritis, and many others diseases. In systemic vasculitides, a group of uncommon diseases characterized by blood vessel inflammation, the contribution of CS in the development of inflammatory damage has been demonstrated. Treatment is mainly based on clinical manifestations and severity of organ involvement. Evidences on the efficacy of traditional immunosuppressive therapies have been collected as well as data from clinical trials that involve the modulation of the CS. In particular in small-medium-vessel vasculitides, the CS represents an attractive target. Herein, we reviewed the pathogenetic role of CS in these systemic vasculitides as urticarial vasculitis, ANCA-associated vasculitides, anti-glomerular basement membrane disease, cryoglobulinaemic vasculitides, Henoch-Schönlein purpura/IgA nephropathy, and Kawasaki disease and therefore its potential therapeutic use in this context.
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Andersen MF, Longhurst HJ, Rasmussen ER, Bygum A. How Not to Be Misled by Disorders Mimicking Angioedema: A Review of Pseudoangioedema. Int Arch Allergy Immunol 2016; 169:163-70. [DOI: 10.1159/000445835] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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38
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Wong SM, McComish J, Douglass J, Tsui A, Chee L. Rare skin manifestations successfully treated with primary B-cell chronic lymphocytic leukemia treatment. J Cutan Pathol 2016; 43:552-5. [DOI: 10.1111/cup.12684] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2015] [Revised: 01/18/2016] [Accepted: 01/19/2016] [Indexed: 01/16/2023]
Affiliation(s)
- Shu Min Wong
- Department of Clinical Haematology and Bone Marrow Transplant Unit; The Royal Melbourne Hospital; Parkville VIC Australia
| | - Jeremy McComish
- Department of Immunology and Allergy; The Royal Melbourne Hospital; Parkville VIC Australia
| | - Jo Douglass
- Department of Immunology and Allergy; The Royal Melbourne Hospital; Parkville VIC Australia
| | - Alpha Tsui
- Department of Anatomical Pathology; The Royal Melbourne Hospital; Parkville VIC Australia
| | - Lynette Chee
- Department of Clinical Haematology and Bone Marrow Transplant Unit; The Royal Melbourne Hospital; Parkville VIC Australia
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39
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Vasculitides: Proposal for an integrated nomenclature. Autoimmun Rev 2016; 15:167-73. [DOI: 10.1016/j.autrev.2015.10.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Accepted: 10/29/2015] [Indexed: 12/25/2022]
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40
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Flageul B. Que faut-il penser de la vascularite urticarienne hypocomplémentémique en 2015 ? Ann Dermatol Venereol 2015; 142:531-3. [DOI: 10.1016/j.annder.2015.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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41
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Hauser B. Systemic Manifestations of Hypocomplementemic Urticarial Vasculitis: Comment on the Article by Jachiet et al. Arthritis Rheumatol 2015; 67:1984-5. [DOI: 10.1002/art.39097] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Accepted: 03/31/2015] [Indexed: 11/10/2022]
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Jachiet M, Flageul B, Deroux A, Le Quellec A, Maurier F, Cordoliani F, Godmer P, Abasq C, Astudillo L, Belenotti P, Bessis D, Bigot A, Doutre MS, Ebbo M, Guichard I, Hachulla E, Héron E, Jeudy G, Jourde-Chiche N, Jullien D, Lavigne C, Machet L, Macher MA, Martel C, Melboucy-Belkhir S, Morice C, Petit A, Simorre B, Zenone T, Bouillet L, Bagot M, Frémeaux-Bacchi V, Guillevin L, Mouthon L, Dupin N, Aractingi S, Terrier B. The clinical spectrum and therapeutic management of hypocomplementemic urticarial vasculitis: data from a French nationwide study of fifty-seven patients. Arthritis Rheumatol 2015; 67:527-34. [PMID: 25385679 DOI: 10.1002/art.38956] [Citation(s) in RCA: 99] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Accepted: 11/06/2014] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Hypocomplementemic urticarial vasculitis (HUV) is an uncommon vasculitis of unknown etiology that is rarely described in the literature. We undertook this study to analyze the clinical spectrum and the therapeutic management of patients with HUV. METHODS We conducted a French nationwide retrospective study that included 57 patients with chronic urticaria, histologic leukocytoclastic vasculitis, and hypocomplementemia. We assessed clinical and laboratory data and evaluated the patients' cutaneous and immunologic responses to therapy. We evaluated treatment efficacy by measuring the time to treatment failure. RESULTS Urticarial lesions were typically more pruritic than painful and were associated with angioedema in 51% of patients, purpura in 35%, and livedo reticularis in 14%. Extracutaneous manifestations included constitutional symptoms (in 56% of patients) as well as musculoskeletal involvement (in 82%), ocular involvement (in 56%), pulmonary involvement (in 19%), gastrointestinal involvement (in 18%), and kidney involvement (in 14%). Patients with HUV typically presented with low C1q levels and normal C1 inhibitor levels, in association with anti-C1q antibodies in 55% of patients. Hydroxychloroquine or colchicine seemed to be as effective as corticosteroids as first-line therapy. In patients with relapsing and/or refractory disease, rates of cutaneous and immunologic response to therapy seemed to be higher with conventional immunosuppressive agents, in particular, azathioprine, mycophenolate mofetil, or cyclophosphamide, while a rituximab-based regimen tended to have higher efficacy. Finally, a cutaneous response to therapy was strongly associated with an immunologic response to therapy. CONCLUSION HUV represents an uncommon systemic and relapsing vasculitis with various manifestations, mainly, musculoskeletal and ocular involvement associated with anti-C1q antibodies, which were found in approximately half of the patients. The best strategy for treating HUV has yet to be defined.
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Affiliation(s)
- Marie Jachiet
- Hôpital Cochin, AP-HP, and Université Paris Descartes, Paris 5, Paris, France
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Panelius J, Meri S. Complement system in dermatological diseases - fire under the skin. Front Med (Lausanne) 2015; 2:3. [PMID: 25688346 PMCID: PMC4310328 DOI: 10.3389/fmed.2015.00003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Accepted: 01/09/2015] [Indexed: 12/03/2022] Open
Abstract
The complement system plays a key role in several dermatological diseases. Overactivation, deficiency, or abnormality of the control proteins are often related to a skin disease. Autoimmune mechanisms with autoantibodies and a cytotoxic effect of the complement membrane attack complex on epidermal or vascular cells can cause direct tissue damage and inflammation, e.g., in systemic lupus erythematosus (SLE), phospholipid antibody syndrome, and bullous skin diseases like pemphigoid. By evading complement attack, some microbes like Borrelia spirochetes and staphylococci can persist in the skin and cause prolonged symptoms. In this review, we present the most important skin diseases connected to abnormalities in the function of the complement system. Drugs having an effect on the complement system are also briefly described. On one hand, drugs with free hydroxyl on amino groups (e.g., hydralazine, procainamide) could interact with C4A, C4B, or C3 and cause an SLE-like disease. On the other hand, progress in studies on complement has led to novel anti-complement drugs (recombinant C1-inhibitor and anti-C5 antibody, eculizumab) that could alleviate symptoms in diseases associated with excessive complement activation. The main theme of the manuscript is to show how relevant the complement system is as an immune effector system in contributing to tissue injury and inflammation in a broad range of skin disorders.
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Affiliation(s)
- Jaana Panelius
- Department of Bacteriology and Immunology, Haartman Institute, University of Helsinki , Helsinki , Finland ; Department of Dermatology and Allergology, Skin and Allergy Hospital, Helsinki University Central Hospital , Helsinki , Finland
| | - Seppo Meri
- Department of Bacteriology and Immunology, Haartman Institute, University of Helsinki , Helsinki , Finland ; Huslab, Helsinki University Central Hospital , Helsinki , Finland ; Research Programs Unit, Immunobiology, University of Helsinki , Helsinki , Finland
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Biology and immunopathogenesis of vasculitis. Rheumatology (Oxford) 2015. [DOI: 10.1016/b978-0-323-09138-1.00154-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Koudoukpo C, Jachiet M, Zini JM, Andreoli A, Pinquier L, Rybojad M, Bosset D, de Masson A, Bagot M, Lebbé C, Bouaziz JD. Vascularite urticarienne associée à une thrombocytémie essentielle avec myélofibrose secondaire. Ann Dermatol Venereol 2014; 141:773-6. [DOI: 10.1016/j.annder.2014.09.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Revised: 07/31/2014] [Accepted: 09/01/2014] [Indexed: 11/24/2022]
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Park C, Choi SW, Kim M, Park J, Lee JS, Chung HC. Membranoproliferative glomerulonephritis presenting as arthropathy and cardiac valvulopathy in hypocomplementemic urticarial vasculitis: a case report. J Med Case Rep 2014; 8:352. [PMID: 25339233 PMCID: PMC4209772 DOI: 10.1186/1752-1947-8-352] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Accepted: 08/28/2014] [Indexed: 11/16/2022] Open
Abstract
Introduction Hypocomplementemic urticarial vasculitis syndrome is a rare disorder characterized by chronic urticarial vasculitis, arthralgia, arthritis, and hypocomplementemia. Previously, only six patients with concomitant hypocomplementemic urticarial vasculitis syndrome, Jaccoud’s arthropathy, and valvular heart disease have been reported. Case presentation A 30-year-old Korean man presented with hypocomplementemic urticarial vasculitis syndrome. In addition to urticarial cutaneous lesions, he experienced polyarthralgia and arthritis that resulted in progressive deformity of the joints of both hands, cardiac valvulopathy with mitral, tricuspid, and aortic regurgitation, and intermittent neck swelling with laryngeal edema. He also developed nephritis with azotemia. His renal biopsy results revealed membranoproliferative glomerulonephritis, type I. He showed a partial response to a combination therapy of steroid, cyclophosphamide, and mycophenolate mofetil. Conclusions We describe, to the best of our knowledge, the first case of glomerulonephritis presenting a arthropathy and cardiac valvulopathy in hypocomplementemic urticarial vasculitis syndrome. A combination of corticosteroids, cyclophosphamide, and mycophenolate mofetil appear to be a safe and effective treatment for nephropathy, however are less effective for cutaneous vasculitis, cardiac valvulopathy, and arthropathy.
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Affiliation(s)
| | | | | | | | | | - Hyun Chul Chung
- Department of Internal Medicine, Ulsan University Hospital, 290-3 Jeonha-dong, Dong-gu, Ulsan 682-714, Republic of Korea.
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Pasini A, Bracaglia C, Aceti A, Vivarelli M, Lavacchini A, Miniaci A, De Benedetti F, Montini G. Renal involvement in hypocomplementaemic urticarial vasculitis syndrome: a report of three paediatric cases. Rheumatology (Oxford) 2014; 53:1409-1413. [DOI: 10.1093/rheumatology/keu023] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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Hauser B, McRorie E, McKay N, Brenn T, Amft N. A case of hypocomplementaemic urticarial vasculitis with cardiac valve involvement successfully treated with cyclophosphamide and high-dose glucocorticoids. Int J Rheum Dis 2014; 20:1850-1852. [DOI: 10.1111/1756-185x.12360] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Barbara Hauser
- Department of Rheumatology; Western General Hospital; Edinburgh UK
- Rheumatic Diseases Unit; Institute of Genetics and Molecular Medicine; University of Edinburgh; Edinburgh UK
| | - Euan McRorie
- Department of Rheumatology; Western General Hospital; Edinburgh UK
| | - Neil McKay
- Department of Rheumatology; Western General Hospital; Edinburgh UK
| | - Thomas Brenn
- Edinburgh Department of Pathology; Western General Hospital; Edinburgh UK
| | - Nicole Amft
- Department of Rheumatology; Western General Hospital; Edinburgh UK
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Abstract
Cutaneous vasculitis in children is rare. Causes of cutaneous vasculitis are varied and are typically differentiated by the affected vessel size. A skin biopsy remains the gold standard for diagnosis but other causes for vasculitis, including systemic conditions, should be considered. This article discusses the childhood conditions commonly presenting with cutaneous vasculitis (leukocytoclastic vasculitis, cutaneous polyarteritis nodosa), biopsy recommendations and findings, and management and potential differential diagnoses, and includes a brief summary of other diseases that may include cutaneous symptoms as a constellation of other systemic findings.
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Affiliation(s)
- Tracy V Ting
- Division of Pediatric Rheumatology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 4010, Cincinnati, OH 45229, USA.
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