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Cieza-Terrones M, De La Flor JC, Requejo C, Villa D, Apaza J, Rodríguez-Doyágüez P, Zamora R, Asato-Higa C, Rivera-Estrella D, Carrasco-Yalán A. An Unusual Case of Immune Complex-Mediated Membranoproliferative Glomerulonephritis as Renal Manifestation of Idiopathic Hypereosinophilic Syndrome: A Case Report and Literature Review. MEDICINES (BASEL, SWITZERLAND) 2024; 11:13. [PMID: 38921600 PMCID: PMC11206110 DOI: 10.3390/medicines11060013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 05/18/2024] [Accepted: 05/28/2024] [Indexed: 06/27/2024]
Abstract
BACKGROUND Idiopathic hypereosinophilic syndrome (IHES) is a disorder characterized by abnormal and persistent peripheral blood hypereosinophilia (eosinophil count ≥ 1.5 × 109/L and ≥10% eosinophils) with duration ≥ 6 months, associated organ damage, and/or dysfunction attributable to tissue eosinophilic infiltrate of unknown cause. IHES affects different organs such as the heart, lungs, nervous system, and skin, with renal involvement being rare in this condition. CASE PRESENTATION We present a case of a young patient with IHES and immune complex-mediated membranoproliferative glomerulonephritis with nephrotic syndrome, as a rare renal manifestation. We discuss the clinical, analytical, and histopathologic renal and hematologic features, comparing them with other reported cases in the literature.
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Affiliation(s)
- Michael Cieza-Terrones
- Department of Nephrology, Hospital Cayetano Heredia, Faculty of Medicine, Peruana Cayetano Heredia University, Lima 15002, Peru; (M.C.-T.); (C.R.); (D.R.-E.)
| | - José C. De La Flor
- Department of Nephrology, Hospital Central Defense Gomez Ulla, 280467 Madrid, Spain
- Faculty of Medicine, Alcala de Henares University, 28805 Madrid, Spain
| | - Christian Requejo
- Department of Nephrology, Hospital Cayetano Heredia, Faculty of Medicine, Peruana Cayetano Heredia University, Lima 15002, Peru; (M.C.-T.); (C.R.); (D.R.-E.)
| | - Daniel Villa
- Department of Nephrology, Clínica Universidad de Navarra, 31008 Navarra, Spain;
| | - Jacqueline Apaza
- Department of Nephrology, Hospital Rey Juan Carlos, 28933 Madrid, Spain;
| | | | - Rocío Zamora
- Department of Nephrology, Hospital Universitario General Villalba, 28400 Madrid, Spain;
| | | | - David Rivera-Estrella
- Department of Nephrology, Hospital Cayetano Heredia, Faculty of Medicine, Peruana Cayetano Heredia University, Lima 15002, Peru; (M.C.-T.); (C.R.); (D.R.-E.)
| | - Antonio Carrasco-Yalán
- Postgraduate School, Faculty of Medicine, Universidad Nacional Mayor de San Marcos, Lima 15081, Peru;
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Hahn C, Budhram A, Alikhani K, AlOhaly N, Beecher G, Blevins G, Brooks J, Carruthers R, Comtois J, Cowan J, de Robles P, Hébert J, Kapadia RK, Lapointe S, Mackie A, Mason W, McLane B, Muccilli A, Poliakov I, Smyth P, Williams KG, Uy C, McCombe JA. Canadian Consensus Guidelines for the Diagnosis and Treatment of Autoimmune Encephalitis in Adults. Can J Neurol Sci 2024:1-21. [PMID: 38312020 DOI: 10.1017/cjn.2024.16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2024]
Abstract
Autoimmune encephalitis is increasingly recognized as a neurologic cause of acute mental status changes with similar prevalence to infectious encephalitis. Despite rising awareness, approaches to diagnosis remain inconsistent and evidence for optimal treatment is limited. The following Canadian guidelines represent a consensus and evidence (where available) based approach to both the diagnosis and treatment of adult patients with autoimmune encephalitis. The guidelines were developed using a modified RAND process and included input from specialists in autoimmune neurology, neuropsychiatry and infectious diseases. These guidelines are targeted at front line clinicians and were created to provide a pragmatic and practical approach to managing such patients in the acute setting.
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Affiliation(s)
- Christopher Hahn
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
| | - Adrian Budhram
- Clinical Neurological Sciences, London Health Sciences Centre, London, ON, Canada
- Department of Pathology and Laboratory Medicine, Western University, London Health Sciences Centre, London, ON, Canada
| | - Katayoun Alikhani
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
| | - Nasser AlOhaly
- Division of Neurology, University of Toronto, Toronto, ON, Canada
| | - Grayson Beecher
- Division of Neurology, University of Alberta, Edmonton, AB, Canada
| | - Gregg Blevins
- Division of Neurology, University of Alberta, Edmonton, AB, Canada
| | - John Brooks
- Division of Neurology, University of Toronto, Toronto, ON, Canada
| | - Robert Carruthers
- Division of Neurology, University of British Columbia, Vancouver, BC, Canada
| | - Jacynthe Comtois
- Neurosciences, Universite de Montreal Faculte de Medecine, Montreal, QC, Canada
| | - Juthaporn Cowan
- Division of Infectious Diseases, Department of Medicine Ottawa Hospital, Ottawa, ON, Canada
| | - Paula de Robles
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
- Department of Oncology, University of Calgary, Calgary, AB, Canada
| | - Julien Hébert
- Division of Neurology, University of Toronto, Toronto, ON, Canada
| | - Ronak K Kapadia
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
| | - Sarah Lapointe
- Neurosciences, Universite de Montreal Faculte de Medecine, Montreal, QC, Canada
| | - Aaron Mackie
- Department of Psychiatry, University of Calgary, Calgary, AB, Canada
| | - Warren Mason
- Division of Neurology, University of Toronto, Toronto, ON, Canada
| | - Brienne McLane
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
- Department of Psychiatry, University of Calgary, Calgary, AB, Canada
| | | | - Ilia Poliakov
- Division of Neurology, University of Saskatchewan College of Medicine, Saskatoon, SK, Canada
| | - Penelope Smyth
- Division of Neurology, University of Alberta, Edmonton, AB, Canada
| | | | - Christopher Uy
- Division of Neurology, University of British Columbia, Vancouver, BC, Canada
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Elbahoty M, Elnaggar S, Soror N, Elkeraie A, Youssef A. Co-occurrence of Idiopathic Hypereosinophilic Syndrome in End-Stage Renal Disease Patients Undergoing Maintenance Hemodialysis. Cureus 2024; 16:e53758. [PMID: 38465088 PMCID: PMC10921820 DOI: 10.7759/cureus.53758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2024] [Indexed: 03/12/2024] Open
Abstract
Hypereosinophilic syndrome (HES) is defined as the presence of (1) peripheral blood eosinophilia >1.5 x 109/L for at least one month, (2) evidence of eosinophil-mediated organ damage and/or dysfunction, and (3) exclusion of other potential causes of eosinophilia. In hemodialysis patients, HES has been associated with manifestations because of low blood pressure or gastrointestinal symptoms that result in dialysis intolerance. Very few cases of HES co-occurrence in dialysis patients have been reported in the literature, and their clinical characteristics are not fully understood. Here, we report two end-stage renal disease patients diagnosed with idiopathic HES while undergoing maintenance hemodialysis. The first patient presented with unexplained persistent pruritus and intradialytic hypotension, which started 10 minutes after the dialysis session initiation. Hematologic studies revealed hypereosinophilia which remarkably improved on steroid therapy. The second patient was accidentally discovered with asymptomatic persistent hypereosinophilia. His blood counts improved initially on interferon treatment before achieving full remission on steroid therapy. Neither of the two patients reported any history of allergy or atopic manifestations. Our case report sheds light on the possible occurrence of HES in hemodialysis patients which may be confused with other dialysis-related complications. Although steroids remain the mainstay of treatment, the optimal dose and duration of treatment remain unknown.
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Affiliation(s)
- Mohamed Elbahoty
- Department of Pathology, University of Alabama at Birmingham, Birmingham, USA
- Department of Internal Medicine, Hematology Unit, Faculty of Medicine, Alexandria University, Alexandria, EGY
| | - Sherine Elnaggar
- Nephrology and Hemodialysis Unit, Alexandria University Hospitals, Alexandria, EGY
| | - Nooran Soror
- Department of Internal Medicine, Hematology Unit, Faculty of Medicine, Alexandria University, Alexandria, EGY
| | - Ahmed Elkeraie
- Department of Internal Medicine, Nephrology and Hemodialysis Unit, Faculty of Medicine, Alexandria University, Alexandria, EGY
| | - Ayman Youssef
- Anesthesiology and Critical Care, Duke University Medical Center, Durham, USA
- Department of Internal Medicine, Hematology Unit, Faculty of Medicine, Alexandria University, Alexandria, EGY
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4
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Hwee J, Huynh L, Du S, Kwon N, Jakes RW, Alfonso-Cristancho R, Baylis L, Requena G, Khanal A, Rothenberg ME, Sheng Duh M. Hypereosinophilic syndrome in Europe: Retrospective study of treatment patterns, clinical manifestations, and healthcare resource utilization. Ann Allergy Asthma Immunol 2023:S1081-1206(23)00129-1. [PMID: 36863663 DOI: 10.1016/j.anai.2023.02.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 02/20/2023] [Accepted: 02/21/2023] [Indexed: 03/04/2023]
Abstract
BACKGROUND The burden of hypereosinophilic syndrome (HES) in Europe is not well characterized. OBJECTIVE To evaluate real-world patient characteristics, treatment patterns, clinical manifestations, and healthcare resource utilization for patients with HES from France, Germany, Italy, Spain, and the United Kingdom. METHODS In this retrospective, noninterventional study, data for patients with a physician-confirmed diagnosis of HES were abstracted from medical chart reviews. Patients were aged 6 years or older at the time of HES diagnosis and had 1 or more years of follow-up from the index date (first clinic visit between January 2015 and December 2019). Data on treatment patterns, comorbidities, clinical manifestations, clinical outcomes, and healthcare resource utilization were collected from diagnosis or index date to end of follow-up. RESULTS Data for 280 patients were abstracted from medical charts by 121 physicians treating HES, with multiple specialties. Most patients (55%) had idiopathic HES, and 24% had myeloid HES; the median number (interquartile range [IQR]) of diagnostic tests per patient was 10 (6-12). The most common comorbidities were asthma (45%) and anxiety or depression (36%). Most patients (89%) used oral corticosteroids; 64% used immunosuppressants or cytotoxic agents, and 44% used biologics. Patients had a median (IQR) of 3 clinical manifestations (1-5), most commonly constitutional (63%), lung (49%), and skin (48%). Twenty-three percent of patients experienced a flare, and 40% had a complete treatment response. Some patients (30%) were hospitalized with a median (IQR) stay of 9 days (5-15) for HES-related issues. CONCLUSION Patients with HES across 5 European countries had a substantial disease burden despite extensive oral corticosteroids treatment, highlighting the need for additional targeted therapies.
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Affiliation(s)
| | - Lynn Huynh
- Analysis Group, Inc., Boston, Massachusetts, United States
| | - Shawn Du
- Analysis Group, Inc., Boston, Massachusetts, United States
| | - Namhee Kwon
- Clinical Sciences, Respiratory, GSK, Brentford, Middlesex, United Kingdom
| | | | | | - Lee Baylis
- Global Medical Affairs, GSK, Durham, North Carolina, United States
| | | | - Anamika Khanal
- Analysis Group, Inc., Boston, Massachusetts, United States
| | - Marc E Rothenberg
- Division of Allergy and Immunology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati School of Medicine, Cincinnati, Ohio, United States
| | - Mei Sheng Duh
- Analysis Group, Inc., Boston, Massachusetts, United States
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5
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Dzelebdzic S, Sasaki N, Welch E, Muniz JC. Hypereosinophilic Syndrome with Advanced-Stage Loeffler Endocarditis. CASE 2022; 6:191-195. [PMID: 35818495 PMCID: PMC9270668 DOI: 10.1016/j.case.2022.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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6
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Kanchongkittiphon W, Kittinon K, Wanitchakorn A, Benjaponpitak S, Manuyakorn W. Favorable Response to Interferon-α in Infantile-onset Idiopathic Hypereosinophilic Syndrome Complicated by Status Epilepticus During Treatment. J Pediatr Hematol Oncol 2021; 43:e1052-e1053. [PMID: 33448715 DOI: 10.1097/mph.0000000000002052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Watcharoot Kanchongkittiphon
- Division of Allergy and Immunology Department of Pediatrics, Ramathibodi Hospital, Mahidol University, Bangkok Thailand
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7
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Basso JR, Bizinoto LGZ, Limone GA, Enokihara MMSS, Espirito-Santo Filho KD, Fonseca AR, Agondi RC, Gois AFTD, Cunha LL. Episodic angioedema with eosinophilia (Gleich's syndrome) associated with urticarial vasculitis: a coincidence or a novel clinical entity? ACTA ACUST UNITED AC 2021; 54:e10745. [PMID: 33886812 PMCID: PMC8055181 DOI: 10.1590/1414-431x202010745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 01/13/2021] [Indexed: 11/23/2022]
Abstract
Episodic angioedema with eosinophilia (EAE) is a rare condition characterized by recurrent attacks of angioedema and urticaria accompanied by a marked elevation of peripheral eosinophil count. We report the case of a young female patient diagnosed with EAE associated with urticarial vasculitis. A 40-year-old female patient was admitted to our institution due to recurrent episodes of cheek and eyelid angioedema in the previous year. Episodes of facial angioedema lasted for two months with spontaneous remission afterwards. In addition, she presented pruritic and painful skin eruptions of erythematous circles, which persisted for longer than 24 h, that were palpable, somewhat purplish, and more pronounced on the face, arms, and trunk. Laboratory investigation showed a sustained elevation of white cell counts with marked eosinophilia. Serum IgM, IgE, and IgA were normal; IgG was slightly elevated. C1-esterase inhibitor and tryptase test were normal. Reverse transcriptase-polymerase chain reaction was performed for detection of FIP1L1-PDGFRA and BCR-ABL rearrangements. None of these alterations were found. Skin biopsies were suggestive of urticarial vasculitis. The patient was submitted to esophagogastroduodenoscopy, which showed mild chronic gastritis, with no eosinophilic infiltration. Cardiac dimensions and function were normal. Abdominal ultrasound and total body CT-scan failed to show lymphadenopathy, organomegaly, and tumors. We report the first case of association between episodic angioedema with eosinophilia and urticarial vasculitis. It is possible that both conditions share a physiopathological mechanism, suggesting that it is not just a chance association.
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Affiliation(s)
- J R Basso
- Departamento de Medicina, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | - L G Z Bizinoto
- Departamento de Medicina, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | - G A Limone
- Departamento de Patologia, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | - M M S S Enokihara
- Departamento de Patologia, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | - K do Espirito-Santo Filho
- Departamento de Patologia, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | - A R Fonseca
- Disciplina de Hematologia, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | - R C Agondi
- Serviço de Imunologia Clínica e Alergia do Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - A F T de Gois
- Disciplina da Medicina Baseada em Evidências, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | - L L Cunha
- Departamento de Medicina, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil.,Programa de Pós-graduação em Endocrinologia e Metabolismo, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
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8
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Mutsuyoshi Y, Hirai K, Morino J, Kaneko S, Minato S, Yanai K, Ishii H, Matsuyama M, Kitano T, Aomatsu A, Miyazawa H, Ito K, Ueda Y, Ookawara S, Morishita Y. Idiopathic hypereosinophilic syndrome in hemodialysis patients: Case reports. Medicine (Baltimore) 2021; 100:e25164. [PMID: 33725918 PMCID: PMC7969317 DOI: 10.1097/md.0000000000025164] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 02/25/2021] [Indexed: 01/05/2023] Open
Abstract
RATIONALE Herein, we report 3 hemodialysis patients with idiopathic hypereosinophilic syndrome who were successfully treated using corticosteroid therapy. PATIENT CONCERNS Case 1 was a 63-year-old man who was undergoing hemodialysis because of bilateral nephrectomy and developed hypereosinophilia with digestive symptoms, myocardial injury, and intradialytic hypotension. Case 2 was an 83-year-old man who was undergoing hemodialysis because of nephrosclerosis and developed hypereosinophilia with pruritus, myocardial injury, and intradialytic hypotension. Case 3 was a 59-year-old man who was undergoing hemodialysis because of diabetic nephropathy and developed hypereosinophilia with pruritus, myocardial injury, and intradialytic hypotension. DIAGNOSES All 3 patients presented with hypereosinophilia (eosinophil count ≥1500 /μL for more than 1 month) and multiple-organ involvement (intradialytic hypotension, cardiac injury, digestive symptoms, and allergic dermatitis). A specific cause for the hypereosinophilia was not identified by systemic computed tomography, electrocardiography, echocardiography, bone marrow examination, or blood tests. Furthermore, Case 2 and 3 had not recently started taking any new drugs and drug-induced lymphocyte stimulation tests were negative in Case 1. Therefore, they were diagnosed with idiopathic hypereosinophilic syndrome. INTERVENTIONS All 3 patients received corticosteroid therapy with prednisolone at a dose of 40 mg/d, 30 mg/d, and 60 mg/d in Case 1, 2, and 3, respectively. OUTCOMES Their digestive symptoms, pruritus, intradialytic hypotension, and serum troponin I concentrations were immediately improved alongside reductions in their eosinophil counts. LESSONS There have been few case reports of idiopathic hypereosinophilic syndrome in patients undergoing hemodialysis. We believe that recording of the clinical findings and treatments of such patients is mandatory to establish the optimal management of idiopathic hypereosinophilic syndrome.
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9
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Sáiz Chumillas RM, Jiménez Moreno MA, Hontoria Bautista G, Alba Hernández L. Idiopathic hyperosinophilic syndrome presenting as acute abdomen: A case report. GASTROENTEROLOGIA Y HEPATOLOGIA 2021; 45 Suppl 1:149-150. [PMID: 33662402 DOI: 10.1016/j.gastrohep.2020.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 12/16/2020] [Accepted: 12/31/2020] [Indexed: 10/22/2022]
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10
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Molecular Pathogenesis and Treatment Perspectives for Hypereosinophilia and Hypereosinophilic Syndromes. Int J Mol Sci 2021; 22:ijms22020486. [PMID: 33418988 PMCID: PMC7825323 DOI: 10.3390/ijms22020486] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 12/29/2020] [Accepted: 12/30/2020] [Indexed: 12/25/2022] Open
Abstract
Hypereosinophilia (HE) is a heterogeneous condition with a persistent elevated eosinophil count of >350/mm3, which is reported in various (inflammatory, allergic, infectious, or neoplastic) diseases with distinct pathophysiological pathways. HE may be associated with tissue or organ damage and, in this case, the disorder is classified as hypereosinophilic syndrome (HES). Different studies have allowed for the discovery of two major pathogenetic variants known as myeloid or lymphocytic HES. With the advent of molecular genetic analyses, such as T-cell receptor gene rearrangement assays and Next Generation Sequencing, it is possible to better characterize these syndromes and establish which patients will benefit from pharmacological targeted therapy. In this review, we highlight the molecular alterations that are involved in the pathogenesis of eosinophil disorders and revise possible therapeutic approaches, either implemented in clinical practice or currently under investigation in clinical trials.
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11
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Hu Z, Wang W, Thakral B, Chen Z, Estrov Z, Bueso-Ramos CE, Verstovsek S, Medeiros LJ, Wang SA. Lymphocytic variant of hypereosinophilic syndrome: A report of seven cases from a single institution. CYTOMETRY PART B-CLINICAL CYTOMETRY 2020; 100:352-360. [PMID: 32157815 DOI: 10.1002/cyto.b.21874] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Revised: 02/09/2020] [Accepted: 02/26/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Lymphocytic variant of hypereosinophilic syndrome (L-HES) is a subtype of HES driven by cytokines produced by clonal T-cells. Due to the rarity of its occurrence and challenges in diagnosis, this subtype of HES is under recognized. METHODS AND RESULTS We report seven patients with L-HES, diagnosed from a group of 136 patients who were referred to our institution for the work-up of hypereosinophilia. The clinical presentation, symptoms and signs were heterogeneous and uncharacteristic; indistinguishable from idiopathic HES. Flow cytometry immunophenotypic analysis revealed aberrant T-cells in all patients, with a Th2 immunophenotype, CD2 + CD3-CD4 + CD5 + CD7dim+/-CD8- in six of seven (86%) cases. CD10 was partially expressed in one of seven (14%) cases, and clonal TCR gene rearrangement was detected by PCR in five of seven (71%) patients. All patients were treated with corticosteroids and two of seven (29%) patients received anti-IL5 antibody therapy. With a median follow-up time of 7.5 years (2.3-14.1 years), one (11%) patient developed peripheral T-cell lymphoma 6.1 years after the initial diagnosis of L-HES and responded well to chemotherapy. All patients were alive at the last follow-up. CONCLUSION In conclusion, a combination of flow cytometry immunophenotyping and molecular analysis allows the identification of aberrant T-cells, facilitating a diagnosis of L-HES in patients with eosinophilia. A correct diagnosis is essential for the proper management of these patients.
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Affiliation(s)
- Zhihong Hu
- Department of Pathology, The University of Texas Health Center at Houston, Houston, Texas, USA
| | - Wei Wang
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Beenu Thakral
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Zhining Chen
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.,Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Zeev Estrov
- Department of Pathology, Affiliated Tumor Hospital, Guangxi Medical University, Nanning, China
| | - Carlos E Bueso-Ramos
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Srdan Verstovsek
- Department of Pathology, Affiliated Tumor Hospital, Guangxi Medical University, Nanning, China
| | - L Jeffrey Medeiros
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Sa A Wang
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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12
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Gastrointestinal Manifestations of Hypereosinophilic Syndromes and Mast Cell Disorders: a Comprehensive Review. Clin Rev Allergy Immunol 2020; 57:194-212. [PMID: 30003499 DOI: 10.1007/s12016-018-8695-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Hypereosinophilic syndrome and mastocytosis are relatively rare proliferative diseases encountered in the general population. However, allergists frequently consider these disorders in the differential of patients presenting with gastrointestinal, pulmonary, cutaneous, and allergic symptoms. Gastrointestinal symptoms are some of the most frequent and/or debilitating aspects of both disease states and in many cases lead to poor quality of life and functional limitation for the patient. They are the third most common clinical manifestation in hypereosinophilic syndrome and have been found to be the most distressful aspect of the disorder in those with systemic mastocytosis. Both eosinophils and mast cells play integral parts in normal gut physiology, but when and how exactly their effector functionality translates into clinically significant disease remains unclear, and the available literature regarding their pathophysiology remains sparse. Eosinophils and mast cells even, in fact, may not necessarily function in isolation from each other but can participate in bidirectional crosstalk. Both are affected by similar mediators and can also influence one another in a paracrine fashion. Their interactions include both production of soluble mediators for specific eosinophil and mast cell receptors (for example, eosinophil recruitment and activation by mast cells releasing histamine and eotaxin) as well as direct physical contact. The mechanistic relationship between clonal forms of hypereosinophilia and systemic mastocytosis has also been explored. The nature of gastrointestinal symptomatology in the setting of both hypereosinophilic syndrome and mast cell disease is frequently manifold, heterogeneous, and the lack of better targeted therapy makes diagnosis and management challenging, especially when faced with a substantial differential. Currently, the management of these gastrointestinal symptoms relies on the treatment of the overall disease process. In hypereosinophilia patients, systemic corticosteroids are mainstay, although steroid-sparing agents such as hydroxyurea, IFN-α, methotrexate, cyclosporine, imatinib, and mepolizumab have been utilized with varying success. In mastocytosis patients, anti-mediator therapy with antihistamines and mast cell stabilization with cromolyn sodium can be considered treatments of choice, followed by other therapies yet to be thoroughly studied, including the role of the low-histamine diet, corticosteroids, and treatment of associated IBS symptoms. Given that both eosinophils and mast cells may have joint pathophysiologic roles, they have the potential to be a combined target for therapeutic intervention in disease states exhibiting eosinophil or mast cell involvement.
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13
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Nagamura N, Fukiwake N, Ozasa R. Steroid Resistant Hypereosinophilic Syndrome Suspected to Be Caused by Aberrant T-cell Subset. Kurume Med J 2020; 65:185-191. [PMID: 31723076 DOI: 10.2739/kurumemedj.ms654003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
A 53-year-old male presented with cough, skin rash and lymphadenopathies complicated with hypereosinophilia (HE) in the blood, and patchy shadows in both lungs on chest computed tomography. Reactive causes for HE were excluded, and no clinical or laboratory features of myeloproliferative disorders could be found. HE caused by aberrant T-cell subsets was suspected because of serum hyper-immunoglobulin E level, and organ involvement of skin and lungs, though we could show neither aberrant T-cell surface markers nor T-cell receptor gene rearrangement. In the course of steroid monotherapy, tolerable maintenance dose could not be attained and the steroid-sparing agents of hydroxycarbamide, cyclosporine and interferon-α were introduced. However, the therapeutic response was inadequate, and organ involvement of lungs and intestinal tract developed. HE caused by aberrant T-cell subsets has steroid resistance and a risk of malignant transition, and we considered this progressive steroid refractoriness to be a sign of such a transition. Cytotoxic chemotherapy or bone marrow transplantation will likely be the next treatment modality in this patient.
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Affiliation(s)
- Norihiro Nagamura
- Department of Rheumatology and Allergy, Shimane Prefectural Central Hospital
| | - Noriko Fukiwake
- Department of General Medicine, Shimane Prefectural Central Hospital
| | - Ryotaro Ozasa
- Department of General Medicine, Shimane Prefectural Central Hospital
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Li D, Xu L, Lin D, Jiang S, Feng S, Zhu L. Acute pulmonary embolism and deep vein thrombosis secondary to idiopathic hypereosinophilic syndrome. Respir Med Case Rep 2018; 25:213-215. [PMID: 30237972 PMCID: PMC6143698 DOI: 10.1016/j.rmcr.2018.09.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 09/08/2018] [Accepted: 09/08/2018] [Indexed: 02/06/2023] Open
Abstract
Acute pulmonary embolism (PE) is a most dangerous complication that needs prompt treatment to reduce potentially death. There are many well-known prognostic factors indicate the morbidity and mortality in various thromboembolic events. Persistent eosinophilia in peripheral blood can lead to tissue infiltration and even organ damage, but the urgent event of thromboembolism in pulmonary provoked by eosinophil eosinophilia in idiopathic hypereosinophilic syndrome (HES) is relative an unusual presentation. In this paper, we present two cases of patients with multiple PE and deep vein thrombosis secondary to the idiopathic HES. Patients were all treated using anticoagulant therapy and corticosteroids successfully. Accordingly, eosinophilia is another risk and precipitating factor of pulmonary thromboembolism. It is necessary for physicians to make a diagnosis in hypereosinophilia as soon as possible for proper prognosis and in case of further thromboembolic events and prevent end-organ damage.
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Affiliation(s)
- Dezhi Li
- Department of Respiratory Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Li Xu
- Department of Respiratory Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Dianjie Lin
- Department of Respiratory Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Shujuan Jiang
- Department of Respiratory Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Saran Feng
- Department of Hematology, Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Ling Zhu
- Department of Respiratory Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
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15
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Dispenza MC, Bochner BS. Diagnosis and Novel Approaches to the Treatment of Hypereosinophilic Syndromes. Curr Hematol Malig Rep 2018; 13:191-201. [PMID: 29680938 PMCID: PMC6029712 DOI: 10.1007/s11899-018-0448-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE OF REVIEW Hypereosinophilic syndrome (HES) is characterized by persistent hypereosinophilia associated with end-organ damage. As our understanding of the pathogenesis of various forms of HES broadens, so does our ability to tailor steroid-sparing therapies for each subtype. The purpose of this review is to summarize recent literature related to the etiology, diagnosis, and management of HES. RECENT FINDINGS Mutations involved in subsets of HES can guide the choice of tyrosine kinase inhibitors beyond just imatinib. Several biologics that target interleukin-5 or its receptor have shown beneficial and selective eosinophil-reducing effects in clinical trials for asthma and other disorders including HES. Early clinical data with emerging therapies such as dexpramipexole and anti-Siglec-8 antibody show promise, but need to be confirmed in randomized trials. Several new biologics and tyrosine kinase inhibitors have been shown to lower eosinophil numbers, but more randomized trials are needed to confirm efficacy in HES.
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Affiliation(s)
- Melanie C Dispenza
- Division of Allergy and Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, 240 E. Huron Street, Room M306, Chicago, IL, 60611, USA
| | - Bruce S Bochner
- Division of Allergy and Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, 240 E. Huron Street, Room M306, Chicago, IL, 60611, USA.
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16
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Abayazeed RM, Abdel-Hay MA, Elfwal S, Hssanein M. A case report of Löffler endocarditis in idiopathic hypereosinophilic syndrome: recovery is possible. Eur Heart J Case Rep 2018; 2:yty030. [PMID: 31020113 PMCID: PMC6177098 DOI: 10.1093/ehjcr/yty030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Accepted: 02/20/2018] [Indexed: 11/16/2022]
Abstract
Introduction Hypereosinophilic syndrome (HES) is a myeloproliferative disorder characterized by persistent eosinophilia that is associated with damage to multiple organs. Case Presentation Herein, we describe a case of left ventricular (LV) Löffler endocarditis on top of idiopathic HES leading to inflow and outflow obstruction. The posterior mitral leaflet was involved in the fibrotic process leading to severe mitral valve regurgitation. There was a mural thrombus in the left ventricle, which resulted in thrombo-embolic complications in the form of lower limb ischaemia. The patient was treated with high-dose corticosteroids and anticoagulants with significant improvement of his cardiac condition. Discussion In patients with persistent hypereosinophilia, thorough workup is recommended to identify any possible primary cause and detect associated end-organ damage. Treatment should be started as early as possible after establishing the diagnosis to reduce morbidity and prevent complications. Corticosteroids are the first-line therapy that usually cause a rapid reduction in the level of the eosinophilia and must be started promptly if cardiac involvement is present to attain rapid reduction in the eosinophil level and reverse the cardiac damage.
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Affiliation(s)
| | | | - Sara Elfwal
- Department of Cardiology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Mahmoud Hssanein
- Department of Cardiology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
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17
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Dal Berto AS, Camiña RH, Machado ES, Baptistella AR. FIP1L1-PDGFRA fusion-negative hypereosinophilic syndrome with uncommon cardiac involvement responding to imatinib treatment: A case report. Mol Clin Oncol 2018; 9:35-39. [PMID: 29977537 DOI: 10.3892/mco.2018.1637] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 05/21/2018] [Indexed: 12/28/2022] Open
Abstract
Hypereosinophilic syndrome is a rare, chronic hematological disease characterized by a persistently elevated eosinophil count exceeding 1.5×109/l, following the exclusion of other potential etiologies. The systemic involvement of the disease causes tissue damage through eosinophil infiltration, and may affect various organs; cardiac complications are observed in 50-60% of cases, which are predominately attributed to endomyocardial fibrosis. The treatment is based initially on determining the presence of the FIP1L1-PDGFRA fusion. Patients with positive results for this mutation tend to achieve a complete response with imatinib treatment, which is thus the first line of treatment for this condition. However, patients who are negative for this mutation initially undergo treatment with corticosteroids. This study reports the case of a male 53-year-old patient diagnosed with hypereosinophilic syndrome in 2012, with negative results for the FIP1L1-PDGFRA mutation, and persistently high eosinophil levels, despite receiving the second line of standard treatment for this condition with hydroxyurea, and having already used corticosteroids without success. At the time of admission, the patient presented with acute decompensated heart failure due to severe mitral regurgitation, without any evidence of prior myocardial fibrosis or restrictive cardiomyopathy, and without suggestion of an associated ventricular hypertrophy. This clinical presentation is uncommon, as valvular involvement usually appears in the third stage of the development of cardiac involvement, and is usually associated with fibrosis and thrombotic events. Alternative therapeutic possibilities were evaluated due to the significant progression of the disease, and it was decided to attempt the use of imatinib, despite its use being preferably recommended for FIPIL1-PDGFRA-positive patients. The patient exhibited an evident and immediate response to imatinib, with normalization of the eosinophil count within 24 h of the first dose, which was maintained for at least the next 19 months. This clinical presentation is uncommon, as patients negative for FIPIL1-PDGFRA fusion do not frequently respond to imatinib treatment, and symptomatic heart failure usually appears in the third stage of disease progression.
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Affiliation(s)
| | | | - Eduardo Silva Machado
- Santa Terezinha University Hospital, Joaçaba, Santa Catarina 89600-000, Brazil.,University of West Santa Catarina, Joaçaba, Santa Catarina 89600-000, Brazil.,Department of Clinical Oncology, Santa Terezinha University Hospital, Joaçaba, Santa Catarina 89600-000, Brazil
| | - Antuani Rafael Baptistella
- Santa Terezinha University Hospital, Joaçaba, Santa Catarina 89600-000, Brazil.,University of West Santa Catarina, Joaçaba, Santa Catarina 89600-000, Brazil.,Oncology Research Group of Santa Terezinha University Hospital/University of West Santa Catarina, Joaçaba, Santa Catarina 89600-000, Brazil.,Post Graduation Program in Bioscience and Health/University of West Santa Catarina, Joaçaba, Santa Catarina 89600-000, Brazil
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18
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Dupuch V, Tridon A, Ughetto S, Walrand S, Bonnet B, Dubray C, Virlogeux A, Vasson MP, Saroul N, Mom T, Gilain L, Evrard B. Activation state of circulating eosinophils in nasal polyposis. Int Forum Allergy Rhinol 2018; 8:584-591. [DOI: 10.1002/alr.22079] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 11/29/2017] [Accepted: 12/12/2017] [Indexed: 01/21/2023]
Affiliation(s)
- Vincent Dupuch
- Department of Otorhinolaryngology-Head and Neck Surgery; University Hospital; Clermont-Ferrand France
| | - Arlette Tridon
- Department of Immunology; University Hospital; Clermont-Ferrand France
- Université Clermont Auvergne, INRA, UMR 1019; ECREIN; Clermont-Ferrand France
| | - Sylvie Ughetto
- Department of Information and Biostatistics; University Hospital; Clermont-Ferrand France
| | - Stéphane Walrand
- Université Clermont Auvergne, INRA, UMR 1019; ECREIN; Clermont-Ferrand France
| | - Benjamin Bonnet
- Department of Immunology; University Hospital; Clermont-Ferrand France
- Université Clermont Auvergne, INRA, UMR 1019; ECREIN; Clermont-Ferrand France
| | - Claude Dubray
- INSERM CIC-501; Université Clermont Auvergne; Clermont-Ferrand France
| | - Aude Virlogeux
- Department of Immunology; University Hospital; Clermont-Ferrand France
| | - Marie-Paule Vasson
- Université Clermont Auvergne, INRA, UMR 1019; ECREIN; Clermont-Ferrand France
| | - Nicolas Saroul
- Department of Otorhinolaryngology-Head and Neck Surgery; University Hospital; Clermont-Ferrand France
| | - Thierry Mom
- Department of Otorhinolaryngology-Head and Neck Surgery; University Hospital; Clermont-Ferrand France
- Université Clermont Auvergne; INSERM, UMR 1107; Clermont-Ferrand France
| | - Laurent Gilain
- Department of Otorhinolaryngology-Head and Neck Surgery; University Hospital; Clermont-Ferrand France
- Université Clermont Auvergne; INSERM, UMR 1107; Clermont-Ferrand France
| | - Bertrand Evrard
- Department of Immunology; University Hospital; Clermont-Ferrand France
- Université Clermont Auvergne, INRA, UMR 1019; ECREIN; Clermont-Ferrand France
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19
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Kavanagh S, Lipton JH. How I Diagnose Hypereosinophilic Syndromes. EUROPEAN MEDICAL JOURNAL 2017. [DOI: 10.33590/emj/10313450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Hypereosinophilic syndromes are a group of disorders characterised by significant eosinophilia and organ damage. They have proven challenging to define, diagnose, and study for many years, due in part to their variable clinical presentations, the overlap between neoplastic and reactive eosinophilia, and the lack of a universal marker of eosinophil clonality. Herein, we give an overview of the term and discuss aetiology and our approach to diagnosis.
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Affiliation(s)
- Simon Kavanagh
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Jeffrey H. Lipton
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
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20
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A patient with germ-line gain-of-function PDGFRB p.N666H mutation and marked clinical response to imatinib. Genet Med 2017; 20:142-150. [PMID: 28726812 DOI: 10.1038/gim.2017.104] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Accepted: 05/24/2017] [Indexed: 12/25/2022] Open
Abstract
PurposeHeterozygous germ-line activating mutations in PDGFRB cause Kosaki and Penttinen syndromes and myofibromatosis. We describe a 10-year-old child with a germ-line PDGFRB p.N666H mutation who responded to the tyrosine kinase inhibitor imatinib by inhibition of PDGFRB.MethodsThe impact of p.N666H on PDGFRB function and sensitivity to imatinib was studied in cell culture.ResultsCells expressing the p.N666H mutation showed constitutive PDGFRB tyrosine phosphorylation. PDGF-independent proliferation was abolished by imatinib at 1 μM concentration. Patient fibroblasts showed constitutive receptor tyrosine phosphorylation that was also abrogated by imatinib with reduced proliferation of treated cells.This led to patient treatment with imatinib at 400 mg daily (340 mg/m2) for a year with objective improvement of debilitating hand and foot contractures, reduced facial coarseness, and significant improvement in quality of life. New small subcutaneous nodules developed, but remained stable. Transient leukopenia, neutropenia, and fatigue resolved without intervention; however, mildly decreased growth velocity resulted in reducing imatinib dose to 200 mg daily (170 mg/m2). The patient continues treatment with ongoing clinical response.ConclusionTo our knowledge, this is one of the first personalized treatments of a congenital disorder caused by a germ-line PDGF receptor mutation with a PDGFRB inhibitor.
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21
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Hernandez CM, Arisha MJ, Ahmad A, Oates E, Nanda NC, Nanda A, Wasan A, Caleti BE, Bernal CLP, Gallardo SM. Usefulness of three-dimensional echocardiography in the assessment of valvular involvement in Loeffler endocarditis. Echocardiography 2017; 34:1050-1056. [PMID: 28600838 DOI: 10.1111/echo.13575] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Loeffler endocarditis is a complication of hypereosinophilic syndrome resulting from eosinophilic infiltration of heart tissue. We report a case of Loeffler endocarditis in which three-dimensional transthoracic and transesophageal echocardiography provided additional information to what was found by two-dimensional transthoracic echocardiography alone. Our case illustrates the usefulness of combined two- and three-dimensional echocardiography in the assessment of Loeffler endocarditis. In addition, a summary of the features of hypereosinophilic syndrome and Loeffler endocarditis is provided in tabular form.
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Affiliation(s)
- Carlos M Hernandez
- National Medical Center (Siglo XXI), Cardiology Hospital, IMSS, Mexico City, Mexico
| | - Mohammed J Arisha
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Amier Ahmad
- Division of Internal Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Ethan Oates
- Division of Internal Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Navin C Nanda
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Anil Nanda
- Asthma and Allergy Center, Lewisville and Flower Mound, TX, USA.,Division of Allergy and Immunology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | | | - Beda E Caleti
- National Medical Center (Siglo XXI), Cardiology Hospital, IMSS, Mexico City, Mexico
| | - Cinthia L P Bernal
- National Medical Center (Siglo XXI), Cardiology Hospital, IMSS, Mexico City, Mexico
| | - Sergio M Gallardo
- National Medical Center (Siglo XXI), Specialties Hospital (Dr. Bernardo Sepulveda), IMSS, Mexico City, Mexico
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22
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McGrath K, Stein B, Kalhagen L, Leighton L. Imatinib mesylate- and dasatinib-induced eosinophilia in a patient with chronic myelocytic leukemia. Ann Allergy Asthma Immunol 2017; 119:85-86. [PMID: 28499700 DOI: 10.1016/j.anai.2017.04.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2017] [Revised: 04/23/2017] [Accepted: 04/25/2017] [Indexed: 12/20/2022]
Affiliation(s)
- Kris McGrath
- Division of Allergy and Immunology, Department of Medicine, Northwestern University, Chicago, Illinois.
| | - Brady Stein
- Division of Hematology/Oncology, Department of Medicine, Northwestern University, Chicago, Illinois
| | - Lindsey Kalhagen
- Division of Hematology/Oncology, Department of Medicine, Northwestern University, Chicago, Illinois
| | - Lauren Leighton
- Division of Allergy and Immunology, Department of Medicine, Northwestern University, Chicago, Illinois
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23
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Rapid Change in Mental Status in a Patient with Hypereosinophilia. Case Rep Hematol 2017; 2017:6936709. [PMID: 28168065 PMCID: PMC5259615 DOI: 10.1155/2017/6936709] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Accepted: 12/19/2016] [Indexed: 12/28/2022] Open
Abstract
We present the case of a 48-year-old female with acute onset altered mental status, who was found to have eosinophilia, elevated troponin, and embolic strokes. Extensive testing for autoimmune, infectious, and coronary artery etiologies was unremarkable. After a cardiac MRI revealed focal myocardial hyperenhancement, the patient underwent an endomyocardial biopsy with findings consistent with eosinophilic myocarditis. The patient was diagnosed of idiopathic hypereosinophilic syndrome and started on prednisone and apixaban. Our case highlights the importance of considering hypereosinophilic syndrome when eosinophilia is associated with multisystem impairments, as tissue biopsy is usually required to diagnose this rare condition.
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24
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Gao SJ, Wei W, Chen JT, Tan YH, Yu CB, Litzow MR, Liu QJ. Hypereosinophilic syndrome presenting with multiple organ infiltration and deep venous thrombosis: A case report and literature review. Medicine (Baltimore) 2016; 95:e4658. [PMID: 27583887 PMCID: PMC5008571 DOI: 10.1097/md.0000000000004658] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Hypereosinophilic syndrome (HES) can be fatal, particularly when eosinophils infiltrate vital organs and/or if extensive thrombosis develops. However there are no standard recommendations for the use of anticoagulant therapy of HES in the setting of thrombosis. METHODS We herein present a case of a 46-year-old female who presented with marked peripheral eosinophilia with symptoms of multi-organ infiltration and extensive deep venous thrombosis (DVT). In this case, evaluation was carried out before the diagnosis was established, and timely standard-dose corticosteroids combined with a new oral anticoagulant (NOAC) therapy were carried out. RESULTS These measures resulted in a rapid response and long-term disease control. CONCLUSION Although there are no data to support which anticoagulant is preferred in this setting, this case indicates that the new oral anticoagulants may play an important role in the treatment of thrombosis in HES.
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Affiliation(s)
- Su-jun Gao
- Hematology section, Cancer Center, the First Hospital of Jilin University
| | - Wei Wei
- Department of Urology, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Jiang-tao Chen
- Hematology section, Cancer Center, the First Hospital of Jilin University
| | - Ye-hui Tan
- Hematology section, Cancer Center, the First Hospital of Jilin University
| | - Cheng-bao Yu
- Second Department of Cardiology, The First Hospital of Qiqihaer Hospital, Qiqihaer, Heilongjiang, China
| | | | - Qiu-ju Liu
- Hematology section, Cancer Center, the First Hospital of Jilin University
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
- Correspondence: Qiu-ju Liu, Hematology Section, Cancer Center, The First Hospital of Jilin University, No 71 Xinmin Street, Changchun 130021, China (e-mail: )
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