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Moroni L, Gallina G, Dagna L. Unmasking eosinophilic granulomatosis with polyangiitis (EGPA). Eur J Intern Med 2024:S0953-6205(24)00347-9. [PMID: 39129123 DOI: 10.1016/j.ejim.2024.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2024] [Accepted: 08/08/2024] [Indexed: 08/13/2024]
Affiliation(s)
- Luca Moroni
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS San Raffaele Scientific Institute Milan, Italy; Università Vita-Salute San Raffaele Milan, Italy.
| | - Gabriele Gallina
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS San Raffaele Scientific Institute Milan, Italy; Università Vita-Salute San Raffaele Milan, Italy
| | - Lorenzo Dagna
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS San Raffaele Scientific Institute Milan, Italy; Università Vita-Salute San Raffaele Milan, Italy.
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Chapuis E, Bousquet E, Viallard JF, Terrier B, Amoura Z, Batani V, Brézin A, Cacoub P, Caminati M, Chazal T, Comarmond C, Durieu I, Ebbo M, Grall M, Ledoult E, Losappio L, Mattioli I, Mékinian A, Padoan R, Regola F, Schroeder J, Seluk L, Trefond L, Wechsler ME, Lefevre G, Kahn JE, Sève P, Groh M. Ophthalmic vascular manifestations in eosinophil-associated diseases: a comprehensive analysis of 57 patients from the CEREO and EESG networks and a literature review. Front Immunol 2024; 15:1379611. [PMID: 38720897 PMCID: PMC11078014 DOI: 10.3389/fimmu.2024.1379611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 04/04/2024] [Indexed: 05/12/2024] Open
Abstract
Introduction Eosinophils have widespread procoagulant effects. In daily practice, eosinophil-related cardiovascular toxicity consists of endomyocardial damage, eosinophilic vasculitis and arterial or venous thrombosis. Here we aim to report on the clinical features and treatment outcomes of patients with unexplained ophthalmic vascular manifestations and eosinophilia. Methods We conducted a retrospective, multicenter, observational study and a literature review of patients with eosinophilia (≥0.5 x109/L) and concomitant ophthalmic vascular manifestations independent of the underlying eosinophilic disease but with no alternative cause for ophthalmic manifestations. Results Fifty-seven patients were included (20 from the observational study and 37 from the literature review). Ophthalmic vascular features were the initial manifestation of eosinophil-related disease in 34 (59%) patients and consisted of 29 central retinal artery occlusions, six branch retinal artery occlusions, five central retinal vein occlusions, two branch retinal vein occlusions, seven retinal vasculitides, two retinal vasospasms, 12 Purtscher's retinopathies, 13 anterior ischemic optic neuropathies and two posterior ischemic optic neuropathies. The median [IQR] absolute eosinophil count at onset of ophthalmic vascular manifestations was 3.5 [1.7-7.8] x109/L. Underlying eosinophil-related diseases included eosinophilic granulomatosis with polyangiitis (n=32), clonal hypereosinophilic syndrome (HES) (n=1), idiopathic HES (n=13), lymphocytic HES (n=2), adverse drug reactions (n=3), parasitosis (n=2), polyarteritis nodosa (n=1), IgG4-related disease (n=1), eosinophilic fasciitis (n=1) and primary sclerosing cholangitis (n=1). Other extra-ophthalmologic arterial or venous thromboses related to eosinophilia were reported in four (7%) and nine (16%) patients, respectively. Visual prognosis was poor: only eight (10%) patients achieved full recovery of ophthalmologic symptoms. After a median follow-up of 10.5 [1-18] months, one patient (3%) had a recurrence of an ophthalmic vascular manifestation, and three patients (10%) had a recurrence of other vascular symptoms (deep vein thrombosis in two and pulmonary embolism in one patient). At the time of recurrence, absolute eosinophil counts were above 0.5 x109/L in all cases (n=4). Discussion This study broadens the spectrum of vascular manifestations associated with hypereosinophilia by adding ophthalmic vascular manifestations. In patients with ophthalmological vascular manifestations and hypereosinophilia, aggressive treatment of the underlying pathology (and normalization of blood count) should be implemented.
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Affiliation(s)
- Elisa Chapuis
- National Reference Center for Hypereosinophilic Syndromes, CEREO, Suresnes, France
- Department of Internal Medicine, Bichat Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Elodie Bousquet
- Department of Ophthalmology, Lariboisière Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Jean-François Viallard
- National Reference Center for Hypereosinophilic Syndromes, CEREO, Suresnes, France
- Department of Internal Medicine, Bordeaux University Hospital, Bordeaux, France
| | - Benjamin Terrier
- Department of Internal Medicine, National Referral Center for Systemic and Autoimmune Diseases, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Zahir Amoura
- Department of Internal Medicine, Autoimmune and systemic diseases, La Pitié Salpetrière Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Veronica Batani
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Antoine Brézin
- Department of Ophthalmology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Patrice Cacoub
- Department of Internal Medicine and Clinical Immunology, La Pitié Salpetrière Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Marco Caminati
- Asthma Center and Allergy Unit, Center for Hyper-Eosinophilic Dysimmune Conditions, Department of Medicine, University of Verona, Verona, Italy
| | - Thibaud Chazal
- Department of Internal Medicine, Hospital Fondation Adolphe de Rothschild, Paris, France
| | - Cloé Comarmond
- Department of Internal Medicine, Competence Center for Rare Autoimmune and Inflammatory Diseases, Lariboisière Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Isabelle Durieu
- Department of Internal Medicine, Centre Hospitalier Universitaire Lyon Sud, Pierre-Bénite, France
| | - Mikael Ebbo
- National Reference Center for Hypereosinophilic Syndromes, CEREO, Suresnes, France
- Internal Medicine Department, Hopital La Timone, APHM, Aix Marseille University, Marseille, France
| | | | - Emmanuel Ledoult
- National Reference Center for Hypereosinophilic Syndromes, CEREO, Suresnes, France
- Department of Internal Medicine and Clinical Immunology, CHU Lille, Lille, France
| | - Laura Losappio
- Department of Clinical Immunology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Irene Mattioli
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Arsène Mékinian
- Department of Internal Medicine, St Antoine Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Roberto Padoan
- Unit of Rheumatology, Department of Medicine DIMED, University of Padua, Padua, Italy
| | - Francesca Regola
- Rheumatology and Clinical Immunology Unit, Department of Clinical and Experimental Sciences, ASST Spedali Civili and University of Brescia, Brescia, Italy
| | - Jan Schroeder
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Lior Seluk
- Department of Medicine, National Jewish Health, Denver, CO, United States
| | - Ludovic Trefond
- National Reference Center for Hypereosinophilic Syndromes, CEREO, Suresnes, France
- Department of Internal Medicine, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | | | - Guillaume Lefevre
- National Reference Center for Hypereosinophilic Syndromes, CEREO, Suresnes, France
- Inserm, U1286 - INFINITE - Institute for Translational Research in Inflammation, University of Lille, CHU Lille, Lille, France
| | - Jean-Emmanuel Kahn
- National Reference Center for Hypereosinophilic Syndromes, CEREO, Suresnes, France
- Department of Internal Medicine, Ambroise Pare Hospital, Assistance Publique-Hôpitaux de Paris, Boulogne, France
| | - Pascal Sève
- Department of Internal Medicine, Lyon University Hospital, Lyon, France
| | - Matthieu Groh
- National Reference Center for Hypereosinophilic Syndromes, CEREO, Suresnes, France
- Department of Internal Medicine, Foch Hospital, Suresnes, France
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Boiardi L, Marvisi C, Macchioni P, Cavazza A, Croci S, Besutti G, Spaggiari L, Giorgi Rossi P, Cimino L, Pipitone N, Ricordi C, Muratore F, Salvarani C. Eosinophilic giant cell arteritis: A different subset of disease? Semin Arthritis Rheum 2024; 65:152409. [PMID: 38350341 DOI: 10.1016/j.semarthrit.2024.152409] [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: 11/06/2023] [Revised: 01/10/2024] [Accepted: 01/26/2024] [Indexed: 02/15/2024]
Abstract
OBJECTIVES To describe the clinical findings, response to therapy and course of patients with transmural eosinophilic infiltration at temporal artery biopsy (TAB). METHODS The study consisted of a retrospective cohort of 254 consecutive GCA patients with evidence of transmural inflammation at TAB seen at the Santa Maria Nuova Hospital over a 28-year period. The findings of the 22 patients with eosinophilic infiltration (≥ 20 eosinophils/hpf) at TAB were compared with those of 232 patients without. Among these 232 patients, we sampled 42 GCA patients matched for age, sex and follow-up duration to the 22 with eosinophilic infiltration, to compare allergic manifestations. RESULTS GCA patients with eosinophilic infiltration compared to those without presented more frequently cranial symptoms (p = 0.052), headaches (p = 0.005), abnormalities of TAs at physical examination (p = 0.045), jaw claudication (p = 0.024), and systemic manifestations (p = 0.016) and had higher CRP levels at diagnosis (p = 0.001). Regarding histological lesions, a severe transmural inflammation, laminar necrosis and intraluminal acute thrombosis were more frequently observed in patients with eosinophilic infiltration (p = 0.066, p < 0.001, and p = 0.010, respectively). Long-term remission and flares were similar in the two groups. When 21 GCA patients with eosinophilic infiltration were compared to 42 without, blood eosinophilic counts at diagnosis were normal and no patients had evidence or developed allergic manifestations and/or clinical findings of systemic necrotizing vasculitis. CONCLUSION Patients with transmural eosinophilic infiltration represent a subset of GCA with cranial disease and more severe inflammation.
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Affiliation(s)
- Luigi Boiardi
- Rheumatology Unit, Azienda USL-IRCCS di Reggio Emilia, Viale Risorgimento, 80, Reggio Emilia 42123, Italy
| | - Chiara Marvisi
- Rheumatology Unit, Azienda USL-IRCCS di Reggio Emilia, Viale Risorgimento, 80, Reggio Emilia 42123, Italy; University of Modena and Reggio Emilia, Modena, Italy
| | - Pierluigi Macchioni
- Rheumatology Unit, Azienda USL-IRCCS di Reggio Emilia, Viale Risorgimento, 80, Reggio Emilia 42123, Italy
| | - Alberto Cavazza
- Operative Unit of Pathologic Anatomy, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Stefania Croci
- Clinical Immunology, Allergy and Advanced Biotechnologies Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Giulia Besutti
- University of Modena and Reggio Emilia, Modena, Italy; Radiology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Lucia Spaggiari
- Radiology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Paolo Giorgi Rossi
- Epidemiology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Luca Cimino
- University of Modena and Reggio Emilia, Modena, Italy; Ocular Immunology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Nicolò Pipitone
- Rheumatology Unit, Azienda USL-IRCCS di Reggio Emilia, Viale Risorgimento, 80, Reggio Emilia 42123, Italy
| | - Caterina Ricordi
- Rheumatology Unit, Azienda USL-IRCCS di Reggio Emilia, Viale Risorgimento, 80, Reggio Emilia 42123, Italy; University of Modena and Reggio Emilia, Modena, Italy
| | - Francesco Muratore
- Rheumatology Unit, Azienda USL-IRCCS di Reggio Emilia, Viale Risorgimento, 80, Reggio Emilia 42123, Italy; University of Modena and Reggio Emilia, Modena, Italy
| | - Carlo Salvarani
- Rheumatology Unit, Azienda USL-IRCCS di Reggio Emilia, Viale Risorgimento, 80, Reggio Emilia 42123, Italy; University of Modena and Reggio Emilia, Modena, Italy.
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Maronese CA, Derlino F, Moltrasio C, Cattaneo D, Iurlo A, Marzano AV. Neutrophilic and eosinophilic dermatoses associated with hematological malignancy. Front Med (Lausanne) 2024; 10:1324258. [PMID: 38249974 PMCID: PMC10796805 DOI: 10.3389/fmed.2023.1324258] [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: 10/19/2023] [Accepted: 12/20/2023] [Indexed: 01/23/2024] Open
Abstract
Cutaneous manifestations of hematologic malignancy represent both a clinical challenge for the treating physician and a pathophysiological model for advancing the knowledge on individual neoplasms. Indeed, a growing body of evidence supports the concept of recurrent molecular defects associating with specific clinical features, as best exemplified by VEXAS. Herein neutrophilic and eosinophilic dermatoses of potential interest for both hematologists and dermatologists will be reviewed, including subcorneal pustular dermatosis-type IgA pemphigus, neutrophilic eccrine hidradenitis, Sweet's syndrome as well as myelodysplasia cutis and VEXAS, pyoderma gangrenosum, eosinophilic annular erythema, eosinophilic dermatosis of hematological malignancy, Wells syndrome and cutaneous involvement in hypereosinophilic syndromes. Possible management approaches are discussed for each, emphasizing scenarios that require treatment of the underlying condition to achieve remission at the skin level.
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Affiliation(s)
- Carlo Alberto Maronese
- Dermatology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Federica Derlino
- Dermatology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Chiara Moltrasio
- Dermatology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Daniele Cattaneo
- Hematology Division, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Alessandra Iurlo
- Hematology Division, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Angelo Valerio Marzano
- Dermatology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
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Rubenstein E, Maldini C, Vaglio A, Bello F, Bremer JP, Moosig F, Bottero P, Pesci A, Sinico RA, Grosskreutz J, Feder C, Saadoun D, Trivioli G, Maritati F, Rewerska B, Szczeklik W, Fraticelli P, Guida G, Gregorini G, Moroncini G, Hellmich B, Zwerina J, Resche-Rigon M, Emmi G, Neumann T, Mahr A. Cluster Analysis to Explore Clinical Subphenotypes of Eosinophilic Granulomatosis With Polyangiitis. J Rheumatol 2023; 50:1446-1453. [PMID: 37739478 DOI: 10.3899/jrheum.2023-0325] [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] [Accepted: 08/15/2023] [Indexed: 09/24/2023]
Abstract
OBJECTIVE Previous studies suggested that distinct phenotypes of eosinophilic granulomatosis with polyangiitis (EGPA; formerly known as Churg-Strauss syndrome) could be determined by the presence or absence of antineutrophil cytoplasmic antibodies (ANCA), reflecting predominant vasculitic or eosinophilic processes, respectively. This study explored whether ANCA-based clusters or other clusters can be identified in EGPA. METHODS This study used standardized data of 15 European centers for patients with EGPA fulfilling widely accepted classification criteria. We used multiple correspondence analysis, hierarchical cluster analysis, and a decision tree model. The main model included 10 clinical variables (musculoskeletal [MSK], mucocutaneous, ophthalmological, ENT, cardiovascular, pulmonary, gastrointestinal, renal, central, or peripheral neurological involvement); a second model also included ANCA results. RESULTS The analyses included 489 patients diagnosed between 1984 and 2015. ANCA were detected in 37.2% of patients, mostly perinuclear ANCA (85.4%) and/or antimyeloperoxidase (87%). Compared with ANCA-negative patients, those with ANCA had more renal (P < 0.001) and peripheral neurological involvement (P = 0.04), fewer cardiovascular signs (P < 0.001), and fewer biopsies with eosinophilic tissue infiltrates (P = 0.001). The cluster analyses generated 4 (model without ANCA) and 5 clusters (model with ANCA). Both models identified 3 identical clusters of 34, 39, and 40 patients according to the presence or absence of ENT, central nervous system, and ophthalmological involvement. Peripheral neurological and cardiovascular involvement were not predictive characteristics. CONCLUSION Although reinforcing the known association of ANCA status with clinical manifestations, cluster analysis does not support a complete separation of EGPA in ANCA-positive and -negative subsets. Collectively, these data indicate that EGPA should be regarded as a phenotypic spectrum rather than a dichotomous disease.
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Affiliation(s)
- Emma Rubenstein
- E. Rubenstein, MD, MPH, Infectious Diseases Department, Saint-Louis Hospital, Paris, France;
| | - Carla Maldini
- C. Maldini, MD, PhD, Catedra de Semiologia UHMI 3, Facultad de Ciencias Medicas, Universidad Nacional de Cordoba, Cordoba, Argentina
| | - Augusto Vaglio
- A. Vaglio, MD, PhD, Department of Biomedical, Experimental and Clinical Sciences, University of Firenze, and Nephrology and Dialysis Unit, Meyer Children's Hospital, Florence, Italy
| | - Federica Bello
- F. Bello, MD, Internal Interdisciplinary Medicine Unit, Careggi University Hospital, and Department of Experimental and Clinical Medicine, University of Firenze, Florence, Italy
| | | | - Frank Moosig
- F. Moosig, MD, PhD, Rheumazentrum Schleswig-Holstein Mitte, Neumünster, Germany
| | - Paolo Bottero
- P. Bottero, MD, Allergy and Clinical Immunology, G. Fornaroli Hospital, Milan, Italy
| | - Alberto Pesci
- A. Pesci, MD, Pneumology, University of Milano Bicocca, San Gerardo Hospital, Monza, Italy
| | - Renato Alberto Sinico
- R.A. Sinico, MD, PhD, Department of Nephrology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Julian Grosskreutz
- J. Grosskreutz, MD, Precision Neurology, Excellence Cluster Precision Medicine in Inflammation, University of Lübeck, University Hospital Schleswig-Holstein Campus Lübeck, Lübeck, Germany
| | - Claudia Feder
- C. Feder, MD, Department of Internal Medicine V, Jena University Hospital, Jena, Germany
| | - David Saadoun
- D. Saadoun, MD, PhD, Department of Internal Medicine and Clinical Immunology, Sorbonne Universités, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Centre national de références Maladies Autoimmunes et systémiques rares, Centre national de références Maladies Autoinflammatoires rares et Amylose inflammatoire INSERM, UMR S959, Immunology-Immunopathology-Immunotherapy (I3), Paris, France
| | - Giorgio Trivioli
- G. Trivioli, MD, Department of Nephrology, Cambridge University Hospitals, Cambridge, UK
| | - Federica Maritati
- F. Maritati, MD, Nephrology, Dialysis and Renal Transplant Unit, IRCCS-Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Barbara Rewerska
- B. Rewerska, MD, PhD, Diamond Clinic, Diamond Medical Centre, Krakow, Poland
| | - Wojciech Szczeklik
- W. Szczeklik, MD, PhD, Centre for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Paolo Fraticelli
- P. Fraticelli, MD, PhD, Medical Clinic, Department of Internal Medicine, Marche University Hospital, Ancona, Italy
| | - Giuseppe Guida
- G. Guida, MD, PhD, Department of Clinical and Biological Sciences, University of Turin, and Severe Asthma and Rare Lung Disease Unit San Luigi Gonzaga University Hospital, Orbassano, Turin, Italy
| | - Gina Gregorini
- G. Gregorini, MD, Nephrology, Spedali Civili, University of Brescia, Brescia, Italy
| | - Gianluca Moroncini
- G. Moroncini, MD, PhD, Medical Clinic, Department of Clinical and Molecular Science, Marche Polytechnic University, Ancona, Italy
| | - Bernhard Hellmich
- B. Hellmich, MD, PhD, Internal Medicine, Rheumatology and Immunology, Medius Kliniken, University of Tübingen, Kirchheim-Teck, Germany
| | - Jochen Zwerina
- J. Zwerina, MD, 1st Medical Department, Hanusch Hospital, Vienna, Austria
| | - Matthieu Resche-Rigon
- M. Resche-Rigon, MD, PhD, Clinical Research Unit, Saint-Louis Hospital, Paris, France
| | - Giacomo Emmi
- G. Emmi, MD, PhD, Internal Interdisciplinary Medicine Unit, Careggi University Hospital, Firenze, Italy, Department of Experimental and Clinical Medicine, University of Firenze, Firenze, Italy, and Centre for Inflammatory Diseases, Monash University Department of Medicine, Monash Medical Centre, Clayton, Melbourne, Australia
| | - Thomas Neumann
- T. Neumann, MD, Rheumatology and Internal Medicine, Kantonsspital St. Gallen, St. Gallen, Switzerland, and Department of Internal Medicine III, Jena University Hospital, Jena, Germany
| | - Alfred Mahr
- A. Mahr, MD, PhD, Nephrology, Dialysis and Renal Transplant Unit, IRCCS-Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy, and Rheumatology and Internal Medicine, Kantonsspital St. Gallen, St. Gallen, Switzerland
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Phuong DLC, The HB, Duy QV. Hypereosinophilic vasculitis with Raynaud phenomenon presentation: a case report. Egypt Heart J 2023; 75:89. [PMID: 37851184 PMCID: PMC10584751 DOI: 10.1186/s43044-023-00418-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 10/12/2023] [Indexed: 10/19/2023] Open
Abstract
BACKGROUND Previous case series have reported idiopathic eosinophilic vasculitis as a potential manifestation of hypereosinophilic syndrome (HES). This condition is characterized by digital necrotizing, systemic vasculitis that affects varying-sized blood vessels. This report presents our experience in treating a patient with eosinophilic vasculitis. CASE PRESENTATION We describe the case of a 23-year-old man who presented with idiopathic HES, which manifested as digital ulcers and peripheral ischemia in both the upper and lower limbs, without the involvement of other organ systems. After ruling out primary and secondary causes of eosinophilia, a diagnosis of HES was established. Our patient has shown a positive response to corticosteroid therapy. CONCLUSIONS Our case contributes to the existing evidence about diagnosing idiopathic eosinophilic vasculitis in patients with HES. We observed a favorable response to corticosteroid treatment in our patient.
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Affiliation(s)
- Duy Le Cao Phuong
- Department of Cardiovascular Intervention, Nguyen Tri Phuong Hospital, Ho Chi Minh City, Vietnam
- Faculty of Medicine, Nguyen Tat Thanh University, Ho Chi Minh City, Vietnam
| | - Hoa Bui The
- Department of Cardiovascular Intervention, Nguyen Tri Phuong Hospital, Ho Chi Minh City, Vietnam
| | - Quan Vo Duy
- Department of Cardiovascular Intervention, Nguyen Tri Phuong Hospital, Ho Chi Minh City, Vietnam.
- Faculty of Medicine, Nguyen Tat Thanh University, Ho Chi Minh City, Vietnam.
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7
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Watanabe R, Hashimoto M. Eosinophilic Granulomatosis with Polyangiitis: Latest Findings and Updated Treatment Recommendations. J Clin Med 2023; 12:5996. [PMID: 37762936 PMCID: PMC10532073 DOI: 10.3390/jcm12185996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 09/08/2023] [Accepted: 09/13/2023] [Indexed: 09/29/2023] Open
Abstract
Eosinophilic granulomatosis with polyangiitis (EGPA) causes necrotizing vasculitis and eosinophil-rich granulomatous inflammation in small- to medium-sized vessels, resulting in multiple organ damage. EGPA is classified as an antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis, with myeloperoxidase-ANCA detected in approximately one-third of the patients. Conventional treatment of EGPA relies on systemic glucocorticoids (GCs) in combination with cyclophosphamide when poor prognostic factors are present; however, the dilemma between disease control and drug-related adverse effects has long been a challenge. Recent studies have revealed that the genetic background, pathophysiology, and clinical manifestations differ between ANCA-positive and ANCA-negative patients; however, mepolizumab, an interleukin (IL)-5 inhibitor, is effective in both groups, suggesting that the IL-5-eosinophil axis is deeply involved in the pathogenesis of both ANCA-positive and ANCA-negative EGPA. This review summarizes the latest knowledge on the pathophysiology of EGPA and focuses on the roles of eosinophils and ANCA. We then introduce the current treatment recommendations and accumulated evidence for mepolizumab on EGPA. Based on current unmet clinical needs, we discuss potential future therapeutic strategies for EGPA.
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Affiliation(s)
- Ryu Watanabe
- Department of Clinical Immunology, Osaka Metropolitan University Graduate School of Medicine, Osaka 545-8585, Japan
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8
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Rohmer J, Nguyen Y, Trefond L, Agard C, Allain JS, Berezne A, Charles P, Cohen P, Gondran G, Groh M, Huscenot T, Lacout C, Lazaro E, London J, Maurier F, Mekinian A, Mesbah R, Nubourgh I, Perard L, Puéchal X, Pugnet G, Puyade M, Queyrel V, Roux A, Rouzaud D, Durel CA, Guillevin L, Terrier B. Clinical features and long-term outcomes of patients with systemic polyarteritis nodosa diagnosed since 2005: Data from 196 patients. J Autoimmun 2023; 139:103093. [PMID: 37536165 DOI: 10.1016/j.jaut.2023.103093] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Revised: 06/19/2023] [Accepted: 07/11/2023] [Indexed: 08/05/2023]
Abstract
BACKGROUND The landscape of polyarteritis nodosa (PAN) has substantially changed during the last decades. Recent data regarding causes, characteristics, and prognosis of systemic PAN in the modern era are lacking. METHODS This retrospective study included patients with systemic PAN referred to the French Vasculitis Study Group between 2005 and 2019. Characteristics, associated conditions and outcomes were collected, and predictors of relapse and death were analyzed. RESULTS 196 patients were included. Main clinical symptoms were constitutional (84%), neurological (59%), skin (58%) and musculoskeletal (58%) manifestations. Secondary PAN accounted for 55 (28%) patients, including myelodysplastic syndrome (9%), solid cancer (7%), lymphoma (4%) and autoinflammatory diseases (4%). No patient had active HBV infection. All treated patients (98.5%) received glucocorticoids (GCs), alone (41%) or in combination with immunosuppressants (59%), with remission achieved in 90%. Relapses were independently associated with age >65 years (HR 1.85; 95% CI1.12-3.08), gastrointestinal involvement (1.95; 95% CI1.09-3.52) and skin necrotic lesions (HR 1.95; 95%CI 1.24-3.05). One-, 5- and 10-year overall survival rates were 93%, 87% and 81%, respectively. In multivariate analyses, age >65 years (HR 2.80; 95%CI 1.23-6.37), necrotic purpura (HR 4.16; 95%CI 1.62-10.70), acute kidney injury (HR 4.89; 95% 1.71-13.99) and secondary PAN (HR 2.98; 95%CI 1.29-6.85) were independently associated with mortality. CONCLUSION Landscape of PAN has changed during the last decades, with the disappearance of HBV-PAN and the emergence of secondary PAN. Relapse rate remains high, especially in aged patients with gastrointestinal and cutaneous necrosis, as well as mortality.
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Affiliation(s)
- Julien Rohmer
- Department of Internal Medicine, Hôpital Cochin, AP-HP.Centre, Université Paris Cité, Paris, France
| | - Yann Nguyen
- Department of Internal Medicine, Hôpital Cochin, AP-HP.Centre, Université Paris Cité, Paris, France; Autoimmunity Team, Immunology of Viral Infections and Autoimmune Diseases, INSERM U1184, Université Paris Saclay, Le Kremlin-Bicêtre, France
| | - Ludovic Trefond
- Department of Internal Medicine, CHU, Clermont Ferrand, France
| | - Christian Agard
- Nantes Université, CHU Nantes, Service de médecine interne, F-44000, Nantes, France
| | | | - Alice Berezne
- Department of Internal Medicine, CH, Annecy, Genevois, France
| | - Pierre Charles
- Department of Internal Medicine, Institut Mutualiste Montsouris, Paris, France
| | - Pascal Cohen
- Department of Internal Medicine, Hôpital Cochin, AP-HP.Centre, Université Paris Cité, Paris, France
| | - Guillaume Gondran
- Department of Internal Medicine and dermatology, CHU, Limoges, France
| | - Matthieu Groh
- Department of Internal Medicine, National Reference Center for Hypereosinophilic Syndromes, Foch Hospital, Suresnes, France; University of Lille, INSERM U1286 - INFINITE - Institute for Translational Research in Inflammation, Lille, France
| | - Tessa Huscenot
- Department of Internal Medicine, Hôpital Ambroise Parée, Paris, France
| | - Carole Lacout
- Department of Internal Medicine and Clinical Immunology, CHU, Angers, France
| | - Estibaliz Lazaro
- Department of Internal Medicine, Hôpital Haut Leveque, CHU, Bordeaux, France
| | - Jonathan London
- Department of Internal Medicine, Hôpital de la Croix Saint Simon, Paris, France
| | | | - Arsène Mekinian
- Department of Internal Medicine, Hôpital Saint Antoine, AP-HP, Sorbonne Université, Paris, France
| | - Rafik Mesbah
- Department of Internal Medicine, CH, de Boulogne sur Mer, France
| | - Isabelle Nubourgh
- Department of Internal Medicine, Université libre de Bruxelles, Belgique
| | - Laurent Perard
- Department of Internal Medicine, Hôpital Saint Joseph Saint Luc, Lyon, France
| | - Xavier Puéchal
- Department of Internal Medicine, Hôpital Cochin, AP-HP.Centre, Université Paris Cité, Paris, France
| | - Gregory Pugnet
- Department of Internal Medicine and clinical immunology, CHU, Toulouse, France
| | | | | | - Arthur Roux
- Department of Nephrology, HEGP, Paris, France
| | - Diane Rouzaud
- Department of Internal Medicine, Hôpital Bichat, Paris, France
| | | | - Loïc Guillevin
- Department of Internal Medicine, Hôpital Cochin, AP-HP.Centre, Université Paris Cité, Paris, France
| | - Benjamin Terrier
- Department of Internal Medicine, Hôpital Cochin, AP-HP.Centre, Université Paris Cité, Paris, France; University Paris-Cité, F-75006, Paris, France.
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9
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Serrano-Santiago SM, Colon-Donate M, Rivera-Franceschini C, Caceres-Perkins W, Nazario-Jimenez S. Digital Ischemia as a Presenting Feature of Hypereosinophilic Syndrome-Associated Vasculitis. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:2572-2573. [PMID: 37367713 DOI: 10.1016/j.jaip.2023.05.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 04/16/2023] [Accepted: 05/05/2023] [Indexed: 06/28/2023]
Affiliation(s)
- Sybelle M Serrano-Santiago
- Department of Allergy and Immunology, University of Puerto Rico School of Medicine, San Juan, Puerto Rico.
| | - Miguel Colon-Donate
- Department of Hematology and Oncology, VA Caribbean Healthcare System, San Juan, Puerto Rico
| | | | - William Caceres-Perkins
- Department of Hematology and Oncology, VA Caribbean Healthcare System, San Juan, Puerto Rico
| | - Sylvette Nazario-Jimenez
- Department of Allergy and Immunology, University of Puerto Rico School of Medicine, San Juan, Puerto Rico
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10
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Fijolek J, Radzikowska E. Eosinophilic granulomatosis with polyangiitis - Advances in pathogenesis, diagnosis, and treatment. Front Med (Lausanne) 2023; 10:1145257. [PMID: 37215720 PMCID: PMC10193253 DOI: 10.3389/fmed.2023.1145257] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 03/13/2023] [Indexed: 05/24/2023] Open
Abstract
Eosinophilic granulomatosis with polyangiitis (EGPA) is a rare disease characterized by eosinophil-rich granulomatous inflammation and necrotizing vasculitis, pre-dominantly affecting small-to-medium-sized vessels. It is categorized as a primary antineutrophil cytoplasmic antibody (ANCA)-associated vasculitides (AAVs) but also shares features of hypereosinophilic syndrome (HES); therefore, both vessel inflammation and eosinophilic infiltration are suggested to cause organ damage. This dual nature of the disease causes variable clinical presentation. As a result, careful differentiation from mimicking conditions is needed, especially from HES, given the overlapping clinical, radiologic, and histologic features, and biomarker profile. EGPA also remains a diagnostic challenge, in part because of asthma, which may pre-dominate for years, and often requires chronic corticosteroids (CS), which can mask other disease features. The pathogenesis is still not fully understood, however, the interaction between eosinophils and lymphocytes B and T seems to play an important role. Furthermore, the role of ANCA is not clear, and only up to 40% of patients are ANCA-positive. Moreover, two ANCA-dependent clinically and genetically distinct subgroups have been identified. However, a gold standard test for establishing a diagnosis is not available. In practice, the disease is mainly diagnosed based on the clinical symptoms and results of non-invasive tests. The unmet needs include uniform diagnostic criteria and biomarkers to help distinguish EGPA from HESs. Despite its rarity, notable progress has been made in understanding the disease and in its management. A better understanding of the pathophysiology has provided new insights into the pathogenesis and therapeutic targets, which are reflected in novel biological agents. However, there remains an ongoing reliance on corticosteroid therapy. Therefore, there is a significant need for more effective and better-tolerated steroid-sparing treatment schemes.
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11
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Cottin V. Eosinophilic Lung Diseases. Immunol Allergy Clin North Am 2023; 43:289-322. [PMID: 37055090 DOI: 10.1016/j.iac.2023.01.002] [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: 04/15/2023]
Abstract
The eosinophilic lung diseases may manifest as chronic eosinophilic pneumonia, acute eosinophilic pneumonia, or as the Löffler syndrome (generally of parasitic etiology). The diagnosis of eosinophilic pneumonia is made when both characteristic clinical-imaging features and alveolar eosinophilia are present. Peripheral blood eosinophils are generally markedly elevated; however, eosinophilia may be absent at presentation. Lung biopsy is not indicated except in atypical cases after multidisciplinary discussion. The inquiry to possible causes (medications, toxic drugs, exposures, and infections especially parasitic) must be meticulous. Idiopathic acute eosinophilic pneumonia may be misdiagnosed as infectious pneumonia. Extrathoracic manifestations raise the suspicion of a systemic disease especially eosinophilic granulomatosis with polyangiitis. Airflow obstruction is frequent in allergic bronchopulmonary aspergillosis, idiopathic chronic eosinophilic pneumonia, eosinophilic granulomatosis with polyangiitis, and hypereosinophilic obliterative bronchiolitis. Corticosteroids are the cornerstone of therapy, but relapses are common. Therapies targeting interleukin 5/interleukin-5 are increasingly used in eosinophilic lung diseases.
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Affiliation(s)
- Vincent Cottin
- Service de pneumologie, Hospices Civils de Lyon, Hôpital Louis Pradel, Centre de référence coordonnateur des maladies pulmonaires rares (OrphaLung), 28 Avenue Doyen Lepine, Lyon Cedex 69677, France; Université Lyon 1, INRAE, UMR754, Lyon, France.
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12
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Groh M, Rohmer J, Etienne N, Abou Chahla W, Baudet A, Chan Hew Wai A, Chenivesse C, Clisson Rusek I, Cottin V, Decamp M, De Groote P, Delahousse F, Duployez N, Faguer S, Gottrand F, Huang F, Leblanc T, Magnan A, Martin T, Mortuaire G, Néel A, Paris L, Petit A, Rossignol J, Schleinitz N, Soret-Dulphy J, Staumont-Salle D, Terrier B, Terriou L, Viallard JF, Lefèvre G, Kahn JE. French guidelines for the etiological workup of eosinophilia and the management of hypereosinophilic syndromes. Orphanet J Rare Dis 2023; 18:100. [PMID: 37122022 PMCID: PMC10148979 DOI: 10.1186/s13023-023-02696-4] [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: 01/18/2023] [Accepted: 04/02/2023] [Indexed: 05/02/2023] Open
Abstract
Eosinophilic-related clinical manifestations are protean and the underlying conditions underpinning eosinophilia are highly diverse. The etiological workup of unexplained eosinophilia/hypereosinophilia can be challenging, and can lead sometimes to extensive, inappropriate, costly and/or invasive investigations. To date, guidelines for the etiological workup and management of eosinophilia are mainly issued by hematologists, and thus mostly cover the scope of clonal hypereosinophilic syndromes (HES). Here, thanks to an extensive literature review, and thanks to the joint work of a large panel of experts involving physicians from both adult and pediatric medicine and from various subspecialties (as well as a representative of a patients' association representative), we provide recommendations for both the step-by step diagnostic workup of eosinophilia (whether unexplained or within specific contexts) as well as the management and follow-up of the full spectrum of eosinophilic disorders (including clonal, reactive, lymphocytic and idiopathic HES, as well as single-organ diseases). Didactic prescription summaries intended to facilitate the prescription of eosinophil-targeted drugs are also provided, as are practical diagnostic and therapeutic algorithms. Lastly, this set of recommendations also includes a summary intended for general practitioners, as well as an overview of the therapeutic patient education program set up by the French reference center for HES. Further updates will be mandatory as new validated information emerges.
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Affiliation(s)
- Matthieu Groh
- Department of Internal Medicine, National Reference Center for Hypereosinophilic Syndromes (CEREO), Hôpital Foch, 40, Rue Worth, 92151, Suresnes, France.
- Department of Internal Medicine, Hôpital Foch, Suresnes, France.
- Inserm, U1286 - INFINITE - Institute for Translational Research in Inflammation, University of Lille, CHU Lille, Lille, France.
- Department of Internal Medicine, University of Paris Saclay, APHP, CHU Ambroise Paré, Boulogne-Billancourt, France.
| | - Julien Rohmer
- Department of Internal Medicine, National Reference Center for Hypereosinophilic Syndromes (CEREO), Hôpital Foch, 40, Rue Worth, 92151, Suresnes, France
- Department of Internal Medicine, University of Sorbonne-Paris-Cité, APHP, CHU Bichat, Paris, France
- Department of Internal Medicine, University of Paris Saclay, APHP, CHU Ambroise Paré, Boulogne-Billancourt, France
| | - Nicolas Etienne
- Department of Infectious Diseases and Tropical Medicine, University of Sorbonne-Paris-Cité, APHP, CHU Necker-Enfants Malades, Paris, France
- Department of Internal Medicine, University of Paris Saclay, APHP, CHU Ambroise Paré, Boulogne-Billancourt, France
| | - Wadih Abou Chahla
- Department of Internal Medicine, National Reference Center for Hypereosinophilic Syndromes (CEREO), Hôpital Foch, 40, Rue Worth, 92151, Suresnes, France
- Department of Pediatric Hematology, University of Lille, CHU Lille, Lille, France
- Department of Internal Medicine, University of Paris Saclay, APHP, CHU Ambroise Paré, Boulogne-Billancourt, France
| | - Antoine Baudet
- Department of Internal Medicine, National Reference Center for Hypereosinophilic Syndromes (CEREO), Hôpital Foch, 40, Rue Worth, 92151, Suresnes, France
- Department of Internal Medicine, CH Annecy Genevois, Metz Tessy, France
- Department of Internal Medicine, University of Paris Saclay, APHP, CHU Ambroise Paré, Boulogne-Billancourt, France
| | - Aurélie Chan Hew Wai
- Department of Internal Medicine, National Reference Center for Hypereosinophilic Syndromes (CEREO), Hôpital Foch, 40, Rue Worth, 92151, Suresnes, France
- Department of Pharmacology, Hôpital Foch, Suresnes, France
- Department of Internal Medicine, University of Paris Saclay, APHP, CHU Ambroise Paré, Boulogne-Billancourt, France
| | - Cécile Chenivesse
- Department of Internal Medicine, National Reference Center for Hypereosinophilic Syndromes (CEREO), Hôpital Foch, 40, Rue Worth, 92151, Suresnes, France
- CNRS, Inserm, Institut Pasteur de Lille, U1019-UMR9017-CIIL-Centre d'Infection et d'Immunité de Lille, University of Lille, CHU Lille, Lille, France
- CRISALIS (Clinical Research Initiative in Severe Asthma: a Lever for Innovation and Science), F-CRIN Network, INSERM US015, Toulouse, France
- Department of Internal Medicine, University of Paris Saclay, APHP, CHU Ambroise Paré, Boulogne-Billancourt, France
| | - Irena Clisson Rusek
- Association Pour l'Information sur les Maladies à Eosinophiles, Bourg-la-Reine, France
- Department of Internal Medicine, University of Paris Saclay, APHP, CHU Ambroise Paré, Boulogne-Billancourt, France
| | - Vincent Cottin
- Department of Respiratory Medicine, Hôpital Louis Pradel, UMR754 INRAE, University of Lyon 1, Hospices Civils de Lyon, Lyon, France
- Department of Internal Medicine, University of Paris Saclay, APHP, CHU Ambroise Paré, Boulogne-Billancourt, France
| | - Matthieu Decamp
- Department of Cytogenetics, CHU de Caen, Caen, France
- Department of Internal Medicine, University of Paris Saclay, APHP, CHU Ambroise Paré, Boulogne-Billancourt, France
| | - Pascal De Groote
- Department of Internal Medicine, National Reference Center for Hypereosinophilic Syndromes (CEREO), Hôpital Foch, 40, Rue Worth, 92151, Suresnes, France
- Department of Cardiology, University of Lille, CHU Lille, Lille, France
- Department of Internal Medicine, University of Paris Saclay, APHP, CHU Ambroise Paré, Boulogne-Billancourt, France
| | - Fanny Delahousse
- , Nantes, France
- Department of Internal Medicine, University of Paris Saclay, APHP, CHU Ambroise Paré, Boulogne-Billancourt, France
| | - Nicolas Duployez
- Department of Internal Medicine, National Reference Center for Hypereosinophilic Syndromes (CEREO), Hôpital Foch, 40, Rue Worth, 92151, Suresnes, France
- Laboratory of Hematology, University of Lille, CHU Lille, Lille, France
- CNRS, Inserm, IRCL, UMR9020 - UMR1277 - Canther - Cancer Heterogeneity, Plasticity and Resistance to Therapies, 59000, Lille, France
- Department of Internal Medicine, University of Paris Saclay, APHP, CHU Ambroise Paré, Boulogne-Billancourt, France
| | - Stanislas Faguer
- Department of Nephrology and Organ Transplantation, University of Paul Sabatier Toulouse III, CHU Toulouse, Toulouse, France
- Department of Internal Medicine, University of Paris Saclay, APHP, CHU Ambroise Paré, Boulogne-Billancourt, France
| | - Frédéric Gottrand
- Department of Internal Medicine, National Reference Center for Hypereosinophilic Syndromes (CEREO), Hôpital Foch, 40, Rue Worth, 92151, Suresnes, France
- Inserm, U1286 - INFINITE - Institute for Translational Research in Inflammation, University of Lille, CHU Lille, Lille, France
- Division of Gastroenterology, Hepatology and Nutrition, Department of Paediatrics, Jeanne de Flandre Children's Hospital, University of Lille, CHU Lille, Lille, France
- Department of Internal Medicine, University of Paris Saclay, APHP, CHU Ambroise Paré, Boulogne-Billancourt, France
| | - Florent Huang
- Department of Internal Medicine, National Reference Center for Hypereosinophilic Syndromes (CEREO), Hôpital Foch, 40, Rue Worth, 92151, Suresnes, France
- Department of Cardiology, Hôpital Foch, Suresnes, France
- Department of Internal Medicine, University of Paris Saclay, APHP, CHU Ambroise Paré, Boulogne-Billancourt, France
| | - Thierry Leblanc
- Pediatric Hematology and Immunology Department, University Sorbonne-Paris-Cité, APHP, CHU Robert Debré, Paris, France
- Department of Internal Medicine, University of Paris Saclay, APHP, CHU Ambroise Paré, Boulogne-Billancourt, France
| | - Antoine Magnan
- Department of Internal Medicine, National Reference Center for Hypereosinophilic Syndromes (CEREO), Hôpital Foch, 40, Rue Worth, 92151, Suresnes, France
- Department of Respiratory Medicine, Hôpital Foch, Suresnes, France
- Department of Internal Medicine, University of Paris Saclay, APHP, CHU Ambroise Paré, Boulogne-Billancourt, France
| | - Thierry Martin
- Department of Internal Medicine, National Reference Center for Hypereosinophilic Syndromes (CEREO), Hôpital Foch, 40, Rue Worth, 92151, Suresnes, France
- Department of Internal Medicine, CHU Strasbourg, Strasbourg, France
- Department of Internal Medicine, University of Paris Saclay, APHP, CHU Ambroise Paré, Boulogne-Billancourt, France
| | - Geoffrey Mortuaire
- Department of Internal Medicine, National Reference Center for Hypereosinophilic Syndromes (CEREO), Hôpital Foch, 40, Rue Worth, 92151, Suresnes, France
- Inserm, U1286 - INFINITE - Institute for Translational Research in Inflammation, University of Lille, CHU Lille, Lille, France
- Otorhinolaryngology-Head and Neck Department, University of Lille, CHU de Lille, Lille, France
- Department of Internal Medicine, University of Paris Saclay, APHP, CHU Ambroise Paré, Boulogne-Billancourt, France
| | - Antoine Néel
- Department of Internal Medicine, National Reference Center for Hypereosinophilic Syndromes (CEREO), Hôpital Foch, 40, Rue Worth, 92151, Suresnes, France
- Department of Internal Medicine, CHU Nantes, Nantes, France
- Department of Internal Medicine, University of Paris Saclay, APHP, CHU Ambroise Paré, Boulogne-Billancourt, France
| | - Luc Paris
- Department of Parasitology and Mycology, Sorbonne Université, APHP, CHU Pitié-Salpêtrière, Paris, France
- Department of Internal Medicine, University of Paris Saclay, APHP, CHU Ambroise Paré, Boulogne-Billancourt, France
| | - Arnaud Petit
- Department of Hematology and Pediatric Oncology, Sorbonne Université, APHP, CHU Armand Trousseau, Paris, France
- Department of Internal Medicine, University of Paris Saclay, APHP, CHU Ambroise Paré, Boulogne-Billancourt, France
| | - Julien Rossignol
- Department of Hematology, University of Sorbonne-Paris-Cité, APHP, CHU Necker, Paris, France
- Department of Internal Medicine, University of Paris Saclay, APHP, CHU Ambroise Paré, Boulogne-Billancourt, France
| | - Nicolas Schleinitz
- Department of Internal Medicine, National Reference Center for Hypereosinophilic Syndromes (CEREO), Hôpital Foch, 40, Rue Worth, 92151, Suresnes, France
- Department of Internal Medicine, APHM, CHU La Timone, Marseille, France
- Department of Internal Medicine, University of Paris Saclay, APHP, CHU Ambroise Paré, Boulogne-Billancourt, France
| | - Juliette Soret-Dulphy
- Centre d'Investigation Clinique, University of Sorbonne-Paris-Cité, AP-HP, CHU St-Louis, Paris, France
- Department of Internal Medicine, University of Paris Saclay, APHP, CHU Ambroise Paré, Boulogne-Billancourt, France
| | - Delphine Staumont-Salle
- Department of Internal Medicine, National Reference Center for Hypereosinophilic Syndromes (CEREO), Hôpital Foch, 40, Rue Worth, 92151, Suresnes, France
- Department of Dermatology, University of Lille, CHU de Lille, Lille, France
- Department of Internal Medicine, University of Paris Saclay, APHP, CHU Ambroise Paré, Boulogne-Billancourt, France
| | - Benjamin Terrier
- Department of Internal Medicine, University of Sorbonne-Paris-Cité, AP-HP, Paris, France
- Department of Internal Medicine, University of Paris Saclay, APHP, CHU Ambroise Paré, Boulogne-Billancourt, France
| | - Louis Terriou
- Department of Internal Medicine, National Reference Center for Hypereosinophilic Syndromes (CEREO), Hôpital Foch, 40, Rue Worth, 92151, Suresnes, France
- Department of Internal Medicine and Clinical Immunology, University of Lille, CHU de Lille, Lille, France
- Department of Internal Medicine, University of Paris Saclay, APHP, CHU Ambroise Paré, Boulogne-Billancourt, France
| | - Jean-François Viallard
- Department of Internal Medicine, National Reference Center for Hypereosinophilic Syndromes (CEREO), Hôpital Foch, 40, Rue Worth, 92151, Suresnes, France
- Department of Internal Medicine, CHU de Bordeaux, Bordeaux, France
- Department of Internal Medicine, University of Paris Saclay, APHP, CHU Ambroise Paré, Boulogne-Billancourt, France
| | - Guillaume Lefèvre
- Department of Internal Medicine, National Reference Center for Hypereosinophilic Syndromes (CEREO), Hôpital Foch, 40, Rue Worth, 92151, Suresnes, France
- Inserm, U1286 - INFINITE - Institute for Translational Research in Inflammation, University of Lille, CHU Lille, Lille, France
- Department of Internal Medicine and Clinical Immunology, University of Lille, CHU de Lille, Lille, France
- Department of Internal Medicine, CHU de Bordeaux, Bordeaux, France
- Department of Internal Medicine, University of Paris Saclay, APHP, CHU Ambroise Paré, Boulogne-Billancourt, France
| | - Jean-Emmanuel Kahn
- Department of Internal Medicine, National Reference Center for Hypereosinophilic Syndromes (CEREO), Hôpital Foch, 40, Rue Worth, 92151, Suresnes, France
- Institut d'Immunologie, University of Lille, CHU de Lille, Lille, France
- Department of Internal Medicine, University of Paris Saclay, APHP, CHU Ambroise Paré, Boulogne-Billancourt, France
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13
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Fox E, Cohen B, Treyster Z. Successful use of mepolizumab for severe hypereosinophilic vasculitis with c-ANCA positivity in a previously healthy 7-year-old boy. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. GLOBAL 2023; 2:124-126. [PMID: 37780105 PMCID: PMC10509853 DOI: 10.1016/j.jacig.2022.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 09/16/2022] [Accepted: 09/19/2022] [Indexed: 10/03/2023]
Abstract
An unusual case of a pediatric patient with severe eosinophilic vasculitis causing digital ischemia is reported. The patient responded well to the anti-IL-5 agent mepolizumab, lending support for use of mepolizumab in pediatric patients with hypereosinophilic syndromes.
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Affiliation(s)
- Eryn Fox
- Department of Pediatrics, The Children’s Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY
| | - Barrie Cohen
- Division of Pediatric Allergy, Immunology and Infectious Disease, Rutgers–Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Zoya Treyster
- Division of Allergy and Immunology, The Children’s Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY
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14
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Caproni M, Calabria VRD, Mariotti EB, Verdelli A, Aimo C, Corrà A, Quintarelli L, Volpi W, Alpsoy E, Sunderkötter C. The impact on the scientific community of the 2018 addendum to the CHCC. Front Med (Lausanne) 2022; 9:1081063. [DOI: 10.3389/fmed.2022.1081063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 11/02/2022] [Indexed: 12/02/2022] Open
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15
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Takeuchi H, Kawamura K, Kawasaki T, Oka N. Distinct features of hypereosinophilic syndrome with neuropathy from eosinophilic granulomatosis with polyangiitis. Front Neurol 2022; 13:1057767. [PMID: 36457867 PMCID: PMC9705778 DOI: 10.3389/fneur.2022.1057767] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 10/28/2022] [Indexed: 12/27/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Hypereosinophilic syndrome (HES) and eosinophilic granulomatosis with polyangiitis (EGPA) have overlapping clinical considerations, which frequently involve peripheral neuropathy. The current study aimed to discriminate between the clinicopathological features of HES and EGPA, focusing on the mechanism of peripheral nerve damage. METHODS A total of 53 patients who underwent nerve biopsies at our laboratory were examined: nine patients with idiopathic HES (iHES), three patients with reactive HES, 14 patients with myeloperoxidase-anti-neutrophil cytoplasmic antibody (ANCA)-positive EGPA, and 27 patients with negative EGPA. Nerve biopsies were performed using light and electron microscopy. RESULTS Polyneuropathy was more common than mononeuritis multiplex in iHES, which differed from that in ANCA-negative EGPA groups (p = 0.012). Nerve biopsies showed that iHES was associated with neuropathy features such as rare vasculitis and non-vasculitic eosinophilic infiltrates, which differed from those of ANCA-negative EGPA. Fibrinoid necrosis was found only in the reactive HES and ANCA-positive groups. The percentage of endoneurial vessels occluded with eosinophils tended to be higher in iHES (1.8%) than in ANCA-positive EGPA (0%) and negative EGPA (0.7%). In a patient with ANCA-negative EGPA, the endoneurial vessels were occluded with platelets, fibrinoid materials, and eosinophils, demonstrating the morphology of eosinophil extracellular traps. CONCLUSION iHES with neuropathy showed a pattern more similar to polyneuropathy than mononeuritis multiplex, which is dominant in ANCA-negative EGPA, and tended to show vasculitis in the peripheral nerves less frequently compared with EGPA. Eosinophilic infiltration and endoneurial vascular occlusion by eosinophils may cause nerve damage.
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Affiliation(s)
- Hiroki Takeuchi
- Department of Neurology, National Hospital Organization Minami Kyoto Hospital, Kyoto, Japan
| | - Kazuyuki Kawamura
- Department of Neurology, National Hospital Organization Minami Kyoto Hospital, Kyoto, Japan
| | - Teruaki Kawasaki
- Kyoto Clinical and Translational Research Center for Neurocognitive Disorders, Kyoto, Japan
| | - Nobuyuki Oka
- Department of Neurology, National Hospital Organization Minami Kyoto Hospital, Kyoto, Japan
- Department of Neurology, Kyoto Konoe Rehabilitation Hospital, Kyoto, Japan
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16
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Wen-fei H, Zi-jing L, Peng-yuan C, Yuan-hui L, Chong-yang D, Li-huan Z, Ze-huo L, Zhi-qiang G, Jian-fang L. Association between high-sensitivity C-reactive protein and bleeding in non-ST-segment elevation acute coronary syndrome: A multicentre cohort of Chinese population.. [DOI: 10.21203/rs.3.rs-2241865/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Abstract
Background
The association between high-sensitivity C-reactive protein (hs-CRP) and bleeding risk in acute coronary syndrome (ACS) patients remains unclear. This study aimed to examine the association between bleeding events and different hs-CRP levels in patients with non-ST elevation ACS (NSTE-ACS).
Methods
This study retrospectively included 2583 adults with NSTE-ACS between January 1, 2010, and December 31, 2014, at 5 medical centres in China. The primary outcome was major bleeding, defined by the Bleeding Academic Research Consortium definition (grades 3–5).
Results
Fifty-three (2.1%) patients experienced major bleeding in the hospital. Patients with hs-CRP levels greater than 8.20 mg/L had the highest incidence of in-hospital major bleeding (25 (3.9%), P < 0.001) compared with the other groups. Multivariable analysis indicated that hs-CRP was an independent factor associated with in-hospital major bleeding (continuous: adjusted OR = 1.01, 95% CI: 1.01–1.02, P < 0.001; quartiles: adjusted OR for quartile 4 (referring to quartile 1) = 3.71, 95% CI: 1.35 ~ 10.23, P = 0.011), which was further confirmed by subgroup analysis and receiver operating characteristic curves. The restricted cubic spline analysis demonstrated an S-shaped association between hs-CRP and major bleeding. During the 5-year follow-up, there was a significantly high risk of bleeding in patients with higher hs-CRP levels.
Conclusion
Higher hs-CRP level at admission in NSTE-ACS patients is associated with high risk of in-hospital major bleeding. An S-shaped association was found between hs-CRP and bleeding events. Further studies are warranted to optimize antithrombotic drug therapy in high-bleeding risk patients during follow-up.
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Affiliation(s)
- He Wen-fei
- Guangdong Provincial People’s Hospital’s Nanhai Hospital, the Second People’s Hospital of Nanhai District
| | | | - Chen Peng-yuan
- Guangdong Provincial People’s Hospital’s Nanhai Hospital, the Second People’s Hospital of Nanhai District
| | - Liu Yuan-hui
- Guangdong Cardiovascular Institute, Guangdong Academy of Medical Sciences
| | | | - Zeng Li-huan
- Guangdong Provincial People’s Hospital’s Nanhai Hospital, the Second People’s Hospital of Nanhai District
| | | | - Guo Zhi-qiang
- Guangdong Provincial People’s Hospital’s Nanhai Hospital, the Second People’s Hospital of Nanhai District
| | - Luo Jian-fang
- Guangdong Provincial People’s Hospital’s Nanhai Hospital, the Second People’s Hospital of Nanhai District
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17
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Seitz L, Seitz P, Pop R, Lötscher F. Spectrum of Large and Medium Vessel Vasculitis in Adults: Primary Vasculitides, Arthritides, Connective Tissue, and Fibroinflammatory Diseases. Curr Rheumatol Rep 2022; 24:352-370. [PMID: 36166150 PMCID: PMC9513304 DOI: 10.1007/s11926-022-01086-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2022] [Indexed: 11/24/2022]
Abstract
Purpose of Review To provide a comprehensive overview of the spectrum of large and medium vessel vasculitis in adults with primary vasculitides, arthritides, connective tissue, and fibroinflammatory diseases as well as vasculitis mimics, for an efficient differential diagnosis and initial diagnostic approach. Recent Findings Imaging has had a tremendous impact on the diagnosis of medium to large vessel vasculitis, now often replacing histopathologic confirmation and identifying new disease manifestations (e.g., intracranial disease in giant cell arteritis; vascular manifestations of IgG4-related disease). Novel diseases or syndromes involving blood vessels have been described (e.g., VEXAS-Syndrome with polychondritis). The use of the terms “medium” or “large” vessel varies considerably between medical specialties. Summary The differential diagnosis of large and medium vessel vasculitis is becoming increasingly complex as new entities or disease manifestations of known inflammatory rheumatic diseases are regularly identified. A more precise and widely recognized definition of the vessel sizes would make future research more comparable.
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Affiliation(s)
- Luca Seitz
- Department of Rheumatology and Immunology, Inselspital, University Hospital, University of Bern, Freiburgstrasse, CH-3010, Bern, Switzerland. .,Immunodeficiency Laboratory, Department of Biomedicine, University Hospital and University of Basel, Basel, Switzerland.
| | - Pascal Seitz
- Department of Rheumatology and Immunology, Inselspital, University Hospital, University of Bern, Freiburgstrasse, CH-3010, Bern, Switzerland
| | - Roxana Pop
- Department of Infectious Diseases and Hospital Hygiene, University Hospital, University of Zurich, Zurich, Switzerland
| | - Fabian Lötscher
- Department of Rheumatology and Immunology, Inselspital, University Hospital, University of Bern, Freiburgstrasse, CH-3010, Bern, Switzerland
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18
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Noro Y, Miyata H, Furuta T, Sugita Y, Suzuki Y, Kusumi M, Tanabe M, Shomori K. Tumefactive eosinophil-rich non-granulomatous small vessel vasculitis in the cerebrum in a patient with idiopathic hypereosinophilic syndrome. Neuropathology 2022; 42:239-244. [PMID: 35411628 PMCID: PMC9541515 DOI: 10.1111/neup.12810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 02/16/2022] [Accepted: 02/27/2022] [Indexed: 11/26/2022]
Abstract
The definite diagnosis of central nervous system vasculitis requires pathological verification by biopsy or surgical resection of the lesion, which may not always be feasible. A 74-year-old woman with a history of allergic rhinitis, but not asthma, presented with slowly progressive left hemiparesis. Magnetic resonance imaging of the head revealed a heterogeneously enhancing mass involving the right internal capsule and corona radiata. Histological examination of the resected specimen revealed eosinophil-rich non-granulomatous small vessel vasculitis with no neutrophil infiltration or foci of microbial infection. Epstein-Barr virus in situ hybridization was negative, and polymerase chain reaction tests for both T-cell receptor gamma and immunoglobulin heavy-chain variable region genes did not show rearrangements, excluding the possibility of lymphoma and lymphoproliferative disorders. Blood hypereosinophilia and elevated erythrocyte sedimentation rate were observed; however, anti-neutrophil cytoplasmic antibodies were not detected. A biopsy of the erythema in the hips and thighs revealed perivasculitis with eosinophilic infiltration within the dermis. Chest computed tomography revealed multiple small nodules in the lungs. Her symptoms, aside from hemiparesis, disappeared after corticosteroid administration. The clinicopathological features were similar to eosinophilic granulomatosis with polyangiitis but did not meet its current classification criteria and definition. This patient is the first reported case of idiopathic eosinophilic vasculitis or idiopathic hypereosinophilic syndrome-associated vasculitis affecting the small vessels in the brain. Further clinicopathological studies enrolling similar cases are necessary to establish the disease concept and unravel the underlying pathogenesis.
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Affiliation(s)
- Yoshifumi Noro
- Department of Neuropathology, Research Institute for Brain and Blood Vessels, Akita Cerebrospinal and Cardiovascular Center, Akita, Japan.,Akita University School of Medicine, Akita, Japan
| | - Hajime Miyata
- Department of Neuropathology, Research Institute for Brain and Blood Vessels, Akita Cerebrospinal and Cardiovascular Center, Akita, Japan
| | - Takuya Furuta
- Department of Pathology, Kurume University School of Medicine, Kurume, Japan
| | - Yasuo Sugita
- Department of Pathology, Kurume University School of Medicine, Kurume, Japan.,Department of Neuropathology, St. Mary's Hospital, Kurume, Japan
| | - Yuki Suzuki
- Department of Neurology, San-in Rosai Hospital, Yonago, Japan
| | | | - Michiharu Tanabe
- Department of Neurosurgery, San-in Rosai Hospital, Yonago, Japan
| | - Kohei Shomori
- Department of Pathology, San-in Rosai Hospital, Yonago, Japan
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19
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Lin M, Su Z, Huang J, Li J, Luo N, Wang J. Eosinophilic granulomatosis with polyangiitis presenting with repetitive acute coronary syndrome, refractory coronary vasospasm, and spontaneous coronary dissection: a case report. J Int Med Res 2022; 50:3000605221089516. [PMID: 35354311 PMCID: PMC8978318 DOI: 10.1177/03000605221089516] [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] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Eosinophilic granulomatosis with polyangiitis (EGPA) is a type of eosinophilic vasculitis that is mainly limited to small- and medium-sized arteries. Cardiac involvement is the leading cause of death in patients with EGPA. Spontaneous coronary artery dissection (SCAD) is an important cause of acute coronary syndrome in middle-aged women with no or few traditional cardiovascular risk factors. EGPA manifesting as repetitive acute coronary syndrome and SCAD has not been reported. A 45-year-old woman presented with recurrent chest pain and cardiogenic shock associated with coronary vasospasm refractory to common vasodilators. Coronary angiography showed SCAD at the proximal right coronary artery. Blood tests showed significant eosinophilia. In addition to sinusitis as shown by nasal computed tomography and abnormal nerve conduction velocity, the diagnosis of EGPA was made and immunosuppression commenced. During a 20-month follow-up, the patient remained free from symptoms and adverse cardiovascular events. EGPA can involve coronary arteries and may rarely manifest as SCAD or vasospasm. We herein review the mechanism underlying coronary involvement of EGPA and emphasize special clues for its detection. Early recognition and initiation of immunosuppression therapy are important.
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Affiliation(s)
- Maohuan Lin
- Cardiac Catheterization Laboratory, Department of Cardiology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou 510120, China.,Guangdong Province Key Laboratory of Arrhythmia and Electrophysiology, Guangzhou 510120, China
| | - Zizhuo Su
- Cardiac Catheterization Laboratory, Department of Cardiology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou 510120, China.,Guangdong Province Key Laboratory of Arrhythmia and Electrophysiology, Guangzhou 510120, China
| | - Jianzhong Huang
- Department of Cardiology, Dongguan Binhai Bay Central Hospital, Dongguan 523900, China
| | - Jiajie Li
- Cardiac Catheterization Laboratory, Department of Cardiology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou 510120, China.,Guangdong Province Key Laboratory of Arrhythmia and Electrophysiology, Guangzhou 510120, China
| | - Niansang Luo
- Cardiac Catheterization Laboratory, Department of Cardiology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou 510120, China.,Guangdong Province Key Laboratory of Arrhythmia and Electrophysiology, Guangzhou 510120, China
| | - Jingfeng Wang
- Cardiac Catheterization Laboratory, Department of Cardiology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou 510120, China.,Guangdong Province Key Laboratory of Arrhythmia and Electrophysiology, Guangzhou 510120, China
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20
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Ammirati E, Bizzi E, Veronese G, Groh M, Van de Heyning CM, Lehtonen J, Pineton de Chambrun M, Cereda A, Picchi C, Trotta L, Moslehi JJ, Brucato A. Immunomodulating Therapies in Acute Myocarditis and Recurrent/Acute Pericarditis. Front Med (Lausanne) 2022; 9:838564. [PMID: 35350578 PMCID: PMC8958011 DOI: 10.3389/fmed.2022.838564] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 01/28/2022] [Indexed: 12/15/2022] Open
Abstract
The field of inflammatory disease of the heart or "cardio-immunology" is rapidly evolving due to the wider use of non-invasive diagnostic tools able to detect and monitor myocardial inflammation. In acute myocarditis, recent data on the use of immunomodulating therapies have been reported both in the setting of systemic autoimmune disorders and in the setting of isolated forms, especially in patients with specific histology (e.g., eosinophilic myocarditis) or with an arrhythmicburden. A role for immunosuppressive therapies has been also shown in severe cases of coronavirus disease 2019 (COVID-19), a condition that can be associated with cardiac injury and acute myocarditis. Furthermore, ongoing clinical trials are assessing the role of high dosage methylprednisolone in the context of acute myocarditis complicated by heart failure or fulminant presentation or the role of anakinra to treat patients with acute myocarditis excluding patients with hemodynamically unstable conditions. In addition, the explosion of immune-mediated therapies in oncology has introduced new pathophysiological entities, such as immune-checkpoint inhibitor-associated myocarditis and new basic research models to understand the interaction between the cardiac and immune systems. Here we provide a broad overview of evolving areas in cardio-immunology. We summarize the use of new imaging tools in combination with endomyocardial biopsy and laboratory parameters such as high sensitivity troponin to monitor the response to immunomodulating therapies based on recent evidence and clinical experience. Concerning pericarditis, the normal composition of pericardial fluid has been recently elucidated, allowing to assess the actual presence of inflammation; indeed, normal pericardial fluid is rich in nucleated cells, protein, albumin, LDH, at levels consistent with inflammatory exudates in other biological fluids. Importantly, recent findings showed how innate immunity plays a pivotal role in the pathogenesis of recurrent pericarditis with raised C-reactive protein, with inflammasome and IL-1 overproduction as drivers for systemic inflammatory response. In the era of tailored medicine, anti-IL-1 agents such as anakinra and rilonacept have been demonstrated highly effective in patients with recurrent pericarditis associated with an inflammatory phenotype.
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Affiliation(s)
- Enrico Ammirati
- De Gasperis Cardio Center and Transplant Center, Niguarda Hospital, Milano, Italy
| | - Emanuele Bizzi
- Internal Medicine, Fatebenefratelli Hospital, Milano, Italy
| | - Giacomo Veronese
- Department of Health Sciences, University of Milano-Bicocca, Monza, Italy
| | - Matthieu Groh
- National Reference Center for Hypereosinophilic Syndromes, CEREO, Suresnes, France
- Department of Internal Medicine, Hôpital Foch, Suresnes, France
| | - Caroline M. Van de Heyning
- Department of Cardiology, Antwerp University Hospital, and GENCOR Research Group, Antwerp University, Antwerp, Belgium
| | - Jukka Lehtonen
- Department of Cardiology, Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland
| | - Marc Pineton de Chambrun
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris (APHP), Hôpital La Pitié-Salpêtrière, Service de Médecine Intensive-Réanimation, Paris, France
- Sorbonne Université, APHP, Hôpital de la Pitié-Salpêtrière, Service de Médecine Interne 2, Centre de Référence National Lupus et SAPL et Autres Maladies Auto-immunes et Systémiques Rares, Paris, France
- Sorbonne Université, INSERM, UMRS_1166-ICAN, ICAN, Paris, France
| | - Alberto Cereda
- Cardiovascular Department, Association Socio Sanitary Territorial Santi Paolo e Carlo, Milano, Italy
| | - Chiara Picchi
- Internal Medicine, Fatebenefratelli Hospital, Milano, Italy
| | - Lucia Trotta
- Internal Medicine, Fatebenefratelli Hospital, Milano, Italy
| | - Javid J. Moslehi
- Section of Cardio-Oncology and Immunology, Division of Cardiology and the Cardiovascular Research Institute, University of California, San Francisco, San Francisco, CA, United States
| | - Antonio Brucato
- Internal Medicine, Fatebenefratelli Hospital, Milano, Italy
- Department of Biomedical and Clinical Sciences “Luigi Sacco, ” Fatebenefratelli Hospital, University of Milano, Milano, Italy
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21
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Hypereosinophilic syndrome presents as multifocal acute ischemic strokes: case series and review. BRAIN DISORDERS 2022. [DOI: 10.1016/j.dscb.2022.100033] [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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22
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Kanno T, Fukumoto T, Hamada T. Eosinophilic vasculitis as a manifestation of idiopathic hypereosinophilic syndrome. J Dermatol 2021; 49:e140-e141. [PMID: 34927273 DOI: 10.1111/1346-8138.16279] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 10/28/2021] [Accepted: 12/06/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Taisuke Kanno
- Department of Dermatology, Takamatsu Red Cross Hospital, Takamatsu, Japan
| | - Tetsuya Fukumoto
- Department of Hematology, Takamatsu Red Cross Hospital, Takamatsu, Japan
| | - Toshihisa Hamada
- Department of Dermatology, Takamatsu Red Cross Hospital, Takamatsu, Japan
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23
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Ono R, Iwahana T, Kato H, Okada S, Kobayashi Y. Literature reviews of stroke with hypereosinophilic syndrome. IJC HEART & VASCULATURE 2021; 37:100915. [PMID: 34888412 PMCID: PMC8636825 DOI: 10.1016/j.ijcha.2021.100915] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 10/20/2021] [Accepted: 11/06/2021] [Indexed: 11/25/2022]
Abstract
Hypereosinophilic syndrome (HES) is defined by persistently elevated blood eosinophil levels and is associated with evidence of organ damage. Cardiovascular involvement in HES is most commonly associated with Loffler endocarditis (cardiac HES). Cardiac HES is typically characterized by progressive subendocardial fibrosis with overlying mural thrombus formation, leading to restrictive dysfunction of the left ventricle. The thrombus from cardiac HES could result in cardiogenic stroke; however, most of the stroke cases with HES were not associated with huge thromboembolism rather multiple infarcts in the watershed area. The major clinical features of 97 previously reported cases of stroke with HES are as follows: the median age was 52 years, of which 61 (63%) were men; the initial presenting symptoms were neurological (73%), followed by headache (16%), respiratory symptoms (9%), and visual symptoms (9%). Almost half of the cases were diagnosed with cardiac HES. The characteristics of cardiac findings were mural thrombi, endomyocardial fibrosis, and a restrictive pattern of heart failure. Cerebral findings revealed 78 cases (80%) were described as multiple infarctions and 55 cases (57 %) were involved with watershed areas, whereas 11 cases (11%) were described as embolic stroke for one proximal large-vessel occlusion. Regarding treatment, 71 (73%), 28 (29%), and 16 (16%) patients were treated with steroids, anticoagulants, and antiplatelets, respectively. The overall mortality and recovery rates were 11% and 89%, respectively. Physicians should know most cases of stroke with HES are characterized by multiple infarctions in the watershed area, and cardiac HES is not always associated with stroke.
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Affiliation(s)
- Ryohei Ono
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan
| | - Togo Iwahana
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan
| | - Hirotoshi Kato
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan
| | - Sho Okada
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan
| | - Yoshio Kobayashi
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan
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24
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Tennenbaum J, Groh M, Venditti L, Campos-Gazeau F, Chalayer E, De Broucker T, Hamidou M, Hunault M, Lyoubi A, Meunier R, Muron T, Sène D, Slama B, Guidoux C, Lefèvre G, Kahn JE, Denier C, Rohmer J. FIP1L1-PDGFRA-Associated Hypereosinophilic Syndrome as a Treatable Cause of Watershed Infarction. Stroke 2021; 52:e605-e609. [PMID: 34304603 DOI: 10.1161/strokeaha.121.034191] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND AND PURPOSE Ischemic stroke has been reported in various conditions associated with eosinophilia. FIP1L1-PDGFRA fusion ([Fip1-like 1-platelet-derived growth factor receptor alpha]; F/P) leads to the proliferation of the eosinophilic lineage and thus to a clonal hypereosinophilic syndrome that is highly responsive to imatinib. METHODS We previously reported on a nationwide retrospective study of 151 patients with F/P-associated clonal hypereosinophilic syndrome. Patients from this cohort with a clinical history of ischemic stroke (as well as 2 additional cases) were further analyzed to better define their clinical picture and outcomes. RESULTS Sixteen male patients (median age, 51 [43-59] years) with low-to-intermediate cardiovascular risk were included. Median National Institutes of Health Stroke Scale was 4 (range, 1-6). Most cerebral imaging disclosed multiple bilateral infarctions of watershed distribution (69%). Despite frequent cardiac involvement (50%), cardiac thrombus was evidenced in a single patient and, according to the TOAST classification (Trial of ORG 10172 in Acute Stroke Treatment), 62.5% of strokes were presumably of undetermined etiology. Among the 15 patients treated with imatinib, and after a median follow-up of 4.5 years, stroke recurred in only 3 patients (consisting of either cardio embolic or hemorrhagic events, unrelated to the first episode). CONCLUSIONS F/P+ clonal hypereosinophilic syndrome is a diagnosis to consider in patients with unexplained ischemic stroke and hypereosinophilia (especially in the setting of multiple cortical borderzone distribution) and warrants prompt initiation of imatinib.
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Affiliation(s)
- Juliette Tennenbaum
- National Reference Center for Hypereosinophilic syndromes (CEREO), France (J.T., M.G., M. Hamidou, G.L., J.-E.K., J.R.).,Department of Neurology, CHU du Kremlin-Bicêtre, France (J.T., L.V., C.D.)
| | - Matthieu Groh
- National Reference Center for Hypereosinophilic syndromes (CEREO), France (J.T., M.G., M. Hamidou, G.L., J.-E.K., J.R.).,Department of Internal Medicine, Hôpital Foch, Suresnes, France (M.G., J.R.)
| | - Laura Venditti
- Department of Neurology, CHU du Kremlin-Bicêtre, France (J.T., L.V., C.D.)
| | | | - Emilie Chalayer
- Department of Hematology and Cell Therapy, Saint-Priest-en-Jarez, France. (E.C.)
| | - Thomas De Broucker
- Department of Neurology, Hôpital Delafontaire, Saint Denis, France (T.D.B., A.L.)
| | - Mohamed Hamidou
- Department of Internal Medicine, CHU de Nantes, France (M. Hamidou)
| | | | - Aicha Lyoubi
- Department of Neurology, Hôpital Delafontaire, Saint Denis, France (T.D.B., A.L.)
| | | | - Thierry Muron
- Department of Oncology, Saint-Priest-en-Jarez, France. (T.M.)
| | - Damien Sène
- Department of Internal Medicine, CHU Lariboisière, Paris, France (D.S.)
| | - Borhane Slama
- Department of Hematology, Hôpital d'Avignon, France (B.S.)
| | - Céline Guidoux
- Department of Neurology, CHU Bichat, Paris, France (C.G.)
| | - Guillaume Lefèvre
- National Reference Center for Hypereosinophilic syndromes (CEREO), France (J.T., M.G., M. Hamidou, G.L., J.-E.K., J.R.).,Department of Internal Medicine, CHU Lille, France (G.L.)
| | - Jean-Emmanuel Kahn
- National Reference Center for Hypereosinophilic syndromes (CEREO), France (J.T., M.G., M. Hamidou, G.L., J.-E.K., J.R.).,Department of Internal Medicine, CHU Ambroise Paré, Boulogne-Billancourt, France (J.-E.K.)
| | - Christian Denier
- Department of Neurology, CHU du Kremlin-Bicêtre, France (J.T., L.V., C.D.)
| | - Julien Rohmer
- National Reference Center for Hypereosinophilic syndromes (CEREO), France (J.T., M.G., M. Hamidou, G.L., J.-E.K., J.R.).,Department of Internal Medicine, Hôpital Foch, Suresnes, France (M.G., J.R.)
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25
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New therapeutic strategies in lung vasculitis. Curr Opin Pulm Med 2021; 26:496-506. [PMID: 32740376 DOI: 10.1097/mcp.0000000000000693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW To summarize the latest publications and provide a practical overview of treatment strategies for lung vasculitis associated with antineutrophil cytoplasmic antibodies (ANCAs). RECENT FINDINGS In patients with severe ANCA-associated vasculitis, plasma exchange, as adjunctive therapy to standard treatment, is not associated with improved survival or reduced risk of end-stage kidney disease. A regimen with reduced dose of glucocorticoids is equally effective to induce remission as a standard regimen. In patients without organ or life-threatening disease, mycophenolate mofetil can be used in combination with oral glucocorticoid therapy to induce remission, however, with a higher risk of relapse than when using rituximab or cyclophosphamide. For maintenance of remission, a tailored regimen of rituximab infusion was equivalent to a fixed regimen, with fewer perfusions. Belimumab, a human IgG1(Equation is included in full-text article.)monoclonal antibody against B-lymphocyte stimulator, did not decrease the relapse rate when added to azathioprine and glucocorticoids. Avacopan, a complement C5a receptor inhibitor, was effective in replacing high-dose glucocorticoids in achieving complete remission of vasculitis. SUMMARY Significant advances have been made in the treatment strategy to both induce remission and maintain remission in patients with ANCA-associated vasculitis. The choice should take into consideration efficacy, cost-effectiveness, safety profile, ease of use, and possibility of individual tailoring of treatment.
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26
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Iudici M, Puéchal X, Pagnoux C, Courvoisier DS, Hamidou M, Blanchard-Delaunay C, Maurier F, Ruivard M, Quemeneur T, Aumaitre O, Guillevin L, Terrier B. Significance of eosinophilia in granulomatosis with polyangiitis: data from the French Vasculitis Study Group Registry. Rheumatology (Oxford) 2021; 61:1211-1216. [PMID: 34142135 DOI: 10.1093/rheumatology/keab495] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 06/03/2021] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To describe disease presentation and long-term outcome of granulomatosis with polyangiitis (GPA) patients according to blood eosinophils count (Eos) at vasculitis diagnosis. METHODS Data from newly diagnosed GPA patients registered in the French Vasculitis Study Group database with available eosinophil count at diagnosis were reviewed. Disease characteristics, rate and type of relapses and overall survival were analyzed according to Eos, categorized as normal (<500/mm3), mild-to-moderate hypereosinophilia (HE) between 500 and 1500/mm3 and severe HE > 1500/mm3. RESULTS Three hundred and fifty-four patients were included. At diagnosis, 90 (25.4%) patients had HE ≥ 500/mm3; they were more likely male (73% vs 56%, p= 0.006) and had more frequent cutaneous manifestations (49% vs 33%, p= 0.01), peripheral neuropathy (32% vs 17%, p= 0.004) and higher BVAS (21 vs 18, p= 0.01), compared with those with Eos <500/mm3. Patients with severe HE (n = 28; median Eos 2355, range 1500-9114) had more frequent renal function worsening at presentation (p= 0.008). After a median follow-up of 3.95 (IQR 1.95-6.76) years, no difference was found in overall relapse rates according to baseline Eos, but those with HE experienced more neurologic (p= 0.013) and skin (p= 0.024) relapses and had more frequently peripheral neuropathy as damage at last follow-up (p= 0.02). Overall survival difference was not significantly different in patients with normal Eos or HE at diagnosis. (p= 0.08). CONCLUSIONS Blood HE at diagnosis, observed in about one quarter of GPA patients, identifies a subgroup of patients with a more severe disease and higher rate of skin and neurological involvement both at presentation and during follow-up.
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Affiliation(s)
- Michele Iudici
- National Referral Center for Rare Systemic Autoimmune Diseases, Department of Internal Medicine, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (APHP), France, Paris.,Rheumatology Unit, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Xavier Puéchal
- National Referral Center for Rare Systemic Autoimmune Diseases, Department of Internal Medicine, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (APHP), France, Paris
| | - Christian Pagnoux
- Vasculitis Clinic, Mount Sinai Hospital, University of Toronto, Toronto, Canada
| | - Delphine S Courvoisier
- Rheumatology Unit, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | | | | | - François Maurier
- Service de médecine interne, Groupe Hospitalier UNEOS, Metz-Vantoux, France
| | - Marc Ruivard
- Service de médecine interne, CHU, Clermont-Ferrand, France
| | - Thomas Quemeneur
- Département de médecine interne, Centre Hospitalier, Valenciennes, France
| | | | - Loïc Guillevin
- National Referral Center for Rare Systemic Autoimmune Diseases, Department of Internal Medicine, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (APHP), France, Paris.,Université de Paris, Paris, France
| | - Benjamin Terrier
- National Referral Center for Rare Systemic Autoimmune Diseases, Department of Internal Medicine, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (APHP), France, Paris.,Université de Paris, Paris, France
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27
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Kaga M, Takeuchi H, Iwahara K, Ihara H. A case of hypereosinophilia with digital ischaemia successfully treated with intravenous prostaglandin E 1. SKIN HEALTH AND DISEASE 2021; 1:e32. [PMID: 35664976 PMCID: PMC9060027 DOI: 10.1002/ski2.32] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 03/24/2021] [Accepted: 03/24/2021] [Indexed: 11/09/2022]
Abstract
In the therapeutic management of eosinophilic disorder, it is important to prevent hypereosinophilia (HE)-related organ damage even in the process of diagnosis. We describe here a unique clinical and histopathological findings of the patient with HE accompanied with digital ischaemia. Treatment with intravenous prostaglandin E1 was essential for digital ischaemia in our case while benralizumab, humanized monoclonal antibody against interleukin-5 receptorα, did not affect. Our case suggests an earlier intervention for digital ischaemia in the therapeutic management of eosiniphilic disorder.
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Affiliation(s)
- M. Kaga
- Division of DermatologyKoto HospitalTokyoJapan
- Department of Dermatology and AllergologyFaculty of Medicine, Graduate School of Medicine, Juntendo UniversityTokyoJapan
| | - H. Takeuchi
- Division of DermatologyKoto HospitalTokyoJapan
| | - K. Iwahara
- Division of DermatologyKoto HospitalTokyoJapan
| | - H. Ihara
- Division of Respiratory MedicineKoto HospitalTokyoJapan
- Department of Respiratory MedicineFaculty of Medicine, Graduate School of Medicine, Juntendo UniversityTokyoJapan
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28
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Réau V, Terrier B, Ackermann F, Killian M, Hamidou M, Meyer G, Osorio-Perez F, Rohmer J, Lefèvre G, Kahn J, Groh M. Présentation clinique et facteurs de risque de rechute au cours des thromboses veineuses associées à une hyperéosinophilie : étude multicentrique rétrospective à propos de 54 patients. Rev Med Interne 2021. [DOI: 10.1016/j.revmed.2021.03.261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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29
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Descamps V, Deschamps L, El Khalifa J, Groh M, Gibier JB, Lefèvre G, Taillé C. Eosinophilic vasculitis associated with persistent dupilumab-induced hypereosinophilia in severe asthma. Respir Med Res 2021; 79:100821. [PMID: 33984814 DOI: 10.1016/j.resmer.2021.100821] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 04/01/2021] [Accepted: 04/08/2021] [Indexed: 01/01/2023]
Affiliation(s)
- V Descamps
- Groupe Hospitalier Universitaire AP-HP Nord-Université de Paris, Hôpital Bichat, Service de Dermatologie, Paris, France
| | - L Deschamps
- Groupe Hospitalier Universitaire AP-HP Nord-Université de Paris, Hôpital Bichat, Service de Pathologie, Paris, France
| | - J El Khalifa
- Groupe Hospitalier Universitaire AP-HP Nord-Université de Paris, Hôpital Bichat, Service de Dermatologie, Paris, France
| | - M Groh
- Department of Internal Medicine, Hôpital Foch, Suresnes, France; National Reference Center for Hypereosinophilic syndromes (CEREO), France
| | - J-B Gibier
- Centre de Biologie et Pathologie, CHU de Lille, Lille, France
| | - G Lefèvre
- National Reference Center for Hypereosinophilic syndromes (CEREO), France; Institut d'Immunologie, CHU de Lille, U1286-INFINITE-Institute for Translational Research in Inflammation, University Lille, Inserm, CHU de Lille, Lille, France
| | - C Taillé
- Groupe Hospitalier Universitaire AP-HP Nord-Université de Paris, Hôpital Bichat, Service de Pneumologie et Centre de Référence constitutif des Maladies Pulmonaires Rares; Inserm UMR 1152, Paris, France.
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30
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Réau V, Vallée A, Terrier B, Plessier A, Abisror N, Ackermann F, Benainous R, Bohelay G, Chabi-Charvillat ML, Cornec D, Desbois AC, Faguer S, Freymond N, Gaillet A, Hamidou M, Killian M, Le Jeune S, Marchetti A, Meyer G, Osorio-Perez F, Panel K, Rautou PE, Rohmer J, Simon N, Tcherakian C, Vasse M, Zuelgaray E, Lefevre G, Kahn JE, Groh M. Venous thrombosis and predictors of relapse in eosinophil-related diseases. Sci Rep 2021; 11:6388. [PMID: 33737704 PMCID: PMC7973521 DOI: 10.1038/s41598-021-85852-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 03/08/2021] [Indexed: 12/13/2022] Open
Abstract
Eosinophils have widespread procoagulant effects. Eosinophilic cardiovascular toxicity mostly consists of endomyocardial damage or eosinophilic vasculitis, while reported cases of venous thrombosis (VT) are scarce. We aimed to report on the clinical features and treatment outcomes of patients with unexplained VT and eosinophilia, and to identify predictors of relapse. This retrospective, multicenter, observational study included patients aged over 15 years with VT, concomitant blood eosinophilia ≥ 1G/L and without any other moderate-to-strong contributing factors for VT. Fifty-four patients were included. VT was the initial manifestation of eosinophil-related disease in 29 (54%) patients and included pulmonary embolism (52%), deep venous thrombosis (37%), hepatic (11%) and portal vein (9%) thromboses. The median [IQR] absolute eosinophil count at VT onset was 3.3G/L [1.6-7.4]. Underlying eosinophil-related diseases included FIP1L1-PDGFRA-associated chronic myeloid neoplasm (n = 4), Eosinophilic Granulomatosis with Polyangiitis (n = 9), lymphocytic (n = 1) and idiopathic (n = 29) variants of hypereosinophilic syndrome. After a median [IQR] follow-up of 24 [10-62] months, 7 (13%) patients had a recurrence of VT. In multivariate analysis, persistent eosinophilia was the sole variable associated with a shorter time to VT relapse (HR 7.48; CI95% [1.94-29.47]; p = 0.015). Long-term normalization of eosinophil count could prevent the recurrence of VT in a subset of patients with unexplained VT and eosinophilia ≥ 1G/L.
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Affiliation(s)
- Valériane Réau
- Department of Internal and Geriatric Medicine, Henri Mondor Hospital, Assistance Publique-Hôpitaux de Paris, Créteil, France.,National Reference Center for Hypereosinophilic Syndromes, CEREO, France
| | - Alexandre Vallée
- Department of Clinical Research and Innovation (DRCI), Hôpital Foch, 92150, Suresnes, France
| | - Benjamin Terrier
- Department of Internal Medicine, National Referral Center for Systemic and Autoimmune Diseases, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Aurélie Plessier
- Department of Hepatology, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris, Clichy, France
| | - Noémie Abisror
- Department of Internal Medicine, Saint Antoine Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Félix Ackermann
- National Reference Center for Hypereosinophilic Syndromes, CEREO, France.,Department of Internal Medicine, Hôpital Foch, 40, rue Worth, 92151, Suresnes Cedex, France
| | - Ruben Benainous
- Department of Internal Medicine, Avicenne Hospital, Assistance Publique-Hôpitaux de Paris, Bobigny, France
| | - Gérôme Bohelay
- Department of Dermatology, Avicenne Hospital, Assistance Publique-Hôpitaux de Paris, Bobigny, France
| | | | - Divi Cornec
- Department of Rheumatology, Brest University Hospital, Brest, France
| | - Anne-Claire Desbois
- Department of Internal Medicine, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Stanislas Faguer
- Department of Nephrology, Toulouse University Hospital, Toulouse, France
| | | | - Antoine Gaillet
- National Reference Center for Hypereosinophilic Syndromes, CEREO, France.,Department of Internal Medicine, Hôpital Foch, 40, rue Worth, 92151, Suresnes Cedex, France
| | - Mohamed Hamidou
- Department of Internal Medicine, Hôtel-Dieu University Hospital, Nantes, France
| | - Martin Killian
- Department of Internal Medicine, Saint-Etienne University Hospital, Saint-Etienne, France
| | - Sylvain Le Jeune
- Department of Internal Medicine, Avicenne Hospital, Assistance Publique-Hôpitaux de Paris, Bobigny, France
| | - Anne Marchetti
- Department of Dermatology, Lyon-Sud Hospital, Pierre-Bénite, France
| | - Guy Meyer
- Pulmonology and Intensive Care Service, Georges Pompidou European Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | | | - Kewin Panel
- National Reference Center for Hypereosinophilic Syndromes, CEREO, France.,Department of Internal Medicine, Hôpital Foch, 40, rue Worth, 92151, Suresnes Cedex, France
| | - Pierre-Emmanuel Rautou
- Department of Hepatology, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris, Clichy, France
| | - Julien Rohmer
- National Reference Center for Hypereosinophilic Syndromes, CEREO, France.,Department of Internal Medicine, Hôpital Foch, 40, rue Worth, 92151, Suresnes Cedex, France
| | - Nicolas Simon
- Department of Internal Medicine, Grenoble Alpes University Hospital, Grenoble, France
| | | | - Marc Vasse
- Department of Clinical Biology, Foch Hospital, Suresnes, France.,UMR-S INSERM 1176, Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Elina Zuelgaray
- Department of Dermatology, Saint Louis, Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Guillaume Lefevre
- National Reference Center for Hypereosinophilic Syndromes, CEREO, France.,Department of Internal Medicine, Lille University Hospital, Lille, France
| | - Jean-Emmanuel Kahn
- National Reference Center for Hypereosinophilic Syndromes, CEREO, France.,Department of Internal Medicine, Ambroise Paré Hospital, Assistance Publique-Hôpitaux de Paris, Boulogne-Billancourt, France
| | - Matthieu Groh
- National Reference Center for Hypereosinophilic Syndromes, CEREO, France. .,Department of Internal Medicine, Hôpital Foch, 40, rue Worth, 92151, Suresnes Cedex, France.
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31
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Idiopathic non-necrotizing eosinophilic vasculitis limited to the lung: Part of a complex spectrum. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 8:2454-2455. [PMID: 32620438 DOI: 10.1016/j.jaip.2020.04.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 04/09/2020] [Indexed: 11/21/2022]
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32
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Reply to "Idiopathic non-necrotizing eosinophilic vasculitis limited to the lung: Part of a complex spectrum". THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 8:2455-2456. [PMID: 32620439 DOI: 10.1016/j.jaip.2020.04.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 04/09/2020] [Indexed: 11/22/2022]
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33
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Schafer AI. Thrombotic, Vascular, and Bleeding Complications of the Myeloproliferative Neoplasms. Hematol Oncol Clin North Am 2021; 35:305-324. [PMID: 33641871 DOI: 10.1016/j.hoc.2020.11.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Thrombotic, vascular, and bleeding complications are the most frequent causes of morbidity and mortality in myeloproliferative neoplasms (MPNs). The interplay and reciprocal amplification between two factors are considered to lead to thrombosis in MPNs: (1) circulating blood cell-intrinsic abnormalities caused by an MPN driver mutation in their hematopoietic progenitor/stem cells, interacting with vascular endothelial cells, show prothrombotic and proadhesive phenotypes; and (2) a state of usually subclinical systemic inflammation that fuels the thrombotic tendency. Prevention and treatment require maintenance of hematocrit less than 45% and cytoreductive therapy in patients with a high risk for thrombotic and vascular complications.
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Affiliation(s)
- Andrew I Schafer
- Weill Cornell Medicine, 1305 York Avenue, 8th Floor, Room Y-811, New York, NY 10021, USA.
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34
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Asadian S, Jahanshahi B, Rezaeian N. Follow-up CMR in a case of Loeffler endocarditis. Clin Case Rep 2021; 9:599-600. [PMID: 33489229 PMCID: PMC7813085 DOI: 10.1002/ccr3.3582] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Revised: 10/08/2020] [Accepted: 11/05/2020] [Indexed: 01/22/2023] Open
Abstract
The typical finding of hypereosinophilic syndrome (Eosinophilic myocarditis) in the delayed enhancement (DE) cardiac magnetic resonance (CMR) is the "double V" sign, which includes (a) normal myocardium, (b) thickened enhanced endomyocardial layer, and (c) overlying apical thrombus. Corticosteroids may result in significant improvement of myocardial involvement.
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Affiliation(s)
- Sanaz Asadian
- Rajaie Cardiovascular Medical and Research CenterIran University of Medical SciencesTehranIran
| | - Bahareh Jahanshahi
- Rajaie Cardiovascular Medical and Research CenterIran University of Medical SciencesTehranIran
| | - Nahid Rezaeian
- Rajaie Cardiovascular Medical and Research CenterIran University of Medical SciencesTehranIran
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35
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Rohmer J, Couteau‐Chardon A, Trichereau J, Panel K, Gesquiere C, Ben Abdelali R, Bidet A, Bladé J, Cayuela J, Cony‐Makhoul P, Cottin V, Delabesse E, Ebbo M, Fain O, Flandrin P, Galicier L, Godon C, Grardel N, Guffroy A, Hamidou M, Hunault M, Lengline E, Lhomme F, Lhermitte L, Machelart I, Mauvieux L, Mohr C, Mozicconacci M, Naguib D, Nicolini FE, Rey J, Rousselot P, Tavitian S, Terriou L, Lefèvre G, Preudhomme C, Kahn J, Groh M, Ackermann F, Adiko D, Ahwij N, Baruchel A, Beal C, Bemba M, Beylot Barry M, Beyne Rauzy O, Bielefeld P, Boisseau M, Bonmati C, Bonnote B, Borel C, Bouredji D, Brignier A, Brouillard M, Campos F, Carre M, Chalayer E, Chomel JC, Coiteux V, Contejean A, Corby A, Darre S, Dubruille V, Durel CA, El Yamani A, Etancelin P, Etienne N, Evon P, Gyan E, Hachulla E, Hermet M, Huguet F, Ianotto JC, Inchiappa L, Jdid I, Jondeau K, Joubert M, Legrand F, Lejeune C, Le Pendu C, Lidove O, Lemal R, Limal N, Lopinet E, Maloisel F, Marfaing A, Marroun I, Maurier F, Muller E, Muron T, Ojeda M, Paule R, Pignon JM, Rossi C, Roumier M, Sene D, Sene T, Simon L, Slama B, Suarez F, Tcherakian C, Torregrosa JM, Toussaint E, Vatan R, Visanica S, Voilat L, Zini JM. Epidemiology, clinical picture and long-term outcomes of FIP1L1-PDGFRA-positive myeloid neoplasm with eosinophilia: Data from 151 patients. Am J Hematol 2020; 95:1314-1323. [PMID: 32720700 DOI: 10.1002/ajh.25945] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Accepted: 07/23/2020] [Indexed: 12/11/2022]
Abstract
FIP1L1-PDGFRA-positive myeloid neoplasm with eosinophilia (F/P+ MN-eo) is a rare disease: robust epidemiological data are lacking and reported issues are scarce, of low sample-size and limited follow-up. Imatinib mesylate (IM) is highly efficient but no predictive factor of relapse after discontinuation has yet been identified. One hundred and fifty-one patients with F/P+ MN-eo (143 males; mean age at diagnosis 49 years; mean annual incidence: 0.18 case per million population) were included in this retrospective nationwide study involving all French laboratories who perform the search of F/P fusion gene (study period: 2003-2019). The main organs involved included the spleen (44%), skin (32%), lungs (30%), heart (19%) and central nervous system (9%). Serum vitamin B12 and tryptase levels were elevated in 74/79 (94%) and 45/57 (79%) patients, respectively, and none of the 31 patients initially treated with corticosteroids achieved complete hematologic remission. All 148 (98%) IM-treated patients achieved complete hematologic and molecular (when tested, n = 84) responses. Forty-six patients eventually discontinued IM, among whom 20 (57%) relapsed. In multivariate analysis, time to IM initiation (continuous HR: 1,01 [0.99-1,03]; P = .05) and duration of IM treatment (continuous HR: 0,97 [0,95-0,99]; P = .004) were independent factors of relapse after discontinuation of IM. After a mean follow-up of 80 (56) months, the 1, 5- and 10-year overall survival rates in IM-treated patients were 99%, 95% and 84% respectively. In F/P+ MN-eo, prompt initiation of IM and longer treatment durations may prevent relapses after discontinuation of IM.
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Affiliation(s)
- Julien Rohmer
- National Reference Center for Hypereosinophilic syndromes (CEREO) Suresnes France
- Department of Internal Medicine Hôpital Foch Suresnes France
| | - Amélie Couteau‐Chardon
- National Reference Center for Hypereosinophilic syndromes (CEREO) Suresnes France
- Department of Intensive Care medicine Centre Hospitalier Annecy Genevois Saint‐Julien‐en‐Genevois France
| | - Julie Trichereau
- National Reference Center for Hypereosinophilic syndromes (CEREO) Suresnes France
- Clinical Research Department Hôpital Foch Suresnes France
| | - Kewin Panel
- National Reference Center for Hypereosinophilic syndromes (CEREO) Suresnes France
- Clinical Research Department Hôpital Foch Suresnes France
| | - Cyrielle Gesquiere
- National Reference Center for Hypereosinophilic syndromes (CEREO) Suresnes France
| | - Raouf Ben Abdelali
- Pole Hématologie et Oncologie Laboratoire CERBA Saint‐Ouen‐l'Aumône France
| | - Audrey Bidet
- Laboratory of Hematology CHU de Bordeaux Pessac France
| | | | - Jean‐Michel Cayuela
- Laboratory of Hematology Saint‐Louis Hospital, University of Paris Paris France
| | - Pascale Cony‐Makhoul
- National Reference Center for Hypereosinophilic syndromes (CEREO) Suresnes France
- Hematology Department CH Annecy Genevois Annecy France
| | - Vincent Cottin
- National Coordinating Reference Center for Rare Pulmonary Diseases Louis Pradel Hospital Lyon France
- Hospices Civils de Lyon, UMR754, University Claude Bernard Lyon 1 Lyon France
| | - Eric Delabesse
- Laboratory of Hematology Institut Universitaire du Cancer de Toulouse Oncopole, CHU de Toulouse Toulouse France
| | - Mikaël Ebbo
- National Reference Center for Hypereosinophilic syndromes (CEREO) Suresnes France
- Aix Marseille University, Department of Internal Medicine Hôpital de la Timone, AP‐HM, CNRS, INSERM, CIML Marseille France
| | - Olivier Fain
- Department of Internal Medicine CHU Saint Antoine Paris France
| | - Pascale Flandrin
- Laboratory of Hematology Hôpital Nord, CHU de Saint‐Étienne Saint‐Étienne France
| | - Lionel Galicier
- Department of Clinical Immunology Saint Louis hospital Paris France
| | - Catherine Godon
- Laboratoire de cytogénétique hématologique CHU de Nantes Nantes France
| | | | - Aurélien Guffroy
- National Reference Center for Hypereosinophilic syndromes (CEREO) Suresnes France
- Department of Clinical Immunology and Internal Medicine, National Reference Center for Systemic Autoimmune Diseases (RESO), Tertiary Center for Primary Immunodeficiency Strasbourg University Hospital Strasbourg France
| | - Mohamed Hamidou
- National Reference Center for Hypereosinophilic syndromes (CEREO) Suresnes France
- Department of Internal Medicine CHU de Nantes Nantes France
| | | | | | | | - Ludovic Lhermitte
- University of Paris, Institut National de Recherche Médicale U1151 Laboratory of Onco‐Hematology, Hôpital Necker Enfants‐Malades Paris France
| | - Irène Machelart
- National Reference Center for Hypereosinophilic syndromes (CEREO) Suresnes France
- Department of Internal Medicine CHU de Bordeaux Bordeaux France
| | - Laurent Mauvieux
- Université de Strasbourg, INSERM U1113 Interface de Recherche Fondamentale et Appliquée en Cancérologie, Laboratoire d'hématologie du CHRU Strasbourg, Faculté de Médecine de Strasbourg Strasbourg France
| | - Catherine Mohr
- Service d'Hématologie Oncologie, CHU Groupe Hospitalier Sud Réunion Saint Pierre, Reunion France
| | - Marie‐Joelle Mozicconacci
- Institut Paoli‐Calmettes, Centre de Recherche en Cancérologie de Marseille, Biopathologie Marseille France
| | - Dina Naguib
- Laboratory of Hematology CHU Caen Caen France
| | - Franck E. Nicolini
- Department of Hematology INSERM U 1052, CRCL, Centre Léon Bérard Lyon France
| | - Jerome Rey
- Department of Hematology Institut Paoli‐Calmettes Marseille France
| | - Philippe Rousselot
- Hematology Department Versailles André Mignot Hospital, University Paris‐Saclay Le Chesnay France
| | - Suzanne Tavitian
- Service d'Hématologie, Institut Universitaire du Cancer de Toulouse‐Oncopole Centre Hospitalier Universitaire de Toulouse Toulouse France
| | - Louis Terriou
- National Reference Center for Hypereosinophilic syndromes (CEREO) Suresnes France
- Université de Lille, CHU Lille, Département de Médecine Interne et Immunologie Clinique, Centre de Référence des Maladies Auto‐immunes Systémiques Rares du Nord et Nord‐Ouest de France (CeRAINO) Lille France
| | - Guillaume Lefèvre
- National Reference Center for Hypereosinophilic syndromes (CEREO) Suresnes France
- Université de Lille, CHU Lille, Département de Médecine Interne et Immunologie Clinique, Centre de Référence des Maladies Auto‐immunes Systémiques Rares du Nord et Nord‐Ouest de France (CeRAINO) Lille France
| | | | - Jean‐Emmanuel Kahn
- National Reference Center for Hypereosinophilic syndromes (CEREO) Suresnes France
- Université Paris‐Saclay, Department of Internal Medicine Ambroise Paré hospital, Boulogne Billancourt Cedex France
| | - Matthieu Groh
- National Reference Center for Hypereosinophilic syndromes (CEREO) Suresnes France
- Department of Internal Medicine Hôpital Foch Suresnes France
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Lung-limited or lung-dominant variant of eosinophilic granulomatosis with polyangiitis. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2020; 8:2092-2095. [DOI: 10.1016/j.jaip.2020.01.058] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Revised: 01/10/2020] [Accepted: 01/29/2020] [Indexed: 01/27/2023]
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Moller D, Tan J, Gauiran DTV, Medvedev N, Hudoba M, Carruthers MN, Dehghan N, Berghe J, Bruyère H, Chen LY. Causes of hypereosinophilia in 100 consecutive patients. Eur J Haematol 2020; 105:292-301. [DOI: 10.1111/ejh.13437] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 04/28/2020] [Accepted: 04/29/2020] [Indexed: 12/12/2022]
Affiliation(s)
- Daniel Moller
- Department of Medicine University of British Columbia Vancouver BC Canada
| | - Julia Tan
- Department of Medicine University of British Columbia Vancouver BC Canada
| | | | - Nadia Medvedev
- Division of Hematopathology University of British Columbia Vancouver BC Canada
| | - Monika Hudoba
- Division of Hematopathology University of British Columbia Vancouver BC Canada
| | | | - Natasha Dehghan
- Division of Rheumatology University of British Columbia Vancouver BC Canada
| | - Janette Berghe
- Department of Pathology and Laboratory Medicine University of British Columbia and Cytogenomics LaboratoryVancouver General Hospital Vancouver BC Canada
| | - Helene Bruyère
- Department of Pathology and Laboratory Medicine University of British Columbia and Cytogenomics LaboratoryVancouver General Hospital Vancouver BC Canada
| | - Luke Y.C. Chen
- Division of Hematology University of British Columbia Vancouver BC Canada
- Centre for Health Education Scholarship University of British Columbia Vancouver BC Canada
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