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Jameie M, Amanollahi M, Ahli B, Farahmand G, Magrouni H, Sarraf P. Coexistence of myasthenia gravis and lichen planus: A case report and systematic review of related case reports from 1971 to 2024. Clin Case Rep 2024; 12:e9065. [PMID: 38883218 PMCID: PMC11177179 DOI: 10.1002/ccr3.9065] [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: 03/11/2024] [Revised: 05/03/2024] [Accepted: 05/31/2024] [Indexed: 06/18/2024] Open
Abstract
Key Clinical Message The co-occurrence of myasthenia gravis (MG) and lichen planus (LP) is a rare phenomenon, with only 13 cases reported in the English literature between 1971 and 2024. Patients with MG or LP, regardless of the thymoma status, require close monitoring for other autoimmune diseases. Abstract Myasthenia gravis (MG) is an uncommon autoimmune disease, resulting in fatigable muscle weakness in the ocular, bulbar, and respiratory muscles, as well as muscles of the extremities. Lichen planus (LP) is an autoimmune mucocutaneous disease, presenting with pruritic and violaceous plaques on the skin and mucosal surfaces. So far, MG and LP co-occurrence is only reported in anecdotal individuals. This study reports a patient with MG and LP and systematically reviews the English literature on this rare co-occurrence from 1971 to 2024, indicating only 13 cases with similar conditions. A 67-year-old man presented with ocular and progressive bulbar symptoms, a year after being diagnosed with generalized LP. Laboratory evaluations were normal except for the high anti-AchR-Ab titer and a positive ANA titer. Neurologic examinations revealed asymmetric bilateral ptosis, weakness and fatigability in proximal muscles, and a severe reduction in the gag reflex. He was diagnosed with late-onset, seropositive MG. The treatment included pyridostigmine (60 mg, three times daily), intravenous immunoglobulin (25 g daily for 5 days), and oral prednisolone. There was no evidence of thymoma in the chest x-ray and CT scan without contrast. However, a CT scan with contrast was not performed due to the patient's unstable condition. A common autoimmune mechanism may underlie the unclear pathophysiology of MG and LP co-occurrence, with or without thymoma. Patients with MG, LP, or thymoma require close monitoring and assessment for other possible autoimmune diseases.
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Affiliation(s)
- Melika Jameie
- Iranian Center of Neurological Research, Neuroscience Institute Tehran University of Medical Sciences Tehran Iran
| | - Mobina Amanollahi
- School of Medicine Tehran University of Medical Sciences Tehran Iran
| | - Bahareh Ahli
- School of Medicine Tehran University of Medical Sciences Tehran Iran
| | - Ghasem Farahmand
- Neurology Department, Imam Khomeini Hospital Complex Tehran University of Medical Sciences Tehran Iran
| | - Hana Magrouni
- Neurology Department, Imam Khomeini Hospital Complex Tehran University of Medical Sciences Tehran Iran
| | - Payam Sarraf
- Iranian Center of Neurological Research, Neuroscience Institute Tehran University of Medical Sciences Tehran Iran
- Neurology Department, Imam Khomeini Hospital Complex Tehran University of Medical Sciences Tehran Iran
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Goodkin DA, Failor RA, Habra MA. Paraneoplastic Vitiligo Associated With Adrenocortical Carcinoma. JCEM CASE REPORTS 2024; 2:luae070. [PMID: 38707658 PMCID: PMC11066913 DOI: 10.1210/jcemcr/luae070] [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: 02/27/2024] [Indexed: 05/07/2024]
Abstract
Malignancies may induce clinical sequelae distant from the sites of the tumor. Such paraneoplastic phenomena are known to affect many organs, including the skin. Vitiligo is a disorder of patchy depigmentation, appearing as white macules with distinct margins. Rarely, vitiligo has been reported as a paraneoplastic occurrence, in the settings of pituitary adenoma, thymoma, gastric carcinoma, and lymphoma. We now describe a man presenting with the abrupt onset of vitiligo on the hands coinciding with recurrence of adrenocortical carcinoma (ACC) in the abdomen. The vitiligo rapidly dissipated following resection of his cancer. We believe this to be the first report of paraneoplastic vitiligo associated with ACC. Endocrinologists typically manage ACC and should be aware of this link, as the de novo observation of vitiligo may signal the onset or recurrence of underlying tumor. Other practitioners that encounter patients with new vitiligo should add ACC to their differential diagnosis of potential underlying conditions.
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Affiliation(s)
| | - Richard Alan Failor
- Division of Metabolism, Endocrinology, and Nutrition, University of Washington, Seattle, WA 98105, USA
| | - Mouhammed Amir Habra
- Department of Endocrine Neoplasia and Hormonal Disorders, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
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Kuznetsov D, Kalyuzhin O, Mironov A, Neschisliaev V, Kuznetsova A. A case of vitiligo after COVID-19 vaccination: a possible role of thymic dysfunction. J Zhejiang Univ Sci B 2023; 24:1141-1150. [PMID: 38057270 PMCID: PMC10710914 DOI: 10.1631/jzus.b2300025] [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: 01/09/2023] [Accepted: 06/06/2023] [Indexed: 12/08/2023]
Abstract
During the coronavirus disease 2019 (COVID-19) pandemic, vaccines help control the spread of infection. To date, 47 vaccines have been approved, with another 227 candidates in various stages of development. In the short period of time since the beginning of their use, evidence has begun to emerge of complications following vaccination in the form of the development or exacerbation of a number of pathological conditions (Block et al., 2022; Haseeb et al., 2022). For example, a population-based study in France identified 1612 cases of myocarditis and 1613 cases of pericarditis requiring hospital treatment within five months of vaccination (le Vu et al., 2022).
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Affiliation(s)
- Denis Kuznetsov
- G N. Gabrichevsky Scientific and Research Institute of Epidemiology and Microbiology, Moscow 125212, Russia.
| | - Oleg Kalyuzhin
- I M. Sechenov First Moscow State Medical University, Moscow 119991, Russia
| | - Andrey Mironov
- G N. Gabrichevsky Scientific and Research Institute of Epidemiology and Microbiology, Moscow 125212, Russia
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Cho YR, Kim JH, Kim KH. Surgical Removal of a Thymoma without Myasthenia Gravis Can Have a Therapeutic Effect on Concurrent Alopecia Areata: A Case Report. Ann Dermatol 2022; 34:287-290. [PMID: 35948331 PMCID: PMC9365659 DOI: 10.5021/ad.20.087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 07/30/2020] [Accepted: 08/04/2020] [Indexed: 11/24/2022] Open
Abstract
Alopecia areata is a chronic organ-specific autoimmune disease and it could be associated with other autoimmune diseases. We, herein, report a case of alopecia areata in a patient with a thymoma without myasthenia gravis. Multiple hairless patches rapidly developed 6 weeks before the first visit on the patient who had been newly diagnosed with thymoma 2 weeks before the hairless patches occurred, and thymectomy was done 2 weeks before visiting dermatologic department. She had no symptoms associated with myasthenia gravis, and there were no abnormal findings on neurologic exams and acetylcholine receptor autoantibody was not detected in serum. Scalp biopsy showed numerous lymphocytic inflammations around hair follicles and in immunohistochemical staining, the aggregation of CD4+ and CD8+ T cells was observed around hair follicles and FoxP3+ T lymphocytes were rarely observed around hair follicles. The patient refused any treatment and her hairless patches were completely recovered 3 months after thymectomy, without being recurred 3 years after thymectomy. On the basis of both clinical manifestations and histologic findings, we concluded that alopecia areata in the patient had developed in association with thymoma and was recovered rapidly after thymectomy.
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Affiliation(s)
- Yu-Ri Cho
- Department of Dermatology, College of Medicine, Dong-A University, Busan, Korea
| | - Jung-Hwan Kim
- Department of Dermatology, College of Medicine, Dong-A University, Busan, Korea
| | - Ki-Ho Kim
- Department of Dermatology, College of Medicine, Dong-A University, Busan, Korea
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Cancer-Related Alopecia: From Etiologies to Global Management. Cancers (Basel) 2021; 13:cancers13215556. [PMID: 34771716 PMCID: PMC8583126 DOI: 10.3390/cancers13215556] [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: 09/07/2021] [Revised: 10/25/2021] [Accepted: 11/03/2021] [Indexed: 11/17/2022] Open
Abstract
Simple Summary Although it does not represent a condition that threatens the life of patients, alopecia nevertheless has an essential impact on the quality of life of patients, particularly in terms of the psychological and social aspects. Indeed, while it has long been considered an acceptable side effect in the management of patients, the progressive emergence of a patient-centered approach coupled with a better knowledge of the pathophysiological processes involved has led to a better consideration of alopecia, both on the preventive and palliative sides. Thus, cancerous alopecia can be multifactorial: iatrogenic (in particular via conventional chemotherapy), induced by a vitamin/nutritional deficiency, or even caused by the disease itself. In this state-of-the-art review, we therefore cover alopecia in an exhaustive manner by considering the different mechanisms involved and their frequency as well as the various therapies offered. Abstract Alopecia represents a multifaceted challenge with distinct etiologies and consequences. Transposed to the world of oncology, different types of alopecia and molecular pathways have been characterized, allowing a better understanding of the underlying mechanisms. In patients with cancer, alopecia can be iatrogenic (i.e., due to conventional chemotherapies, endocrine therapies, targeted therapies, immunotherapies, radiotherapy and surgery) or a direct consequence of the disease itself (e.g., malnutrition, scalp metastases and paraneoplastic syndromes). Identification of the actual incriminated mechanism(s) is therefore essential in order to deliver appropriate supportive care, whether preventive or curative. On the preventive side, the last few years have seen the advent of the automated cooling cap, a prophylactic approach supported by several randomized clinical trials. On the curative side, although the treatments currently available are limited, several promising therapeutic approaches are under development. Appropriate alopecia management is essential, particularly regarding its psychological repercussions with significant consequences on the quality of life of patients and their family and with a potential impact on treatment compliance.
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6
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[Alopecia and cancers: From basics to clinical practice]. Bull Cancer 2021; 108:963-980. [PMID: 34304865 DOI: 10.1016/j.bulcan.2021.04.011] [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: 12/20/2020] [Revised: 03/30/2021] [Accepted: 04/19/2021] [Indexed: 11/22/2022]
Abstract
Alopecia, although long considered an unavoidable consequence of cancer therapy, currently presents a multifaceted challenge. The knowledge of the physiology of the hair and consequently of the pathophysiology of alopecia has led to show that there is not one but several types of alopecia. Transposed to the world of oncology, different types of alopecia and subsequently molecular pathways have been characterized, allowing a better understanding of the underlying mechanisms. Thus, in patients with cancer, alopecia can be iatrogenic (chemotherapies, endocrine therapies, targeted therapies, immunotherapies, radiotherapy, surgery) or directly the consequence of the disease itself (malnutrition, scalp metastases, paraneoplastic syndromes). Knowledge of the incriminated mechanism(s) could thus make it possible to deploy an appropriate care component, whether on the preventive or curative sides or in terms of supportive care. These are particularly essential regarding the psychological repercussions caused by alopecia, with significant consequences on the quality of life of patients and with a potential impact on treatment compliance. On the preventive side, the last few years have seen the advent of the automated scalp cooling therapy, supported by several randomized clinical trials. On the curative side, several therapeutic proposals are currently deployed or under development in order to provide relevant treatments.
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Alexakou Z, Liatsos G, Vasileiou N, Vamvakaris I, Mani I, Alexopoulou A. Thymic Carcinoma With Multiple Paraneoplastic Disorders. Am J Med Sci 2021; 362:324-330. [PMID: 33961845 DOI: 10.1016/j.amjms.2021.04.012] [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: 07/03/2020] [Revised: 02/20/2021] [Accepted: 04/25/2021] [Indexed: 10/21/2022]
Abstract
Thymic neoplasms are rare and may run an indolent course. Among them, thymic epithelial carcinoma is exceptional as it may be presented with extensive local invasion and distant metastases. There is a wide spectrum of autoimmune/paraneoplastic syndromes associated with thymic tumors including autoimmune diseases, some of which may precede the diagnosis of thymoma. This article describes a 37-year-old woman with metastatic malignant thymoma and a combination of manifestations from different organs. Vitiligo, Raynaud's phenomenon and anti-centromere antibodies were preceded while eosinophilia, interstitial lung disease, rash, thickening of the skin and asymptomatic cryoglobulinemia were diagnosed concomitantly with the neoplasm. We have reviewed the literature and found only twenty case reports with a cluster of three or more autoimmune/paraneoplastic syndromes in the same patient but none with this unique constellation of disorders. The diversity of thymoma's clinical presentation and laboratory/histological features may cause diagnostic dilemmas and therapeutic challenges.
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Affiliation(s)
- Zoe Alexakou
- 2(nd) Department of Internal Medicine, Medical School, National & Kapodistrian University of Athens, Hippokration General Hospital, Athens, Greece.
| | - George Liatsos
- 2(nd) Department of Internal Medicine, Medical School, National & Kapodistrian University of Athens, Hippokration General Hospital, Athens, Greece.
| | - Nick Vasileiou
- 2(nd) Department of Internal Medicine, Medical School, National & Kapodistrian University of Athens, Hippokration General Hospital, Athens, Greece.
| | | | - Iliana Mani
- 2(nd) Department of Internal Medicine, Medical School, National & Kapodistrian University of Athens, Hippokration General Hospital, Athens, Greece.
| | - Alexandra Alexopoulou
- 2(nd) Department of Internal Medicine, Medical School, National & Kapodistrian University of Athens, Hippokration General Hospital, Athens, Greece.
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Hile GA, Novice T, Kochkodan J, Chan MP, Gudjonsson JE, Eshaq M. Thymoma-associated multiorgan autoimmunity initially manifested by graft-versus-host disease-like erythroderma: Case report and possible therapeutic role of antimalarial drugs. JAAD Case Rep 2020; 6:719-721. [PMID: 32715060 PMCID: PMC7369524 DOI: 10.1016/j.jdcr.2020.06.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Affiliation(s)
- Grace A Hile
- Department of Dermatology, University of Michigan Medical School, Ann Arbor, Michigan
| | - Taylor Novice
- University of Michigan Medical School, Ann Arbor, Michigan
| | | | - May P Chan
- Department of Dermatology, University of Michigan Medical School, Ann Arbor, Michigan.,Department of Pathology, University of Michigan Medical School, Ann Arbor, Michigan
| | - Johann E Gudjonsson
- Department of Dermatology, University of Michigan Medical School, Ann Arbor, Michigan
| | - Milad Eshaq
- Department of Dermatology, University of Michigan Medical School, Ann Arbor, Michigan
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Zhao J, Bhatnagar V, Ding L, Atay SM, David EA, McFadden PM, Stamnes S, Lechtholz-Zey E, Wightman SC, Detterbeck FC, Kim AW. A systematic review of paraneoplastic syndromes associated with thymoma: Treatment modalities, recurrence, and outcomes in resected cases. J Thorac Cardiovasc Surg 2019; 160:306-314.e14. [PMID: 31982129 DOI: 10.1016/j.jtcvs.2019.11.052] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 11/05/2019] [Accepted: 11/06/2019] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Paraneoplastic syndromes associated with thymomas remain incompletely understood. The objective was to examine the association between surgically resected thymomas and paraneoplastic syndromes over the past half century. METHODS A primary PubMed/MEDLINE search was used to identify published articles describing paraneoplastic syndromes associated with thymomas from 1960 to 2019. A secondary search identified additional articles referenced in the articles found in the primary search. Kaplan-Meier and log-rank test were used for time-to-event data analyses. RESULTS From 407 articles describing 507 patients, 123 different paraneoplastic syndromes were associated with thymoma. The 5 most common paraneoplastic syndromes were myasthenia gravis, pure red cell aplasia, lichen planus, Good syndrome, and limbic encephalitis. Complete or partial resolution of paraneoplastic syndrome symptoms after surgery was noted in 76% of patients, of whom 21% had a relapse or new paraneoplastic syndrome onset after surgery. The most common adjunctive therapy associated with resolution of paraneoplastic syndrome was corticosteroids (30%). For all patients after surgery, thymoma recurrence was observed in 17% of cases, whereas recurrence of paraneoplastic syndrome was observed in 34% of cases, and both were observed in approximately 11% of cases. The 5- and 10-year overall survivals were 78% and 66%, respectively. Improved overall survival was associated with patients who had total resolution from paraneoplastic syndrome. CONCLUSIONS A comprehensive assessment of publications over the past half century suggests that a multimodal treatment approach that includes surgical resection of thymomas is able to achieve paraneoplastic syndrome resolution in a majority of patients. Onset of new paraneoplastic syndromes after surgery is associated with the recurrence of the first paraneoplastic syndrome, and resolution of paraneoplastic syndrome is associated with improved overall survival.
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Affiliation(s)
- Jasmine Zhao
- Keck School of Medicine, University of Southern California, Los Angeles, Calif
| | - Vikrant Bhatnagar
- Ohio University Heritage College of Osteopathic Medicine, Athens, Ohio
| | - Li Ding
- Division of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, Calif
| | - Scott M Atay
- Division of Thoracic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, Calif
| | - Elizabeth A David
- Division of Thoracic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, Calif
| | - P Michael McFadden
- Division of Thoracic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, Calif
| | - Stephanie Stamnes
- Keck School of Medicine, University of Southern California, Los Angeles, Calif
| | | | - Sean C Wightman
- Division of Thoracic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, Calif
| | | | - Anthony W Kim
- Division of Thoracic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, Calif.
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Kanduc D, Shoenfeld Y. Human Papillomavirus Epitope Mimicry and Autoimmunity: The Molecular Truth of Peptide Sharing. Pathobiology 2019; 86:285-295. [PMID: 31593963 DOI: 10.1159/000502889] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Accepted: 08/22/2019] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To define the cross-reactivity potential and the consequent autoimmunity intrinsic to viral versus human peptide sharing. METHODS Using human papillomavirus (HPV) infection/active immunization as a research model, the experimentally validated HPV L1 epitopes catalogued at the Immune Epitope DataBase were analyzed for peptide sharing with the human proteome. RESULTS The final data show that the totality of the immunoreactive HPV L1 epi-topes is mostly composed by peptides present in human proteins. CONCLUSIONS Immunologically, the high extent of peptide sharing between the HPV L1 epitopes and human proteins invites to revise the concept of the negative selection of self-reactive lymphocytes. Pathologically, the data highlight a cross-reactive potential for a spectrum of autoimmune diseases that includes ovarian failure, systemic lupus erythematosus (SLE), breast cancer and sudden death, among others. Therapeutically, analyzing already validated immunoreactive epitopes filters out the peptide sharing possibly exempt of self-reactivity, defines the effective potential for pathologic autoimmunity, and allows singling out peptide epitopes for safe immunotherapeutic protocols.
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Affiliation(s)
- Darja Kanduc
- Department of Biosciences, Biotechnologies, and Biopharmaceutics, University of Bari, Bari, Italy,
| | - Yehuda Shoenfeld
- Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Affiliated to Tel-Aviv, University School of Medicine, Ramat Gan, Israel.,I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian, Federation, Sechenov University, Moscow, Russian Federation
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Maruyama N, Sasaki T, Arasaki A, Matsuzaki A, Nakasone T, Teruya T, Matayoshi A, Maruyama T, Karube K, Fujita J, Yoshimi N, Kuniyoshi Y, Nishihara K. Thymoma appearing 9 years after the resection of squamous cell carcinoma of the lip: A case report of triple primary tumors and literature review. Oncol Lett 2019; 18:2777-2788. [PMID: 31452756 PMCID: PMC6704295 DOI: 10.3892/ol.2019.10675] [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: 11/18/2018] [Accepted: 04/09/2019] [Indexed: 11/06/2022] Open
Abstract
The occurrence of second primary tumor (SPT)following malignancy treatment is common. In patients with head and neck (H&N) cancer, SPTs principally occur in the H&N region, lungs or esophagus. Therefore, patient follow-up after cancer treatment is important in order to detect recurrence, metastasis and new primary tumors. However, no standard guidelines on lifelong follow-up imaging are available. Herein, we report a patient who presented with three metachronous primary tumors-squamous cell carcinoma (SCC) of the tongue, SCC of the lip and type A thymoma. The third tumor was incidentally detected during follow-up using contrast-enhanced computed tomography (CT) 9 years following resection of the second tumor. To the best of our knowledge, this specific combination of metachronous tumors has not yet been reported. Based on the literature review, we observed that thymoma occurs following H&N cancer treatment. Therefore, to ensure that the presence of subsequent thymomas is not overlooked, we suggest regular lifelong follow-up using contrast-enhanced CT in patients who had previously been diagnosed with H&N cancer. The literature review revealed that thymomas occur in patients with H&N cancer and should be detected at the earliest convenience.
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Affiliation(s)
- Nobuyuki Maruyama
- Department of Oral and Maxillofacial Functional Rehabilitation, Graduate School of Medicine, University of the Ryukyus, Nishihara, Okinawa 903-0215, Japan
| | - Takanobu Sasaki
- Department of Thoracic and Cardiovascular Surgery, University Hospital of The Ryukyus, Nishihara, Okinawa 903-0215, Japan
- Department of Thoracic Surgery, Tohoku Medical and Pharmaceutical University Hospital, Sendai, Miyagi 983-8512, Japan
| | - Akira Arasaki
- Department of Oral and Maxillofacial Functional Rehabilitation, Graduate School of Medicine, University of the Ryukyus, Nishihara, Okinawa 903-0215, Japan
- Department of Oral and Maxillofacial Surgery, University Hospital of the Ryukyus, Nishihara, Okinawa 903-0215, Japan
| | - Akiko Matsuzaki
- Department of Pathology, University Hospital of the Ryukyus, Nishihara, Okinawa 903-0215, Japan
| | - Toshiyuki Nakasone
- Department of Oral and Maxillofacial Surgery, University Hospital of the Ryukyus, Nishihara, Okinawa 903-0215, Japan
| | - Takao Teruya
- Department of Thoracic and Cardiovascular Surgery, University Hospital of The Ryukyus, Nishihara, Okinawa 903-0215, Japan
| | - Akira Matayoshi
- Department of Oral and Maxillofacial Surgery, University Hospital of the Ryukyus, Nishihara, Okinawa 903-0215, Japan
| | - Tessho Maruyama
- Department of Oral and Maxillofacial Surgery, University Hospital of the Ryukyus, Nishihara, Okinawa 903-0215, Japan
- Molecular Microbiology Group, Tropical Biosphere Research Center, University of the Ryukyus, Nishihara, Okinawa 903-0213, Japan
| | - Kennosuke Karube
- Department of Pathology and Cell Biology, Graduate School of Medicine, University of the Ryukyus, Nishihara, Okinawa 903-0215, Japan
| | - Jiro Fujita
- Department of Infectious Diseases, Respiratory, and Digestive Medicine (The First Department of Internal Medicine), University Hospital of the Ryukyus, Nishihara, Okinawa 903-0215, Japan
| | - Naoki Yoshimi
- Department of Pathology, University Hospital of the Ryukyus, Nishihara, Okinawa 903-0215, Japan
- Department of Pathology and Oncology, Graduate School of Medicine, University of the Ryukyus, Nishihara, Okinawa 903-0215, Japan
| | - Yukio Kuniyoshi
- Department of Thoracic and Cardiovascular Surgery, Graduate School of Medicine, University of the Ryukyus, Nishihara, Okinawa 903-0215, Japan
| | - Kazuhide Nishihara
- Department of Oral and Maxillofacial Functional Rehabilitation, Graduate School of Medicine, University of the Ryukyus, Nishihara, Okinawa 903-0215, Japan
- Department of Oral and Maxillofacial Surgery, University Hospital of the Ryukyus, Nishihara, Okinawa 903-0215, Japan
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Solimani F, Maglie R, Pollmann R, Schmidt T, Schmidt A, Ishii N, Tackenberg B, Kirschbaum A, Didona D, Pickert J, Eming R, Hashimoto T, Hertl M. Thymoma-Associated Paraneoplastic Autoimmune Multiorgan Syndrome-From Pemphigus to Lichenoid Dermatitis. Front Immunol 2019; 10:1413. [PMID: 31293579 PMCID: PMC6598597 DOI: 10.3389/fimmu.2019.01413] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 06/04/2019] [Indexed: 12/25/2022] Open
Abstract
Introduction: Paraneoplastic autoimmune multi-organ syndrome (PAMS) is a rare clinical condition characterized by variable and heterogeneous clinical phenotypes in the presence of neoplasias which largely depend on the activation of humoral and cellular immune responses. Clinically, these patients present with a spectrum of antibody-driven pemphigus-like lesions to graft-vs.-host-disease-like exanthemas with a lichenoid inflammatory infiltrate in the skin. PAMS is occasionally associated with thymoma, in which altered immune surveillance eventually leads to multiorgan autoimmunity which often includes variable cutaneous symptoms. This disorder is associated with a profound disturbance of peripheral immune tolerance against human autoantigens. Objectives: We here present a patient with relapsing thymoma who developed PAMS with several cutaneous and extracutaneous autoimmune disorders. Materials: Peripheral blood mononuclear cells (PBMC), sera, and lesional skin biopsies were obtained at different clinical disease stages. Peripheral T cell subsets were characterized phenotypically and the cytokine profile of the peripheral blood T cellular response against distinct epidermal and dermal autoantigens of the skin was analyzed by ELISpot assay. Serological screening was performed by ELISA and immunoblot analysis. Skin biopsies were subjected to immunohistochemical analysis of distinct T cell subsets. Thymoma tissue was analyzed for the presence of T regulatory cells and compared with adult thymus and indolent thymoma. Results and Conclusions: In the present case, thymoma was the cause of the observed multi-organ autoimmune syndromes as its recurrence and surgical removal was associated with the relapse and regression of the cutaneous symptoms, respectively. Initially, the patient presented with two autoimmune disorders with Th2/Th1 imbalance, myasthenia gravis (MG) and pemphigus foliaceus (PF), which regressed upon immunosuppressive treatment. Months later, the patient developed a lichenoid exanthema with a Th1-dominated skin infiltrate. Further clinical evaluation revealed the recurrence of the thymoma and the lichenoid exanthema gradually regressed upon thymectomy. Our contention that T cell recognition against distinct cutaneous autoantigens, such as desmoglein 1 (Dsg1), shifted from a Th2 to a Th1-dominated immune response could not be fully substantiated as the patient was on a stringent immunosuppressive treatment regimen. We could only observe a decrease of the initially present serum IgG autoantibodies against Dsg1. Phenotypic analysis of the associated thymoma showed a lower number of T regulatory cells compared to adult thymus and indolent thymoma, suggesting that impaired thymus-derived immune surveillance had a direct impact on the outcome of the observed cutaneous autoimmune disorders.
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Affiliation(s)
- Farzan Solimani
- Department of Dermatology and Allergology, Philipps-University, Marburg, Germany
| | - Roberto Maglie
- Department of Dermatology and Allergology, Philipps-University, Marburg, Germany
| | - Robert Pollmann
- Department of Dermatology and Allergology, Philipps-University, Marburg, Germany
| | - Thomas Schmidt
- Department of Dermatology and Allergology, Philipps-University, Marburg, Germany
| | - Ansgar Schmidt
- Institute of Pathology, Philipps-University, Marburg, Germany
| | - Norito Ishii
- Department of Dermatology, Kurume University School of Medicine, and Kurume University Institute of Cutaneous Cell Biology, Kurume, Japan
| | - Björn Tackenberg
- Department of Neuroimmunology, Philipps-University, Marburg, Germany
| | | | - Dario Didona
- Department of Dermatology and Allergology, Philipps-University, Marburg, Germany
| | - Julia Pickert
- Department of Dermatology and Allergology, Philipps-University, Marburg, Germany
| | - Rüdiger Eming
- Department of Dermatology and Allergology, Philipps-University, Marburg, Germany
| | - Takashi Hashimoto
- Department of Surgery, Philipps-University, Marburg, Germany
- Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Michael Hertl
- Department of Dermatology and Allergology, Philipps-University, Marburg, Germany
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13
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Advanced-Stage Thymoma Associating Multiple Paraneoplastic Syndromes with Good Response to Oral Corticosteroids and Topical Tacrolimus. ACTAS DERMO-SIFILIOGRAFICAS 2019. [DOI: 10.1016/j.adengl.2018.07.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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14
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Sánchez-Pérez S, Monteagudo-Castro C, Martín-Hernández J, Ramón-Quiles M. Timoma de estadio avanzado asociado a síndromes paraneoplásicos con buena respuesta a los corticosteroides orales y tacrolimus tópico. ACTAS DERMO-SIFILIOGRAFICAS 2019; 110:60-62. [DOI: 10.1016/j.ad.2017.09.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 09/06/2017] [Accepted: 09/23/2017] [Indexed: 12/11/2022] Open
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15
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Abstract
The interaction between hair and malignancy is complicated. Various hair abnormalities can manifest in oncology patients as a clinical manifestation, the result of cancer therapy, or due to a paraneoplastic condition. The mechanisms of these changes remain unclear. Alopecia is one of the common clinical presentations occurring in oncology patients that affects their quality of life. The condition can concomitantly develop during the course of malignancy or when patients undergo cancer treatment. It is important for physicians to understand alopecia in association with malignancy as it may be an important associated finding or provide the clues to aid diagnosis. The aim of this review is to summarize the clinical characteristics of alopecia that occur in cancer patients and their relationship with the type of malignancy and its treatment.
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16
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Cao Y, Lu X, Wang J, Zhang H, Liu Z, Xu S, Wang T, Ning S, Xiao B, Wang L. Construction of an miRNA-regulated drug-pathway network reveals drug repurposing candidates for myasthenia gravis. Int J Mol Med 2017; 39:268-278. [PMID: 28075449 PMCID: PMC5358695 DOI: 10.3892/ijmm.2017.2853] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Accepted: 01/04/2017] [Indexed: 12/31/2022] Open
Abstract
Myasthenia gravis (MG) is a rare debilitating autoimmune neuromuscular disorder. Many studies have focused on the mechanism and treatment strategies of MG. However, the exact pathogenesis of MG and effective treatment strategies remain unclear. Recent studies have indicated that microRNAs (miRNAs or miRs) can regulate the pathological pathways of MG, suggesting their potential role in novel treatments. In the present study, we created a comprehensive catalog of experimentally confirmed MG risk genes and miRNAs by manually mining published literature and public databases. Based on these genes and miRNAs, we identified 41 MG risk pathways and 105 approved drugs that can affect these pathways. Some important MG-related pathways, such as hsa04060 (cytokine-cytokine receptor interaction) and hsa05200 (pathway in cancer), were found to be regulated by MG risk miRNAs and drugs. Furthermore, we constructed an miRNA-regulated drug-pathway network and identified miRNAs and drugs that synergistically regulate key MG pathways and biological processes. We developed a drug repurposing strategy to identify 25 drug repurposing candidates for MG; several of these drugs, such as rituximab, adalimumab, sunitinib, and muromonab, have the potential to be novel MG treatment drugs. This study provides novel insight into the pathogenesis of MG and potential drug candidates for MG were identified.
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Affiliation(s)
- Yuze Cao
- Department of Neurology, The Second Affiliated Hospital, Harbin Medical University, Harbin, Heilongjiang 150081, P.R. China
| | - Xiaoyan Lu
- Department of Neurology, The Second Affiliated Hospital, Harbin Medical University, Harbin, Heilongjiang 150081, P.R. China
| | - Jianjian Wang
- Department of Neurology, The Second Affiliated Hospital, Harbin Medical University, Harbin, Heilongjiang 150081, P.R. China
| | - Huixue Zhang
- Department of Neurology, The Second Affiliated Hospital, Harbin Medical University, Harbin, Heilongjiang 150081, P.R. China
| | - Zhaojun Liu
- Department of Neurology, The Second Affiliated Hospital, Harbin Medical University, Harbin, Heilongjiang 150081, P.R. China
| | - Si Xu
- Department of Neurology, The Second Affiliated Hospital, Harbin Medical University, Harbin, Heilongjiang 150081, P.R. China
| | - Tianfeng Wang
- Department of Neurology, The Second Affiliated Hospital, Harbin Medical University, Harbin, Heilongjiang 150081, P.R. China
| | - Shangwei Ning
- College of Bioinformatics Science and Technology, Harbin Medical University, Harbin, Heilongjiang 150081, P.R. China
| | - Bo Xiao
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan 410008, P.R. China
| | - Lihua Wang
- Department of Neurology, The Second Affiliated Hospital, Harbin Medical University, Harbin, Heilongjiang 150081, P.R. China
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17
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Álvarez Otero J, Fernández Fernández F, de la Fuente Aguado J. Alopecia areata as a paraneoplastic syndrome of gastric cancer. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2016; 109:83-84. [PMID: 27990839 DOI: 10.17235/reed.2016.4455/2016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Alopecia areata produces hair loss in circular patches by an immune mechanism. The association with hematologic malignancies and with digestive tumors has been described. We report the case of a man who presented alopecia areata and two months later he was diagnosed with gastric adenocarcinoma.
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18
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Abstract
Thymic malignancy is often associated with paraneoplastic neurological diseases (PNDs) and recognition of these disorders is important for physicians who treat these patients. The most common thymoma-associated PNDs are myasthenia gravis (MG), acquired neuromyotonia (Isaacs' syndrome), encephalitis, Morvan's syndrome, and myositis. Diagnosis of these disorders is complex but often aided by testing for specific autoantibodies, including those to the acetylcholine receptor for MG and to contactin-associated protein-like 2, protein of the voltage-gated potassium channel complex, in patients with acquired neuromyotonia, Morvan's syndrome, or encephalitis. Patients who manifest these disorders should be screened for thymoma at diagnosis, and worsening of these PNDs may be associated with recurrent thymoma. These disorders can cause profound disability but usually respond to immunotherapy, and often improve with thymoma treatment. Close cooperation among a team of specialists is required to take proper care of these patients.
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19
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Motegi SI, Uchiyama A, Yamada K, Toki S, Amano H, Ishikawa O. Lichen planus complicated with thymoma: Report of three Japanese cases and review of the published work. J Dermatol 2015; 42:1072-7. [PMID: 26076752 DOI: 10.1111/1346-8138.12987] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Accepted: 05/10/2015] [Indexed: 12/23/2022]
Abstract
Thymoma is recognized to be complicated with autoimmune diseases, such as myasthenia gravis, pemphigus vulgaris and bullous pemphigoid. Abnormal regulation of autoreactive lymphocytes may be involved in the pathogenesis of the autoimmune diseases. The association of thymoma and lichen planus (LP) is relatively rare. Among 50 patients with LP, we identified three patients with LP accompanied by thymoma (6%; 3/50) in our department from 2004 to 2014. This is the first report identifying the frequency of thymoma accompanied by LP among patients with LP. We herein report three cases of LP accompanied by thymoma along with clinical and histological features. In addition, we summarize 29 LP patients accompanied by thymoma previously reported in the English-language published works. Regarding the complications, hypogammaglobulinemia accompanied 58.6% (17/29) of patients diagnosed with Good's syndrome. Alopecia was present in 13.8% (4/29) of patients, and myasthenia gravis was present in 17.2% (5/29) of patients with LP and thymoma. Among the 27 patients with thymectomy, only 25.9% (7/27) experienced the improvement of LP, suggesting that thymectomy may not be effective for the lesions of LP. Treatment-resistant LP was reported in 54.2% (13/24) of patients. In all our cases, oral lesions were intractable to treatment with oral predonisone and topical steroids and/or tacrolimus. It is important for dermatologists to recognize the clinical characteristics of the patients with both LP and thymoma.
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Affiliation(s)
- Sei-Ichiro Motegi
- Department of Dermatology, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Akihiko Uchiyama
- Department of Dermatology, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Kazuya Yamada
- Department of Dermatology, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Sayaka Toki
- Department of Dermatology, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Hiroo Amano
- Department of Dermatology, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Osamu Ishikawa
- Department of Dermatology, Gunma University Graduate School of Medicine, Gunma, Japan
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20
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Iga N, Otsuka A, Kaku Y, Miyachi Y, Kabashima K. Eosinophilic annular erythema limited on the palms and the soles and possibly associated with thymoma. J Eur Acad Dermatol Venereol 2015; 30:1213-4. [DOI: 10.1111/jdv.13139] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- N. Iga
- Department of Dermatology Kyoto University Graduate School of Medicine Kyoto Japan
| | - A. Otsuka
- Department of Dermatology Kyoto University Graduate School of Medicine Kyoto Japan
| | - Y. Kaku
- Department of Dermatology Kyoto University Graduate School of Medicine Kyoto Japan
| | - Y. Miyachi
- Department of Dermatology Kyoto University Graduate School of Medicine Kyoto Japan
| | - K. Kabashima
- Department of Dermatology Kyoto University Graduate School of Medicine Kyoto Japan
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21
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Wolff ASB, Kärner J, Owe JF, Oftedal BEV, Gilhus NE, Erichsen MM, Kämpe O, Meager A, Peterson P, Kisand K, Willcox N, Husebye ES. Clinical and serologic parallels to APS-I in patients with thymomas and autoantigen transcripts in their tumors. JOURNAL OF IMMUNOLOGY (BALTIMORE, MD. : 1950) 2014; 193:3880-90. [PMID: 25230752 PMCID: PMC4190667 DOI: 10.4049/jimmunol.1401068] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Patients with the autoimmune polyendocrine syndrome type I (APS-I), caused by mutations in the autoimmune regulator (AIRE) gene, and myasthenia gravis (MG) with thymoma, show intriguing but unexplained parallels. They include uncommon manifestations like autoimmune adrenal insufficiency (AI), hypoparathyroidism, and chronic mucocutaneous candidiasis plus autoantibodies neutralizing IL-17, IL-22, and type I IFNs. Thymopoiesis in the absence of AIRE is implicated in both syndromes. To test whether these parallels extend further, we screened 247 patients with MG, thymoma, or both for clinical features and organ-specific autoantibodies characteristic of APS-I patients, and we assayed 26 thymoma samples for transcripts for AIRE and 16 peripheral tissue-specific autoantigens (TSAgs) by quantitative PCR. We found APS-I-typical autoantibodies and clinical manifestations, including chronic mucocutaneous candidiasis, AI, and asplenia, respectively, in 49 of 121 (40%) and 10 of 121 (8%) thymoma patients, but clinical features seldom occurred together with the corresponding autoantibodies. Both were rare in other MG subgroups (n = 126). In 38 patients with APS-I, by contrast, we observed neither autoantibodies against muscle Ags nor any neuromuscular disorders. Whereas relative transcript levels for AIRE and 7 of 16 TSAgs showed the expected underexpression in thymomas, levels were increased for four of the five TSAgs most frequently targeted by these patients' autoantibodies. Therefore, the clinical and serologic parallels to APS-I in patients with thymomas are not explained purely by deficient TSAg transcription in these aberrant AIRE-deficient tumors. We therefore propose additional explanations for the unusual autoimmune biases they provoke. Thymoma patients should be monitored for potentially life-threatening APS-I manifestations such as AI and hypoparathyroidism.
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Affiliation(s)
- Anette S B Wolff
- Department of Clinical Science, University of Bergen, 5021 Bergen, Norway;
| | - Jaanika Kärner
- Molecular Pathology Group, Institute of Biomedicine and Translational Medicine, University of Tartu, 50090 Tartu, Estonia
| | - Jone F Owe
- Department of Clinical Medicine, University of Bergen, 5021 Bergen, Norway; Department of Neurology, Haukeland University Hospital, 5021 Bergen, Norway
| | | | - Nils Erik Gilhus
- Department of Clinical Medicine, University of Bergen, 5021 Bergen, Norway; Department of Neurology, Haukeland University Hospital, 5021 Bergen, Norway
| | - Martina M Erichsen
- Department of Medicine, Haukeland University Hospital, 5021 Bergen, Norway
| | - Olle Kämpe
- Department of Medicine, Solna, Karolinska University Hospital, Karolinska Institutet, SE-171 76 Stockholm, Sweden
| | - Anthony Meager
- Biotherapeutics Group, The National Institute for Biological Standards and Control, South Mimms, Potters Bar, Hertfordshire EN6 3QG, United Kingdom; and
| | - Pärt Peterson
- Molecular Pathology Group, Institute of Biomedicine and Translational Medicine, University of Tartu, 50090 Tartu, Estonia
| | - Kai Kisand
- Molecular Pathology Group, Institute of Biomedicine and Translational Medicine, University of Tartu, 50090 Tartu, Estonia
| | - Nick Willcox
- Department of Clinical Neurology, Weatherall Institute for Molecular Medicine, University of Oxford, Oxford OX3 9DU, United Kingdom
| | - Eystein S Husebye
- Department of Clinical Science, University of Bergen, 5021 Bergen, Norway; Department of Medicine, Haukeland University Hospital, 5021 Bergen, Norway
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22
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Paraneoplastic pemphigus: A retrospective case series in a referral center in northern Taiwan. DERMATOL SIN 2014. [DOI: 10.1016/j.dsi.2013.04.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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23
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Reimann E, Kingo K, Karelson M, Reemann P, Vasar E, Silm H, Kõks S. Whole Transcriptome Analysis (RNA Sequencing) of Peripheral Blood Mononuclear Cells of Vitiligo Patients. Dermatopathology (Basel) 2014; 1:11-23. [PMID: 27047918 PMCID: PMC4772995 DOI: 10.1159/000357402] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Vitiligo is an idiopathic disorder characterized by depigmented patches on the skin due to a loss of melanocytes. The cause of melanocyte destruction is not fully understood. The aim of this study was to detect the potential pathways involved in the vitiligo pathogenesis to further understand the causes and entity of vitiligo. For that the transcriptome of peripheral blood mononuclear cells of 4 vitiligo patients and 4 control subjects was analyzed using the SOLiD System platform and whole transcriptome RNA sequencing application. Altogether 2,470 genes were expressed differently and GRID2IP showed the highest deviation in patients compared to controls. Using functional analysis, altogether 993 associations between the gene groups and diseases were found. The analysis revealed associations between vitiligo and diseases such as lichen planus, limb-girdle muscular dystrophy type 2B, and facioscapulohumeral muscular dystrophy. Additionally, the gene groups with an altered expression pattern are participating in processes such as cell death, survival and signaling, inflammation, and oxidative stress. In conclusion, vitiligo is rather a systemic than a local skin disease; the findings from an enormous amount of RNA sequencing data support the previous findings about vitiligo and should be further analyzed.
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Affiliation(s)
- E Reimann
- Department of Physiology, Tartu, Estonia; Department of Dermatology and Venereology, Tartu, Estonia; Institute of Veterinary Medicine and Animal Sciences, Estonian University of Life Sciences, Tartu, Estonia
| | - K Kingo
- Department of Dermatology and Venereology, Tartu, Estonia; Department of Dermatology Clinic of Tartu University Hospital, Tartu, Estonia
| | - M Karelson
- Department of Dermatology and Venereology, Tartu, Estonia
| | - P Reemann
- Department of Physiology, Tartu, Estonia; Department of Dermatology and Venereology, Tartu, Estonia
| | - E Vasar
- Department of Physiology, Tartu, Estonia; Department of Centre of Translational Medicine, University of Tartu, Tartu, Estonia
| | - H Silm
- Department of Dermatology and Venereology, Tartu, Estonia
| | - S Kõks
- Department of Pathological Physiology, Tartu, Estonia; Department of Centre of Translational Medicine, University of Tartu, Tartu, Estonia; Institute of Veterinary Medicine and Animal Sciences, Estonian University of Life Sciences, Tartu, Estonia
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24
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López-Jornet P, Parra-Perez F, Pons-Fuster A. Association of autoimmune diseases with oral lichen planus: a cross-sectional, clinical study. J Eur Acad Dermatol Venereol 2013; 28:895-9. [PMID: 23802853 DOI: 10.1111/jdv.12202] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Accepted: 05/30/2013] [Indexed: 12/16/2022]
Abstract
BACKGROUND The aim of this study was to investigate the association between autoimmune disease and oral lichen planus (OLP), comparing OLP patients with a control population. METHODS This cross-sectional clinical study evaluated the prevalence of autoimmune diseases in male and female patients with OLP. The variables analysed were age, sex, tobacco and alcohol consumption, the clinical form of OLP, time of evolution and the presence of autoimmune diseases. RESULTS Autoimmune diseases were present in 7% of OLP patients (10/130) and 4% of the control group (6/130) without statistically significant difference (P = 0.67). The estimated odds ratios (with 95% confidence intervals) of the presence of autoimmune disease in OLP sufferers was 1.033 (0.97-1.10). A logistic regression model for presence/absence of the risk autoimmune disease found statistically significant differences in relation to age. CONCLUSIONS At present, there is no definitive hypothesis that explains the coexistence of OLP and autoimmune disease; further research is required into the mechanisms whereby this coexistence occurs.
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Affiliation(s)
- P López-Jornet
- Hospital Morales Meseguer, Clínica Odontológica Universitaria, Ageing Research Institute University of Murcia, Murcia, Spain
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25
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Transient liver hypoxia after liver hilus dearterialization. ScientificWorldJournal 1979; 2014:742826. [PMID: 24672362 PMCID: PMC3929580 DOI: 10.1155/2014/742826] [Citation(s) in RCA: 212] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2013] [Accepted: 10/20/2013] [Indexed: 02/06/2023] Open
Abstract
Lichen planus (LP) is a chronic inflammatory disorder that most often affects middle-aged adults. LP can involve the skin or mucous membranes including the oral, vulvovaginal, esophageal, laryngeal, and conjunctival mucosa. It has different variants based on the morphology of the lesions and the site of involvement. The literature suggests that certain presentations of the disease such as esophageal or ophthalmological involvement are underdiagnosed. The burden of the disease is higher in some variants including hypertrophic LP and erosive oral LP, which may have a more chronic pattern. LP can significantly affect the quality of life of patients as well. Drugs or contact allergens can cause lichenoid reactions as the main differential diagnosis of LP. LP is a T-cell mediated immunologic disease but the responsible antigen remains unidentified. In this paper, we review the history, epidemiology, and clinical subtypes of LP. We also review the histopathologic aspects of the disease, differential diagnoses, immunopathogenesis, and the clinical and genetic correlations.
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