1
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Caminati M, Carpagnano LF, Alberti C, Amaddeo F, Bixio R, Caldart F, De Franceschi L, Del Giglio M, Festi G, Friso S, Frulloni L, Gisondi P, Krampera M, Lippi G, Micheletto C, Piacentini G, Pinter P, Rossini M, Schiappoli M, Tecchio C, Tenero L, Tinazzi E, Senna G, Carlucci M. Idiopathic hypereosinophilic syndromes and rare dysimmune conditions associated with hyper-eosinophilia in practice: An innovative multidisciplinary approach. World Allergy Organ J 2024; 17:100928. [PMID: 39156600 PMCID: PMC11327453 DOI: 10.1016/j.waojou.2024.100928] [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: 12/15/2023] [Revised: 05/29/2024] [Accepted: 06/12/2024] [Indexed: 08/20/2024] Open
Abstract
Hypereosinophilic syndromes (HES) represent a group of rare dis-immune conditions characterized by blood hyper-eosinophilia and eosinophilic related burden. Especially the idiopathic subtype (I-HES) is particularly difficult to diagnose because of its heterogeneous clinical presentation, the lack of specific findings on physical exam, lab tools, and imaging informative enough to unequivocally confirm the diagnosis and the overlap with other entities, including eosinophilic organ-diseases or systemic dis-immune conditions other than I-HES (from atopy to eosinophilic granulomatosis with polyangiitis [EGPA], the last often extremely difficult to distinguish from HES). Taken together, all the features mentioned above account for an extremely difficult early recognition HES and on-time referral to a specialized centre. The referral itself is challenging due to a not univocal specialist identification, because of the variability of physicians managing HES in different settings (including allergist/clinical immunologist, haematologist, internal medicine doctors, pulmonologist, rheumatologist). Furthermore, the approach in terms of personalized treatment identification and follow-up plan (timing, organ assessment), is poorly standardized. Further translational and clinical research is needed to address the mentioned unmet needs, but on practical grounds increasing the overall clinicians' awareness on HES and implementing healthcare pathways for HES patients represent a roadmap that every clinician might try to realize in his specific setting. The present review aims at providing an overview about the current challenges and unmet needs in the practical approach to HES and rare hypereosinophilic allergo-immunological diseases, including a proposal for an innovative multidisciplinary organizational model.
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Affiliation(s)
- Marco Caminati
- Department of Medicine, University of Verona, Verona, Italy
- Allergy Unit and Asthma Center, Verona Integrated University Hospital, Verona, Italy
| | | | - Chiara Alberti
- Pharmacy Unit, Verona Integrated University Hospital, Verona, Italy
| | - Francesco Amaddeo
- Unit of Psychosomatics and Medical Psychology, Verona Integrated University Hospital, and Department of Neurosciences, Biomedicine and Movement, University of Verona, Italy
| | - Riccardo Bixio
- Rheumatology Unit, Verona Integrated University Hospital, Verona, Italy
| | - Federico Caldart
- Gastroenterology and Digestive Endoscopy Unit, The Pancreas Institute, Verona Integrated University Hospital, Verona, Italy
| | - Lucia De Franceschi
- Department of Medicine, University of Verona, Verona, Italy
- Unit of Internal Medicine B, Verona Integrated University Hospital, Verona Italy
| | - Micol Del Giglio
- Section of Dermatology and Venereology, Department of Medicine, University of Verona, Verona, Italy
| | - Giuliana Festi
- Pulmonology Unit, Verona Integrated University Hospital, Verona Italy
| | - Simonetta Friso
- Department of Medicine, University of Verona, Verona, Italy
- Unit of Internal Medicine B, Verona Integrated University Hospital, Verona Italy
| | - Luca Frulloni
- Department of Medicine, University of Verona, Verona, Italy
- Gastroenterology and Digestive Endoscopy Unit, The Pancreas Institute, Verona Integrated University Hospital, Verona, Italy
| | - Paolo Gisondi
- Section of Dermatology and Venereology, Department of Medicine, University of Verona, Verona, Italy
| | - Mauro Krampera
- Department of Engineering for Innovation Medicine, Section of Innovation Biomedicine, Hematology Area, University of Verona, Verona, Italy
| | - Giuseppe Lippi
- Section of Clinical Biochemistry and School of Medicine, University of Verona, Verona, Italy
| | | | - Giorgio Piacentini
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, Pediatric Clinic, University of Verona, Verona, Italy
| | - Patrick Pinter
- Unit of Otolaryngology, Head and Neck Department, University of Verona, Verona, Italy
| | - Maurizio Rossini
- Department of Medicine, University of Verona, Verona, Italy
- Rheumatology Unit, Verona Integrated University Hospital, Verona, Italy
| | - Michele Schiappoli
- Allergy Unit and Asthma Center, Verona Integrated University Hospital, Verona, Italy
| | - Cristina Tecchio
- Department of Engineering for Innovation Medicine, Section of Innovation Biomedicine, Hematology Area, University of Verona, Verona, Italy
| | - Laura Tenero
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, Pediatric Clinic, University of Verona, Verona, Italy
| | - Elisa Tinazzi
- Unit of Internal Medicine B, Verona Integrated University Hospital, Verona Italy
| | - Gianenrico Senna
- Department of Medicine, University of Verona, Verona, Italy
- Allergy Unit and Asthma Center, Verona Integrated University Hospital, Verona, Italy
| | - Matilde Carlucci
- Health Directorate, Verona Integrated University Hospital, Verona, Italy
| | - Multidisciplinary Group on rare dysimmune conditions with hyper-Eosinophilia (GEos)
- Department of Medicine, University of Verona, Verona, Italy
- Allergy Unit and Asthma Center, Verona Integrated University Hospital, Verona, Italy
- University of Verona, Verona Italy
- Pharmacy Unit, Verona Integrated University Hospital, Verona, Italy
- Unit of Psychosomatics and Medical Psychology, Verona Integrated University Hospital, and Department of Neurosciences, Biomedicine and Movement, University of Verona, Italy
- Rheumatology Unit, Verona Integrated University Hospital, Verona, Italy
- Gastroenterology and Digestive Endoscopy Unit, The Pancreas Institute, Verona Integrated University Hospital, Verona, Italy
- Unit of Internal Medicine B, Verona Integrated University Hospital, Verona Italy
- Section of Dermatology and Venereology, Department of Medicine, University of Verona, Verona, Italy
- Pulmonology Unit, Verona Integrated University Hospital, Verona Italy
- Department of Engineering for Innovation Medicine, Section of Innovation Biomedicine, Hematology Area, University of Verona, Verona, Italy
- Section of Clinical Biochemistry and School of Medicine, University of Verona, Verona, Italy
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, Pediatric Clinic, University of Verona, Verona, Italy
- Unit of Otolaryngology, Head and Neck Department, University of Verona, Verona, Italy
- Health Directorate, Verona Integrated University Hospital, Verona, Italy
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2
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Caminati M, Brussino L, Carlucci M, Carlucci P, Carpagnano LF, Caruso C, Cosmi L, D’Amore S, Del Giacco S, Detoraki A, Di Gioacchino M, Matucci A, Mormile I, Granata F, Guarnieri G, Krampera M, Maule M, Nettis E, Nicola S, Noviello S, Pane F, Papayannidis C, Parronchi P, Pelaia G, Ridolo E, Rossi FW, Senna G, Triggiani M, Vacca A, Vivarelli E, Vultaggio A, de Paulis A. Managing Patients with Hypereosinophilic Syndrome: A Statement from the Italian Society of Allergy, Asthma, and Clinical Immunology (SIAAIC). Cells 2024; 13:1180. [PMID: 39056762 PMCID: PMC11274683 DOI: 10.3390/cells13141180] [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: 04/11/2024] [Revised: 07/07/2024] [Accepted: 07/08/2024] [Indexed: 07/28/2024] Open
Abstract
Hypereosinophilic syndrome (HES) encompasses a heterogeneous and complex group of different subtypes within the wider group of hypereosinophilic disorders. Despite increasing research interest, several unmet needs in terms of disease identification, pathobiology, phenotyping, and personalized treatment remain to be addressed. Also, the prospective burden of non-malignant HES and, more in general, HE disorders is currently unknown. On a practical note, shortening the diagnostic delay and the time to an appropriate treatment approach probably represents the most urgent issue, even in light of the great impact of HES on the quality of life of affected patients. The present document represents the first action that the Italian Society of Allergy, Asthma, and Clinical Immunology (SIAAIC) has finalized within a wider project aiming to establish a collaborative national network on HES (InHES-Italian Network on HES) for patients and physicians. The first step of the project could not but focus on defining a common language as well as sharing with all of the medical community an update on the most recent advances in the field. In fact, the existing literature has been carefully reviewed in order to critically integrate the different views on the topic and derive practical recommendations on disease identification and treatment approaches.
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Affiliation(s)
- Marco Caminati
- Asthma Centre and Allergy Unit, Center for Hypereosinophilic Dysimmune Diseases, Department of Medicine, University of Verona, 37124 Verona, Italy; (M.C.); (M.M.); (G.S.)
| | - Luisa Brussino
- SSDDU Immunologia Clinica ed Allergologia, AO Mauriziano, 10128 Turin, Italy; (L.B.); (S.N.)
| | - Matilde Carlucci
- Health Directorate, Verona Integrated University Hospital, 35134 Verona, Italy;
| | - Palma Carlucci
- Department of Emergency and Organ Transplantation, School of Allergology and Clinical Immunology, University of Bari Aldo Moro, 70126 Bari, Italy; (P.C.); (E.N.)
| | | | - Cristiano Caruso
- Allergologia dell’Istituto di Clinica Medica del Policlinico Gemelli, Università Cattolica di Roma, 00168 Rome, Italy;
- UOSD DH Internal Medicine and Digestive Disease, Fondazione Policlinico A Gemelli IRCCS, 00168 Rome, Italy
| | - Lorenzo Cosmi
- Department Experimental and Clinical Medicine, University of Florence, 50121 Florence, Italy; (L.C.); (P.P.)
- Immunoallergology Unit, Careggi University Hospital, 50134 Florence, Italy;
| | - Simona D’Amore
- Department of Precision and Regenerative Medicine and Ionian Area, UOC Medicina Interna “Guido Baccelli”, University of Bari Aldo Moro, Policlinico, 70126 Bari, Italy; (S.D.); (S.N.); (A.V.)
| | - Stefano Del Giacco
- Department of Medical Sciences and Public Health, University of Cagliari, 09124 Cagliari, Italy;
| | - Aikaterini Detoraki
- Division of Internal Medicine and Clinical Immunology, Department of Internal Medicine and Clinical Complexity University of Naples Federico II, 80138 Naples, Italy;
| | - Mario Di Gioacchino
- Center for Advanced Studies and Technology (CAST), G. D’Annunzio University of Chieti-Pescara, 66100 Chieti, Italy;
- Institute of Clinical Immunotherapy and Advanced Biological Treatments, 66100 Pescara, Italy
| | - Andrea Matucci
- Immunoallergology Unit, Careggi University Hospital, 50134 Florence, Italy;
| | - Ilaria Mormile
- Department of Translational Medical Sciences, Federico II University, 80131 Naples, Italy; (F.G.); (F.W.R.); (A.d.P.)
| | - Francescopaolo Granata
- Department of Translational Medical Sciences, Federico II University, 80131 Naples, Italy; (F.G.); (F.W.R.); (A.d.P.)
| | - Gabriella Guarnieri
- Department of Engineering for Innovation Medicine, Section of Innovation Biomedicine, Hematology Area, University of Verona, 37129 Verona, Italy; (G.G.); (M.K.)
| | - Mauro Krampera
- Department of Engineering for Innovation Medicine, Section of Innovation Biomedicine, Hematology Area, University of Verona, 37129 Verona, Italy; (G.G.); (M.K.)
| | - Matteo Maule
- Asthma Centre and Allergy Unit, Center for Hypereosinophilic Dysimmune Diseases, Department of Medicine, University of Verona, 37124 Verona, Italy; (M.C.); (M.M.); (G.S.)
| | - Eustachio Nettis
- Department of Emergency and Organ Transplantation, School of Allergology and Clinical Immunology, University of Bari Aldo Moro, 70126 Bari, Italy; (P.C.); (E.N.)
| | - Stefania Nicola
- SSDDU Immunologia Clinica ed Allergologia, AO Mauriziano, 10128 Turin, Italy; (L.B.); (S.N.)
| | - Silvia Noviello
- Department of Precision and Regenerative Medicine and Ionian Area, UOC Medicina Interna “Guido Baccelli”, University of Bari Aldo Moro, Policlinico, 70126 Bari, Italy; (S.D.); (S.N.); (A.V.)
| | - Fabrizio Pane
- Department of Clinical Medicine and Surgery, University Federico II, 80138 Naples, Italy;
| | - Cristina Papayannidis
- IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Istituto Di Ematologia “Seràgnoli”, 40126 Bologna, Italy;
| | - Paola Parronchi
- Department Experimental and Clinical Medicine, University of Florence, 50121 Florence, Italy; (L.C.); (P.P.)
- Immunology and Cell therapies Unit, University Hospital Careggi, 50134 Florence, Italy
| | - Girolamo Pelaia
- Department of Health Sciences, University “Magna Graecia” of Catanzaro, 88100 Catanzaro, Italy;
| | - Erminia Ridolo
- Department of Clinical and Experimental Medicine, University of Parma, 43124 Parma, Italy;
| | - Francesca Wanda Rossi
- Department of Translational Medical Sciences, Federico II University, 80131 Naples, Italy; (F.G.); (F.W.R.); (A.d.P.)
- Center for Basic and Clinical Immunology Research (CISI), University of Naples Federico II, 80131 Naples, Italy
- WAO Center of Excellence, 80131 Naples, Italy
| | - Gianenrico Senna
- Asthma Centre and Allergy Unit, Center for Hypereosinophilic Dysimmune Diseases, Department of Medicine, University of Verona, 37124 Verona, Italy; (M.C.); (M.M.); (G.S.)
| | - Massimo Triggiani
- Division of Allergy and Clinical Immunology, University of Salerno, 84084 Fisciano, Italy;
| | - Angelo Vacca
- Department of Precision and Regenerative Medicine and Ionian Area, UOC Medicina Interna “Guido Baccelli”, University of Bari Aldo Moro, Policlinico, 70126 Bari, Italy; (S.D.); (S.N.); (A.V.)
| | - Emanuele Vivarelli
- Department of Biomedicine, Azienda Ospedaliero Universitaria Careggi, 50134 Florence, Italy; (E.V.); (A.V.)
| | - Alessandra Vultaggio
- Department of Biomedicine, Azienda Ospedaliero Universitaria Careggi, 50134 Florence, Italy; (E.V.); (A.V.)
| | - Amato de Paulis
- Department of Translational Medical Sciences, Federico II University, 80131 Naples, Italy; (F.G.); (F.W.R.); (A.d.P.)
- Center for Basic and Clinical Immunology Research (CISI), University of Naples Federico II, 80131 Naples, Italy
- WAO Center of Excellence, 80131 Naples, Italy
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Malali S, Reddy H, Kotak PS, Kumar S, Dhondge RH. Unveiling Hypereosinophilia's Stealthy Grip on Cerebral Sinus Venous Thrombosis: A Silent Association. Cureus 2024; 16:e60012. [PMID: 38854235 PMCID: PMC11162512 DOI: 10.7759/cureus.60012] [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: 03/17/2024] [Accepted: 05/09/2024] [Indexed: 06/11/2024] Open
Abstract
The report explores a case of cerebral sinus venous thrombosis associated with hypereosinophilia, presenting a unique clinical scenario. A 22-year-old male presented with persistent headache for eight days, escalating in intensity, along with projectile vomiting and blurred vision. Despite the absence of typical indicators such as fever or respiratory symptoms, comprehensive evaluations revealed hypereosinophilia in the complete blood count. Imaging studies, including magnetic resonance angiography and venography, confirmed cerebral sinus venous thrombosis. The patient was successfully treated with a multidimensional approach, including anticoagulation therapy, corticosteroids, and supportive measures. This report highlights the concealed nature of hypereosinophilia in the context of cerebral sinus venous thrombosis and underscores the importance of a vigilant diagnostic approach in unravelling this silent association.
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Affiliation(s)
- Suprit Malali
- Internal Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Medical Research, Wardha, IND
| | - Harshitha Reddy
- Internal Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Medical Research, Wardha, IND
| | - Palash S Kotak
- Internal Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Medical Research, Wardha, IND
| | - Sunil Kumar
- Internal Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Medical Research, Wardha, IND
| | - Rushikesh H Dhondge
- Internal Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Medical Research, Wardha, IND
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Mellgard G, Stoffel E, Michel A, Iqbal F, Provenzano A, Akpan IJ, Amengual J, Pro B. Hypereosinophilic syndrome with leptomeningeal involvement: a not-so-classical case report of classical Hodgkin Lymphoma. Leuk Lymphoma 2023; 64:2208-2213. [PMID: 37639618 DOI: 10.1080/10428194.2023.2252124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 08/14/2023] [Accepted: 08/16/2023] [Indexed: 08/31/2023]
Affiliation(s)
- George Mellgard
- Department of Medicine, NewYork Presbyterian - Columbia University Irving Medical Center, New York, NY, USA
| | - Elina Stoffel
- Department of Medicine, NewYork Presbyterian - Columbia University Irving Medical Center, New York, NY, USA
| | - Alissa Michel
- Department of Hematology and Oncology, NewYork Presbyterian - Columbia University Irving Medical Center, New York, NY, USA
| | - Fatima Iqbal
- Department of Pathology, NewYork Presbyterian - Columbia University Irving Medical Center, New York, NY, USA
| | - Anthony Provenzano
- Department of Hematology and Oncology, NewYork Presbyterian - Columbia University Irving Medical Center, New York, NY, USA
| | - Imo J Akpan
- Department of Hematology and Oncology, NewYork Presbyterian - Columbia University Irving Medical Center, New York, NY, USA
| | - Jennifer Amengual
- Department of Hematology and Oncology, NewYork Presbyterian - Columbia University Irving Medical Center, New York, NY, USA
| | - Barbara Pro
- Department of Hematology and Oncology, NewYork Presbyterian - Columbia University Irving Medical Center, New York, NY, USA
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Thomsen GN, Christoffersen MN, Lindegaard HM, Davidsen JR, Hartmeyer GN, Assing K, Mortz CG, Martin-Iguacel R, Møller MB, Kjeldsen AD, Havelund T, El Fassi D, Broesby-Olsen S, Maiborg M, Johansson SL, Andersen CL, Vestergaard H, Bjerrum OW. The multidisciplinary approach to eosinophilia. Front Oncol 2023; 13:1193730. [PMID: 37274287 PMCID: PMC10232806 DOI: 10.3389/fonc.2023.1193730] [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: 03/25/2023] [Accepted: 04/25/2023] [Indexed: 06/06/2023] Open
Abstract
Eosinophilic granulocytes are normally present in low numbers in the bloodstream. Patients with an increased number of eosinophilic granulocytes in the differential count (eosinophilia) are common and can pose a clinical challenge because conditions with eosinophilia occur in all medical specialties. The diagnostic approach must be guided by a thorough medical history, supported by specific tests to guide individualized treatment. Neoplastic (primary) eosinophilia is identified by one of several unique acquired genetic causes. In contrast, reactive (secondary) eosinophilia is associated with a cytokine stimulus in a specific disease, while idiopathic eosinophilia is a diagnosis by exclusion. Rational treatment is disease-directed in secondary cases and has paved the way for targeted treatment against the driver in primary eosinophilia, whereas idiopathic cases are treated as needed by principles in eosinophilia originating from clonal drivers. The vast majority of patients are diagnosed with secondary eosinophilia and are managed by the relevant specialty-e.g., rheumatology, allergy, dermatology, gastroenterology, pulmonary medicine, hematology, or infectious disease. The overlap in symptoms and the risk of irreversible organ involvement in eosinophilia, irrespective of the cause, warrants that patients without a diagnostic clarification or who do not respond to adequate treatment should be referred to a multidisciplinary function anchored in a hematology department for evaluation. This review presents the pathophysiology, manifestations, differential diagnosis, diagnostic workup, and management of (adult) patients with eosinophilia. The purpose is to place eosinophilia in a clinical context, and therefore justify and inspire the establishment of a multidisciplinary team of experts from diagnostic and clinical specialties at the regional level to support the second opinion. The target patient population requires highly specialized laboratory analysis and therapy and occasionally has severe eosinophil-induced organ dysfunction. An added value of a centralized, clinical function is to serve as a platform for education and research to further improve the management of patients with eosinophilia. Primary and idiopathic eosinophilia are key topics in the review, which also address current research and discusses outstanding issues in the field.
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Affiliation(s)
| | | | - Hanne Merete Lindegaard
- Department of Rheumatology, Odense University Hospital, Denmark; Research Unit for Rheumatology, Odense University Hospital, Odense, Denmark; University of Southern Denmark, Odense, Denmark
| | - Jesper Rømhild Davidsen
- Department of Respiratory Medicine, Odense University Hospital, Denmark; Odense Respiratory Research Unit (ODIN), Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | | | - Kristian Assing
- Department of Clinical Immunology, Odense University Hospital, Odense, Denmark
| | - Charlotte G. Mortz
- Department of Dermatology and Allergy Centre, Odense Research Centre for Anaphylaxis (ORCA), Odense University Hospital, Denmark; University of Southern Denmark, Odense, Denmark
| | | | | | - Anette Drøhse Kjeldsen
- Department of ORL- Head and Neck Surgery and Audiology, Odense University Hospital, Odense, Denmark; University of Southern Denmark, Odense, Denmark
| | - Troels Havelund
- Department of Gastroenterology and Hepatology, Odense University Hospital, Odense, Denmark
| | - Daniel El Fassi
- Department of Hematology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Sigurd Broesby-Olsen
- Department of Dermatology and Allergy Centre, Odense Research Centre for Anaphylaxis (ORCA), Odense University Hospital, Denmark; University of Southern Denmark, Odense, Denmark
| | - Michael Maiborg
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | | | - Christen Lykkegaard Andersen
- Department of Hematology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Centre for General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Hanne Vestergaard
- Department of Hematology, Odense University Hospital, Odense, Denmark
| | - Ole Weis Bjerrum
- Department of Hematology, Odense University Hospital, Odense, Denmark
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Wang X, Hou X, Lv R, Chen J, Zhang F, Yin Q. Cerebral watershed infarctions as a presentation of idiopathic hypereosinophilic syndrome: a case report. Neurol Sci 2023; 44:1429-1431. [PMID: 36454440 DOI: 10.1007/s10072-022-06532-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 11/22/2022] [Indexed: 12/03/2022]
Affiliation(s)
- Xinyu Wang
- Department of Geriatrics, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, Shandong, China
| | - Xunyao Hou
- Department of Geriatrics, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, Shandong, China
- Department of Geriatric Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, Shandong, China
| | - Renjun Lv
- Department of Geriatrics, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, Shandong, China
| | - Jian Chen
- Department of Geriatric Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, Shandong, China
| | - Feng Zhang
- Department of Geriatrics, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, Shandong, China
- Department of Geriatric Hematology and Oncology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, Shandong, China
| | - Qingqing Yin
- Department of Geriatrics, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, Shandong, China.
- Department of Geriatric Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, Shandong, China.
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Gaillet A, Bay P, Péju E, Ait-Oufella H, Azoulay E, Benchabane N, Cerf C, Cohen Y, de Prost N, Faguer S, Geri G, Grangé S, Kahn JE, Kreitmann L, Larcher R, Lefèvre G, Mabrouki A, Mekonsto-Dessap A, Panel K, Pène F, Pineton de Chambrun M, Quenot JP, Tandjaoui-Lambiotte Y, Timsit JF, Vieillard-Baron A, Dargent A, Herault A, Groh M. Epidemiology, clinical presentation, and outcomes of 620 patients with eosinophilia in the intensive care unit. Intensive Care Med 2023; 49:291-301. [PMID: 36723637 DOI: 10.1007/s00134-022-06967-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 12/22/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE Although eosinophil-induced manifestations can be life-threatening, studies focusing on the epidemiology and clinical manifestations of eosinophilia in the intensive care unit (ICU) are lacking. METHODS A retrospective, national, multicenter (14 centers) cohort study over 6 years of adult patients who presented with eosinophilia ≥ 1 × 109/L on two blood samples performed from the day before admission to the last day of an ICU stay. RESULTS 620 patients (0.9% of all ICU hospitalizations) were included: 40% with early eosinophilia (within the first 24 h of ICU admission, ICU-Eo1 group) and 56% with delayed (> 24 h after ICU admission, ICU-Eo2 group) eosinophilia. In ICU-Eo1, eosinophilia was mostly due to respiratory (14.9%) and hematological (25.8%) conditions, frequently symptomatic (58.1%, mainly respiratory and cardiovascular manifestations) requiring systemic corticosteroids in 32.2% of cases. In ICU-Eo2, eosinophil-related organ involvement was rare (25%), and eosinophilia was mostly drug-induced (46.8%). Survival rates at day 60 (D60) after ICU admission were 21.4% and 17.2% (p = 0.219) in ICU-Eo1 and ICU-Eo2 patients, respectively. For ICU-Eo1 patients, in multivariate analysis, risk factors for death at D60 were current immunosuppressant therapy at ICU admission, eosinophilia of onco-hematological origin and the use of vasopressors at ICU admission, whereas older age and the use of vasopressors or mechanical ventilation at the onset of eosinophilia were associated with a poorer prognosis for ICU-Eo2 patients. CONCLUSION Eosinophilia ≥ 1 × 109/L is not uncommon in the ICU. According to the timing of eosinophilia, two subsets of patients requiring different etiological workups and management can be distinguished.
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Affiliation(s)
- Antoine Gaillet
- Department of Internal Medicine, Foch Hospital, Suresnes, France.
- National Reference Center for Hypereosinophilic Syndromes (CEREO), Hôpital Foch, 40, Rue Worth, 92151, Suresnes Cedex, France.
- Medical Intensive Care Unit, Hôpitaux Universitaires Henri Mondor, AP-HP, 1 Rue Gustave Eiffel, 94010, Créteil Cedex, France.
| | - Pierre Bay
- Medical Intensive Care Unit, Hôpitaux Universitaires Henri Mondor, AP-HP, 1 Rue Gustave Eiffel, 94010, Créteil Cedex, France
- Medical Intensive Care Unit, Cardiological Institute, APHP Hôpital Pitié-Salpêtrière, 75013, Paris, France
| | - Edwige Péju
- Medical Intensive Care Unit, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris AP-HP Centre, Université Paris Cité, Paris, France
| | - Hafid Ait-Oufella
- Medical Intensive Care Unit, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Paris, France
| | - Elie Azoulay
- Medical Intensive Care Unit, APHP, Hôpital Saint-Louis, Paris University, 1 Avenue Claude Vellefaux, 75010, Paris, France
| | - Nacime Benchabane
- Intensive Care Medicine Department, Lapeyronie Hospital, Montpellier University Hospital, 371, Avenue du Doyen Gaston Giraud, 34090, Montpellier, France
| | - Charles Cerf
- Medical Intensive Care Unit, Foch Hospital, Suresnes, France
| | - Yves Cohen
- Medical Intensive Care Unit, CHU Avicenne, Groupe Hospitalier Paris Seine Saint-Denis, AP-HP, 93000, Bobigny, France
| | - Nicolas de Prost
- Medical Intensive Care Unit, Hôpitaux Universitaires Henri Mondor, AP-HP, 1 Rue Gustave Eiffel, 94010, Créteil Cedex, France
| | - Stanislas Faguer
- Department of Nephrology and Organ Transplantation, Centre de Référence Des Maladies Rénales Rares, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Guillaume Geri
- Medical Intensive Care Unit, Ambroise Paré Hospital, AP-HP, 9 Avenue Charles de Gaulle, 92100, Boulogne-Billancourt, France
| | - Steven Grangé
- Medical Intensive Care Unit, Rouen University Hospital, 37 Boulevard Gambetta, 76031, Rouen Cedex, France
| | - Jean-Emmanuel Kahn
- National Reference Center for Hypereosinophilic Syndromes (CEREO), Hôpital Foch, 40, Rue Worth, 92151, Suresnes Cedex, France
- Department of Internal Medicine, Hôpital Ambroise-Paré, Boulogne-Billancourt, France
| | - Louis Kreitmann
- Medical Intensive Care Unit, Hospices Civils de Lyon, Hôpital Edouard Herriot, 69437, Lyon, France
| | - Romaric Larcher
- Intensive Care Medicine Department, Lapeyronie Hospital, Montpellier University Hospital, 371, Avenue du Doyen Gaston Giraud, 34090, Montpellier, France
| | - Guillaume Lefèvre
- National Reference Center for Hypereosinophilic Syndromes (CEREO), Hôpital Foch, 40, Rue Worth, 92151, Suresnes Cedex, France
- Department of Internal Medicine, Lille University Hospital, Lille, France
| | - Asma Mabrouki
- Medical Intensive Care Unit, APHP, Hôpital Saint-Louis, Paris University, 1 Avenue Claude Vellefaux, 75010, Paris, France
| | - Armand Mekonsto-Dessap
- Medical Intensive Care Unit, Hôpitaux Universitaires Henri Mondor, AP-HP, 1 Rue Gustave Eiffel, 94010, Créteil Cedex, France
| | - Kewin Panel
- Department of Internal Medicine, Foch Hospital, Suresnes, France
- National Reference Center for Hypereosinophilic Syndromes (CEREO), Hôpital Foch, 40, Rue Worth, 92151, Suresnes Cedex, France
| | - Frédéric Pène
- Medical Intensive Care Unit, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris AP-HP Centre, Université Paris Cité, Paris, France
| | - Marc Pineton de Chambrun
- Medical Intensive Care Unit, Cardiological Institute, APHP Hôpital Pitié-Salpêtrière, 75013, Paris, France
| | | | - Yacine Tandjaoui-Lambiotte
- Medical Intensive Care Unit, CHU Avicenne, Groupe Hospitalier Paris Seine Saint-Denis, AP-HP, 93000, Bobigny, France
- INSERM U1272 Hypoxia and Lung, Bobigny, France
| | - Jean-Francois Timsit
- Medical Intensive Care Unit, Université Paris Diderot/Hôpital Bichat, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Antoine Vieillard-Baron
- Medical Intensive Care Unit, Ambroise Paré Hospital, AP-HP, 9 Avenue Charles de Gaulle, 92100, Boulogne-Billancourt, France
| | - Auguste Dargent
- Medical Intensive Care Unit, Hospices Civils de Lyon, Hôpital Edouard Herriot, 69437, Lyon, France
| | - Antoine Herault
- Medical Intensive Care Unit, Rouen University Hospital, 37 Boulevard Gambetta, 76031, Rouen Cedex, France
| | - Matthieu Groh
- Department of Internal Medicine, Foch Hospital, Suresnes, France
- National Reference Center for Hypereosinophilic Syndromes (CEREO), Hôpital Foch, 40, Rue Worth, 92151, Suresnes Cedex, France
- CHU Lille, Inserm, U1286 - INFINITE - Institute for Translational Research in Inflammation, University of Lille, Lille, France
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8
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Spina E, Maniscalco GT, Petraroli A, Detoraki A, Servillo G, Ranieri A, De Mase A, Renna R, Candelaresi P, De Paulis A, Andreone V. An unusual neurological presentation in a patient with primary hypereosinophilic syndrome. J Stroke Cerebrovasc Dis 2022; 31:106703. [PMID: 36075130 DOI: 10.1016/j.jstrokecerebrovasdis.2022.106703] [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: 05/26/2022] [Revised: 08/01/2022] [Accepted: 08/03/2022] [Indexed: 11/29/2022] Open
Abstract
Hypereosinophilic syndromes are characterized by an increased number of blood eosinophils (usually more than 1.5 × 109) infiltrating tissues and causing organ damage through over-production of pro-inflammatory cytokines with heterogeneous clinical presentation. Here we present a case of a 47 years old male, with an unremarkable previous medical history, with a sudden onset of subungual hemorrhage and low back pain. Admitted for right arm weakness and vomiting, was raised the suspicion of acute cerebrovascular syndrome, but a brain CT scan with angiogram and perfusion sequences did not show any signs of early ischaemic lesions; conversely, lab tests revealed an increased peripheral eosinophil blood count. Clinical conditions rapidly worsened and a brain MRI showed multiple sub-acute ischaemic lesions compatible with vasculitis while EEG was in favor of widespread cortical distress. Diagnosis of the hypereosinophilic syndrome was made through peripheral blood smear and osteo-medullar biopsy, which showed a rich prevalence of eosinophils. The molecular biology testing showed FIP1L1-PDGRA gene mutation. Despite the prompt therapy beginning with intravenous corticosteroids and tyrosine-kinase inhibitors with normalization of cell blood count in a few days, the patient remained in minimal consciousness. When facing unusual symptoms onset (low back pain with weakness in one limb) and a highly impaired WBC not consistent with other courses (such as infections, vasculitis, allergies, and other diseases involving the immune system) clinicians should take into account the possibility of a hematological disorder and treat it as soon as possible to avoid a poor prognosis.
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Affiliation(s)
- E Spina
- Neurology and Stroke Unit, AORN "A. Cardarelli", Naples, Italy; Department of Neuroscience, Reproductive Science and Odontostomatology, Federico II University, Naples, Italy.
| | - G T Maniscalco
- Neurology and Stroke Unit, AORN "A. Cardarelli", Naples, Italy.
| | - A Petraroli
- Internal Medicine and Immunology, Federico II University, Naples.
| | - A Detoraki
- Internal Medicine and Immunology, Federico II University, Naples.
| | - G Servillo
- Neurology and Stroke Unit, AORN "A. Cardarelli", Naples, Italy.
| | - A Ranieri
- Neurology and Stroke Unit, AORN "A. Cardarelli", Naples, Italy.
| | - A De Mase
- Neurology and Stroke Unit, AORN "A. Cardarelli", Naples, Italy.
| | - R Renna
- Neurology and Stroke Unit, AORN "A. Cardarelli", Naples, Italy.
| | - P Candelaresi
- Neurology and Stroke Unit, AORN "A. Cardarelli", Naples, Italy
| | - A De Paulis
- Internal Medicine and Immunology, Federico II University, Naples.
| | - V Andreone
- Neurology and Stroke Unit, AORN "A. Cardarelli", Naples, Italy.
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9
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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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10
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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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11
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Dao K, Kuntzer T, Maeder P, Frossard V, Livio F. Pembrolizumab-induced massive hypereosinophilia associated with mononeuritis multiplex, brain microvascular lesions and intestinal eosinophilic infiltration in a melanoma patient. CURRENT PROBLEMS IN CANCER: CASE REPORTS 2021. [DOI: 10.1016/j.cpccr.2021.100133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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12
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Woo KA, Kim HJ, Park H, Jeon B. Bilateral Hemimasticatory spasm in a patient with hypereosinophilic syndrome. Parkinsonism Relat Disord 2021; 93:55-57. [PMID: 34798570 DOI: 10.1016/j.parkreldis.2021.11.006] [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: 09/12/2021] [Revised: 11/03/2021] [Accepted: 11/07/2021] [Indexed: 11/15/2022]
Affiliation(s)
- Kyung Ah Woo
- Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Han-Joon Kim
- Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea.
| | - Hyeyoung Park
- Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Beomseok Jeon
- Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
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13
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Song XH, Xu T, Zhao GH. Hypereosinophilia with cerebral venous sinus thrombosis and intracerebral hemorrhage: A case report and review of the literature. World J Clin Cases 2021; 9:8571-8578. [PMID: 34754870 PMCID: PMC8554425 DOI: 10.12998/wjcc.v9.i28.8571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 07/08/2021] [Accepted: 07/28/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Hypereosinophilia (HE) is defined as a peripheral blood eosinophil count of > 1.5 × 109/L and may be associated with tissue damage. The clinical presentations of HE vary; however, myocardial fibrosis and thrombosis can threaten the lives of patients with sustained eosinophilia. Cerebral venous sinus thrombosis (CVST) in the setting of eosinophil-related diseases has seldom been reported. Here, we review the literature on HE with CVST to increase knowledge and encourage early diagnosis.
CASE SUMMARY A previously healthy 41-year-old man was admitted to hospital with diarrhea and abdominal pain. He was treated with antibiotics for suspected acute colitis. Three days later, he experienced headache and vomiting. Brain computed tomography (CT) revealed thrombosis of the left jugular vein to the left transverse sinus vein. Platelet (PLT) count decreased to 60 × 1012/L, and absolute eosinophil count (AEC) increased to 2.41 × 109/L. He was treated with low-molecular-weight heparin. PLT count progressively decreased to 14 × 109/L, and we terminated anticoagulation and performed PLT transfusion. Six days after admission, he complained of a worsening headache. Brain CT revealed right temporal lobe and left centrum semiovale intracerebral hemorrhage, and AEC increased to 7.65 × 109/L. We used prednisolone for HE. The level of consciousness decreased, so emergency hematoma removal and decompressive craniectomy for right cerebral hemorrhage were performed. The patient was alert 2 d after surgery. He was treated with anticoagulation again 2 wk after surgery. Corticosteroids were gradually tapered without any symptomatic recurrence or abnormal laboratory findings.
CONCLUSION HE can induce CVST, and we need to focus on eosinophil counts in patients with CVST.
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Affiliation(s)
- Xiu-Hua Song
- Department of Neurology, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu 322000, Zhejiang Province, China
| | - Tian Xu
- Department of Neurology, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu 322000, Zhejiang Province, China
| | - Guo-Hua Zhao
- Department of Neurology, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu 322000, Zhejiang Province, China
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14
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Gehring M, Wieczorek D, Kapp A, Wedi B. Potent Anti-Inflammatory Effects of Tetracyclines on Human Eosinophils. FRONTIERS IN ALLERGY 2021; 2:754501. [PMID: 35386966 PMCID: PMC8974775 DOI: 10.3389/falgy.2021.754501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 09/10/2021] [Indexed: 11/13/2022] Open
Abstract
Eosinophils are potent pro-inflammatory cells. Not only in allergic diseases but also in other diseases there is a need for treatment strategies to induce resolution of eosinophil-mediated inflammation. During the last years beneficial non-antibiotic activities of tetracyclines (TCNs) have been shown in different diseases in which eosinophils play a role, for example, asthma and bullous pemphigoid. The working mechanism of these effects remains to be clarified. Aim of the present study was to investigate the effects of TCNs on eosinophils. Flow cytometry analysis of apoptosis, mitochondrial membrane potential, activation of caspases, intracellular H2O2 and calcium, surface expression of eosinophil activation markers was performed in highly purified peripheral blood eosinophils of non-atopic donors. Tetracycline hydrochloride, minocycline and doxycycline significantly induced eosinophil apoptosis. All TCNs were able to significantly overcome the strong survival enhancing effects of pro-eosinophilic cytokines and staphylococcus aureus enterotoxins. Tetracycline hydrochloride induced eosinophil apoptosis was accompanied by intracellular production of hydrogen peroxide, loss of mitochondrial membrane potential and activation of caspases. Moreover, tetracycline hydrochloride significantly down regulated eosinophil surface expression of CD9 and CD45, and of the activation markers CD11b and CD69, but not of CD54, CD63, or CD95. Our data, propably for the first time, point to a potent anti-inflammatory role of TCNs on eosinophils.
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15
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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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16
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Block HS. Neurologic complications of myocarditis. HANDBOOK OF CLINICAL NEUROLOGY 2021; 177:111-123. [PMID: 33632429 DOI: 10.1016/b978-0-12-819814-8.00030-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Myocarditis, a nonischemic acquired cardiomyopathy, is an uncommon condition with multiple presentation patterns which may be initially difficult to recognize and may simulate other conditions such as acute myocardial infarction, pericarditis, septicemia, etc. There are four distinct clinical presentation patterns that include: (1) low-grade nonspecific symptoms such as fatigue; (2) symptoms that resemble an acute myocardial infarction, especially in younger individuals; (3) a heart failure presentation which may be acute, subacute, or chronic and may be associated with cardiac conduction system defects and arrhythmias; and (4) an arrhythmia presentation that may produce sudden cardiac death, especially in young athletes with minimal or no prodromal symptoms. This chapter will provide a brief overview of various myocarditis etiologies and diagnostic modalities. The ultimate focus will be directed toward neurologic manifestations of myocarditis and its subtypes, complications of specific therapies including extracorporeal membrane oxygenation (ECMO) for refractory heart failure, and review the current literature regarding the appropriate use of therapeutic anticoagulation in myocarditis and heart failure for stroke prevention. Covid-19 infection has been discovered to cause myocarditis. The emerging science will be discussed. Nuances of brain death (BD) determination in patients receiving venoarterial ECMO for heart failure refractory to standard medical therapies will be discussed.
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Affiliation(s)
- H Steven Block
- SSM Health Dean Medical Group, Department of Neurology, St. Mary's Hospital, Madison, WI, United States.
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17
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Kiani R, Naghavi B, Amin A, Sadeghpour A, Zahedmehr A, Firouzi A, Pouraliakbar HR, Ebrahimi Meymand S, Marashizadeh A, Almasi S. Central Nervous System and Cardiac Involvement in the Hypereosinophilic Syndrome: A Case Report. Immunol Invest 2020; 50:356-362. [PMID: 32718188 DOI: 10.1080/08820139.2020.1758131] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Hypereosinophilic syndrome is a rare entity and heterogeneous group of disorders characterized by hypereosinophilia and organ involvement. In this study, we presented a 49-year-old woman with cardiac tamponade in the context of Hypereosinophilic syndrome. Identifying hypereosinophilia as the underlying cause can have tremendous clinical implications for rapid initiation of appropriate treatment to minimize further end organ damage.
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Affiliation(s)
- Reza Kiani
- Department of adult cardiology, Rajaie Cardiovascular Medical and Research Center, Tehran, Iran
| | - Batoul Naghavi
- Department of adult cardiology, Rajaie Cardiovascular Medical and Research Center, Tehran, Iran
| | - Ahmad Amin
- Department of adult cardiology, Rajaie Cardiovascular Medical and Research Center, Tehran, Iran
| | - Anita Sadeghpour
- Department of adult cardiology, Rajaie Cardiovascular Medical and Research Center, Tehran, Iran
| | - Ali Zahedmehr
- Department of adult cardiology, Rajaie Cardiovascular Medical and Research Center, Tehran, Iran
| | - Ata Firouzi
- Department of adult cardiology, Rajaie Cardiovascular Medical and Research Center, Tehran, Iran
| | - Hamid Reza Pouraliakbar
- Department of adult cardiology, Rajaie Cardiovascular Medical and Research Center, Tehran, Iran
| | - Saeed Ebrahimi Meymand
- Department of adult cardiology, Rajaie Cardiovascular Medical and Research Center, Tehran, Iran
| | - Armin Marashizadeh
- Department of internal medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Simin Almasi
- Department of internal medicine, Iran University of Medical Sciences, Tehran, Iran
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18
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Ozturk K, Cayci Z, Gotlib J, Akin C, George TI, Ustun C. Non-hematologic diagnosis of systemic mastocytosis: Collaboration of radiology and pathology. Blood Rev 2020; 45:100693. [PMID: 32334853 DOI: 10.1016/j.blre.2020.100693] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 01/28/2020] [Accepted: 04/02/2020] [Indexed: 11/19/2022]
Abstract
Systemic mastocytosis (SM) is a hematologic disease with a wide range of clinical courses ranging from an indolent condition with normal life expectancy to exceedingly aggressive disorder with a poor prognosis. The symptoms and signs of SM result from the release of mast cell mediators with heterogeneous functions, and/or organ damage from neoplastic mast cell infiltration, or both. Diagnostic criteria for SM are well-defined by the World Health Organization (WHO). However, the diagnosis of SM can be difficult when especially it is not in the differential diagnosis. Routinely used radiologic techniques (e.g., X-ray, ultrasound, CT scans can show findings such as lytic-, sclerotic- or mixed-bone lesions, splenomegaly, hepatomegaly, retroperitoneal or periportal mesenteric lymphadenopathy, and omental thickening). It is essential to emphasize that the constellation of these radiologic findings should strongly concern of SM, especially in patients who also have a skin rash, allergic reactions, gastrointestinal tract symptoms (lasting, intermittent nausea, diarrhea), paroxysmal tachycardias, unexplained weight loss, persistent bone pain, cytopenias, liver dysfunction, eosinophilia. These findings, even coincidentally noted, will likely lead to a tissue biopsy, which reveals diagnosis (as we discussed and illustrated some tissue biopsies here). Moreover, the role of MRI and new techniques such as [18-fluorodeoxyglucose positron emission computed tomography, fibroscan] in the diagnosis of SM have been discussed. Furthermore, we reviewed the use of radiologic methods to evaluate treatment response and prognostication of SM..
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Affiliation(s)
- Kerem Ozturk
- Department of Radiology, University of Minnesota Medical Center, Minneapolis, MN, USA
| | - Zuzan Cayci
- Department of Radiology, University of Minnesota Medical Center, Minneapolis, MN, USA
| | - Jason Gotlib
- Division of Hematology, Stanford Cancer Institute, Stanford University School of Medicine, CA, USA
| | - Cem Akin
- Division of Allergy and Clinical Immunology, University of Michigan, Ann Arbor, MI, USA
| | - Tracy I George
- Department of Pathology, University of Utah, Salt Lake City, UT, USA
| | - Celalettin Ustun
- Division of Hematology, Oncology and Cellular Therapy, Department of Medicine, Rush University, Chicago, IL, USA.
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19
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Abstract
Human eosinophils have characteristic morphologic features, including a bilobed nucleus and cytoplasmic granules filled with cytotoxic and immunoregulatory proteins that are packaged in a specific manner. Eosinophil production in the bone marrow is exquisitely regulated by timely expression of a repertoire of transcription factors that work together via collaborative and hierarchical interactions to direct eosinophil development. In addition, proper granule formation, which occurs in a spatially organized manner, is an intrinsic checkpoint that must be passed for proper eosinophil production to occur. In eosinophil-associated disorders, eosinophils and their progenitors can be recruited in large numbers into tissues where they can induce proinflammatory organ damage in response to local signals. Eosinophils are terminally differentiated and do not proliferate once they leave the bone marrow. The cytokine IL-5 specifically enhances eosinophil production and, along with other mediators, promotes eosinophil activation. Indeed, eosinophil depletion with anti-IL-5 or anti-IL-5Rα is now proven to be clinically beneficial for several eosinophilic disorders, most notably severe asthma, and several therapeutics targeting eosinophil viability and production are now in development. Significant progress has been made in our understanding of eosinophil development and the consequences of tissue eosinophilia. Future research efforts focused on basic eosinophil immunobiology and translational efforts to assist in the diagnosis, treatment selection, and resolution of eosinophil-associated disorders will likely be informative and clinically helpful.
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Affiliation(s)
- Patricia C Fulkerson
- Division of Allergy and Immunology, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Marc E Rothenberg
- Division of Allergy and Immunology, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States.
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Ahn YE, Bae S, Jeong YJ, Park SY, Shin B, Kim TB, Cho YS, Moon HB, Kwon HS. Transient global amnesia associated with toxocariasis and secondary hypereosinophilia. ALLERGY ASTHMA & RESPIRATORY DISEASE 2016. [DOI: 10.4168/aard.2016.4.3.217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Young Eun Ahn
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seongman Bae
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yeong Jin Jeong
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - So Young Park
- Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Bomi Shin
- Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Tae-Bum Kim
- Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - You Sook Cho
- Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hee-Bom Moon
- Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hyouk-Soo Kwon
- Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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