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Ta H, Awada H, Kang P, Gilbert N, Haller N, Mostow E, Lane J, Singh I. Antineutrophil Cytoplasmic Autoantibody (ANCA)-Associated Vasculitis With Mucosal Involvement Following COVID-19 Pneumonia. Cureus 2022; 14:e31441. [DOI: 10.7759/cureus.31441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/03/2022] [Indexed: 11/14/2022] Open
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Conticini E, d'Alessandro M, Al Khayyat SG, D'Alessandro R, D'Ignazio E, Pata AP, Vallifuoco G, Falsetti P, Baldi C, Bardelli M, Gentileschi S, Fabiani C, Mazzei MA, Guarnieri A, Bargagli E, Cantarini L, Frediani B. Inflammatory muscle involvement in systemic vasculitis: A systematic review. Autoimmun Rev 2021; 21:103029. [PMID: 34971804 DOI: 10.1016/j.autrev.2021.103029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Revised: 12/20/2021] [Accepted: 12/25/2021] [Indexed: 11/02/2022]
Abstract
Vasculitis are severe systemic autoimmune diseases which may involve different organs and systems. Conversely, muscles do not represent an organ commonly involved by systemic vasculitis and myositis is not include among any classification or diagnostic criterion of vasculitis. In this regard, we aimed to review the literature in order to report all the available evidence concerning the inflammatory involvement of muscle in patients affected by systemic vasculitis. We collected a total of 108 papers, for a sum of 395 patients affected by muscle vasculitis. Most of them suffered from medium and small vessels vasculitis (mainly polyarteritis nodosa and ANCA-associated vasculitis) or from vasculitis secondary to rheumatoid arthritis. Conversely, muscle involvement in case of large vessel vasculitis occurred seldom, while only few papers reported such occurrence in Kawasaki or Behçet's disease. Histological findings may differ, but the most common ones displayed a necrotizing vasculitis of perimysium vessels, while granulomatous vasculitis was assessed only in case of ANCA-associated vasculitis patients. Creatine kinase were usually within normal range, seldom elevated, while imaging findings were generally undistinguishable from the ones found in idiopathic inflammatory myopathies: magnetic resonance imaging displays signal hyperintensity in T2 and STIR scans, while few data exist for positron emission tomography. The presentation of the disease may be fearsome and severe, sometimes life-threatening, but an overall good response to conventional immunosuppressants and/or glucocorticoids has been reported.
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Affiliation(s)
- Edoardo Conticini
- Rheumatology Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, Italy
| | - Miriana d'Alessandro
- Respiratory Diseases and Lung Transplantation Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, Italy
| | | | - Roberto D'Alessandro
- Rheumatology Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, Italy
| | - Emilio D'Ignazio
- Rheumatology Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, Italy
| | - Anna Paola Pata
- Rheumatology Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, Italy
| | - Giulia Vallifuoco
- Rheumatology Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, Italy
| | - Paolo Falsetti
- Rheumatology Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, Italy
| | - Caterina Baldi
- Rheumatology Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, Italy
| | - Marco Bardelli
- Rheumatology Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, Italy
| | - Stefano Gentileschi
- Rheumatology Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, Italy
| | - Claudia Fabiani
- Ophthalmology Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, Italy
| | - Maria Antonietta Mazzei
- Unit of Diagnostic Imaging Unit, Department of Medicine, Surgery and Neurosciences and Radiological Sciences, University of Siena, Italy
| | - Andrea Guarnieri
- Nephrology, Dialysis and Transplantation Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, Italy
| | - Elena Bargagli
- Respiratory Diseases and Lung Transplantation Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, Italy
| | - Luca Cantarini
- Rheumatology Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, Italy.
| | - Bruno Frediani
- Rheumatology Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, Italy
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Fermon C, Authier FJ, Gallay L. Idiopathic eosinophilic myositis: a systematic literature review. Neuromuscul Disord 2021; 32:116-124. [PMID: 34980535 DOI: 10.1016/j.nmd.2021.10.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Revised: 10/02/2021] [Accepted: 10/06/2021] [Indexed: 11/16/2022]
Abstract
Eosinophilic myositis belong to the idiopathic inflammatory myopathies and are defined by an inflammatory infiltrate composed of eosinophils within the muscle. To date, no consensus exists for diagnosis and care of such patients. The aim of this review was to describe clinical and histological presentation, treatment, and outcome of eosinophilic myositis based on a systematic review of all published histologically proven cases of eosinophilic myositis. A total of 453 records were identified in MEDLINE until November 2020. A total of 69 published cases were identified. The analysis of these allowed the distinction of the 3 previously described pathological subtypes: focal eosinophilic myositis (n = 17); diffuse eosinophilic myositis (n = 36); and eosinophilic perimyositis (n = 16). We propose a simple algorithm for diagnosis and treatment strategy for the care of patient with muscular symptoms and blood eosinophilia. This work also highlights eosinophilic myositis pathogenesis and the need for careful investigations in order to rule out differential diagnoses.
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Affiliation(s)
- Cécile Fermon
- Department of Internal Medicine, Edouard Herriot University Hospital, Hospices Civils de Lyon, University Claude Bernard, 5 Place d'Arsonval, F-69003, Lyon, France.
| | - François-Jérôme Authier
- University Paris Est-Créteil, INSERM, IMRB U955, Team Relaix, F-94010, Créteil, France; Reference Centre for Neuromuscular Diseases "Nord-Est-Ile de France", FILNEMUS, France; Department of Pathology, AP-HP, Henri Mondor University Hospital, F-94010, Créteil, France
| | - Laure Gallay
- Department of Internal Medicine, Edouard Herriot University Hospital, Hospices Civils de Lyon, University Claude Bernard, 5 Place d'Arsonval, F-69003, Lyon, France
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Lacou M, Leroy M, Le Lan N, Toquet C, Espitia-Thibault A, Graveleau J, Masseau A, Agard C, Volteau C, Mussini JM, Hamidou M, Néel A. Muscle biopsy in anti-neutrophil cytoplasmic antibody-associated vasculitis: diagnostic yield depends on anti-neutrophil cytoplasmic antibody type, sex and neutrophil count. Rheumatology (Oxford) 2021; 60:699-707. [PMID: 32789447 DOI: 10.1093/rheumatology/keaa233] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Revised: 04/01/2020] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES This study aimed to examine the sensitivity of muscle biopsy (MB) in ANCA-associated vasculitis (AAV), identify factors predicting MB positivity and assess the prognostic value of a positive MB. METHODS We conducted a single-centre retrospective study of AAV with an MB performed at diagnosis. AAV classification [granulomatosis with polyangiitis (GPA), microscopic polyangiitis (MPA), eosinophilic granulomatosis with polyangiitis (EGPA)] followed the European Medicines Agency algorithm. A logistic regression model was used to identify the factors associated with MB positivity. Survival curves were generated using the Kaplan-Meier method. RESULTS Among 276 AAV patients (1995-2018), 101 had an MB. Seventy-eight patients were included: 33 with GPA, 25 with MPA and 20 with EGPA. MB samples were positive in 45 cases (58%): 17 GPA, 16 MPA and 12 EGPA. Univariate analysis focussed on GPA and MPA, revealed that the MB yield was higher in females [22/31 (71%) vs 11/27 (41%); P = 0.02] and in anti-MPO patients [25/37 (68%) vs 6/19 (32%) for anti-PR3; P = 0.01]. By multivariate analysis, three factors predicted MB positivity: anti-MPO ANCA [odds ratio (OR) 10.67 (CI 2.09, 81.68)], female sex [OR 5.3 (CI 1.16, 32.35)] and neutrophil count [OR 1.33 (CI 1.07, 1.8)]. MB positivity had no impact on relapse, death or end-stage renal disease-free survival. CONCLUSIONS MB is a safe and efficient diagnostic tool for AAV. Predictors of MB yield include ANCA type, sex and neutrophil count. MB cannot substitute for kidney biopsy when indicated, but should be considered in other cases.
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Affiliation(s)
- Mathieu Lacou
- Internal Medicine Unit, Service de Médecine Interne, CHU de Nantes, 44093 Nantes France
| | - Maxime Leroy
- Délégation à la Recherche Clinique, CHU de Nantes, Nantes France
| | - Nowenn Le Lan
- Laboratoire d'anatomopathologie, CHU de Nantes, 44093, Nantes France
| | - Claire Toquet
- Laboratoire d'anatomopathologie, CHU de Nantes, 44093, Nantes France
| | | | - Julie Graveleau
- Internal Medicine Unit, Service de Médecine Interne, CHU de Nantes, 44093 Nantes France
| | - Agathe Masseau
- Internal Medicine Unit, Service de Médecine Interne, CHU de Nantes, 44093 Nantes France
| | - Christian Agard
- Internal Medicine Unit, Service de Médecine Interne, CHU de Nantes, 44093 Nantes France
| | | | - Jean-Marie Mussini
- Internal Medicine Unit, Service de Médecine Interne, CHU de Nantes, 44093 Nantes France
| | - Mohamed Hamidou
- Internal Medicine Unit, Service de Médecine Interne, CHU de Nantes, 44093 Nantes France
| | - Antoine Néel
- Internal Medicine Unit, Service de Médecine Interne, CHU de Nantes, 44093 Nantes France
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Koppikar S, Al-Dabie G, Jerome D, Vinik O. Eosinophilic granulomatosis with polyangiitis presenting with myositis: case based review. Rheumatol Int 2020; 40:1163-1170. [PMID: 32270295 DOI: 10.1007/s00296-020-04567-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 03/24/2020] [Indexed: 10/24/2022]
Abstract
Eosinophilic granulomatosis with polyangitis (EGPA) is a systemic necrotizing small-vessel vasculitis that presents heterogeneously as a multi-organ disease. EGPA evolves through three phases: (1) prodromic phase with asthma, atopy and sinusitis, (2) eosinophilic phase characterized by peripheral eosinophilia and eosinophilic infiltration without necrosis, and (3) vasculitic phase involving organ damage. EGPA often presents with asthma, mononeuritis multiplex, lung infiltrates, sinusitis and constitutional symptoms. Although myalgias are common, EGPA rarely presents with true weakness with elevated creatinine kinase (CK). We describe a rare case of a patient presenting with eosinophilic myositis, who subsequently developed fulminant EGPA. The patient's diagnosis was supported by an initial clinical presentation of weakness and elevated CK, followed by fleeting pulmonary infiltrates and mononeuritis multiplex, peripheral eosinophilia, and strongly positive myeloperoxidase anti-cytoplasmic antibody (MPO-ANCA). Muscle biopsy revealed eosinophilic myositis. The patient responded well to high-dose glucocorticoids and cyclophosphamide with improved symptoms and biochemical markers. Based on our literature review, there are only seven similar cases reported of EGPA presenting with myositis and confirmatory muscle biopsies. There is significant heterogeneity in their clinical findings, histopathology and treatments that were used. Our case report and literature review highlights the importance of recognizing myositis as an initial presenting symptom of EGPA, providing an opportunity for early diagnosis and treatment to reduce risk of further disease progression and morbidity.
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Affiliation(s)
- Sahil Koppikar
- Division of Rheumatology, University of Toronto, Toronto, ON, Canada. .,Division of Rheumatology, Women's College Hospital, University of Toronto, 76 Grenville Street, Toronto, ON, M5S 1B2, Canada.
| | - Ghaydaa Al-Dabie
- Division of Rheumatology, University of Toronto, Toronto, ON, Canada
| | - Dana Jerome
- Division of Rheumatology, University of Toronto, Toronto, ON, Canada.,Division of Rheumatology, Women's College Hospital, University of Toronto, 76 Grenville Street, Toronto, ON, M5S 1B2, Canada
| | - Ophir Vinik
- Division of Rheumatology, University of Toronto, Toronto, ON, Canada.,Division of Rheumatology, St. Michael's Hospital, Toronto, ON, Canada
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Parent ME, Larue S, Ellezam B. Eosinophilic granulomatosis with polyangiitis (Churg-Strauss syndrome) presenting as diffuse myositis. BMC Musculoskelet Disord 2014; 15:388. [PMID: 25414144 PMCID: PMC4247662 DOI: 10.1186/1471-2474-15-388] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Accepted: 11/17/2014] [Indexed: 11/25/2022] Open
Abstract
Background Eosinophilic granulomatosis with polyangiitis is a complex multisystemic syndrome with heterogeneous presentation. Most often, there is a clinical history of asthma or other atopic conditions, and current presentation generally includes signs of cutaneous or pulmonary involvement. Very few reports described myalgia or weakness as the chief complaint. Of these, only a few included muscle biopsy evaluation and none showed convincing evidence of primary myositis. We believe this report is the first to demonstrate true myositis in the setting of early eosinophilic granulomatosis with polyangiitis. Case presentation This report describes a 74 year old Caucasian man, with no known allergies, presenting severe myalgia, muscle weakness, jaw claudication, and fever. Blood work showed marked eosinophilia and high creatine kinase levels. Biceps brachialis muscle biopsy revealed eosinophilic necrotizing vasculitis and true myositis with myophagocytosis of non-necrotic fibers and strong sarcolemmal MHC-1 overexpression by immunohistochemistry. This patient was successfully treated with prednisone and azathioprine. Conclusion Our finding of true myositis in a case of eosinophilic granulomatosis with polyangiitis suggests that primary auto-immunity against muscle fibers, distinct from the secondary effects of vasculitis, can occur in this entity and may represent an overlap syndrome. Early recognition of eosinophilic granulomatosis with polyangiitis in patients presenting with myositis may provide an opportunity to treat the vasculitis before onset of severe multisystemic disease. We recommend the use of muscle biopsy with immunohistochemistry for MHC-1 to confirm the diagnosis of myositis in the setting of eosinophilic granulomatosis with polyangiitis. Electronic supplementary material The online version of this article (doi:10.1186/1471-2474-15-388) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Marc-Etienne Parent
- Department of Internal Medicine, Université de Sherbrooke, 3001 12e Avenue, Fleurimont, QC J1H 5N4, Canada.
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Selva-O'Callaghan A, Trallero-Araguás E, Grau J. Eosinophilic myositis: An updated review. Autoimmun Rev 2014; 13:375-8. [DOI: 10.1016/j.autrev.2014.01.018] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/13/2013] [Indexed: 11/29/2022]
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Kyriakides T, Angelini C, Schaefer J, Mongini T, Siciliano G, Sacconi S, Joseph J, Burgunder JM, Bindoff LA, Vissing J, de Visser M, Hilton-Jones D. EFNS review on the role of muscle biopsy in the investigation of myalgia. Eur J Neurol 2013; 20:997-1005. [DOI: 10.1111/ene.12174] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2013] [Accepted: 02/14/2013] [Indexed: 12/21/2022]
Affiliation(s)
- T. Kyriakides
- Clinical Neurosciences; Cyprus Institute of Neurology and Genetics; Nicosia Cyprus
| | - C. Angelini
- IRCCS Fondazione Ospedale San Camillo; Venezia Italy
| | - J. Schaefer
- Department of Neurology; University of Dresden; Dresden Germany
| | - T. Mongini
- Neuromuscular Center; S.G. Battista Hospital; University of Turin; Turin Italy
| | - G. Siciliano
- Department of Neuroscience; Neurological Clinic; University of Pisa; Pisa Italy
| | - S. Sacconi
- Centre de reference des Maladies nueuromusculaires; CNRS UMR6543; Nice University Hospital; Nice France
| | - J. Joseph
- St George's University of London at the University of Nicosia Medical School; Nicosia Cyprus
| | - J. M. Burgunder
- Departments of Neurology and Clinical Research; University of Bern; Inselspital; Bern Switzerland
| | - L. A. Bindoff
- Department of Neurology; Haukeland University Hospital; Bergen Norway
| | - J. Vissing
- Neuromuscular Clinic and Research Unit; Department of Neurology; Rigshospitalet; University of Copenhagen; Copenhagen Denmark
| | - M. de Visser
- Department of Neurology; Academic Medical Center; Amsterdam The Netherlands
| | - D. Hilton-Jones
- Oxford Neuromuscular Centre; Department of Neurology; John Radcliffe Hospital; Oxford UK
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Polimiositis como forma de presentación de síndrome de Churg-Strauss. Rev Clin Esp 2011; 211:e25-7. [DOI: 10.1016/j.rce.2010.06.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2010] [Revised: 06/02/2010] [Accepted: 06/13/2010] [Indexed: 11/19/2022]
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