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Albarki H, Rimmer J. The Use of Beta-Blockers in Hereditary Hemorrhagic Telangiectasia-Related Epistaxis: A Systematic Review. Am J Rhinol Allergy 2022; 36:890-896. [PMID: 35929049 DOI: 10.1177/19458924221118131] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Hereditary hemorrhagic telangiectasia (HHT) is an autosomal dominant disease affecting 1 in 5000 individuals. Epistaxis is seen in more than 90% of patients with HHT. Severe recurrent epistaxis can significantly decrease quality of life and may be resistant to standard treatment measures. Dysregulation of angiogenesis has been shown to cause the proliferation of abnormal blood vessels. As such, antiangiogenic treatments have been investigated including beta-blockers. OBJECTIVE A systematic review of the efficacy of beta-blockers in topical treatment of epistaxis in patients with HHT based on epistaxis duration, frequency, and severity. METHODS A systematic search was performed using the PubMed, Embase via Ovid, and Cochrane databases. The Preferred Items for Systematic Reviews and Meta-Analyses guidelines were followed. Studies that measured the efficacy of beta-blocker treatment of epistaxis in patients with HHT were included for qualitative analysis. RESULTS Five studies (3 randomized controlled trials and 2 case series) with a total of 132 patients were included. Administration (systemically or topically via a spray or gel) of timolol and propranolol showed mixed evidence of improvement in epistaxis frequency, severity, and duration when compared with control groups. The evidence for propranolol appears more promising than timolol. CONCLUSION There are significant limitations in the included studies, and further investigation with larger longitudinal or randomized prospective trials is recommended. The available evidence suggests that beta-blocker treatment may have a positive effect on HHT-related epistaxis.
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Affiliation(s)
- Hashm Albarki
- Department of Otolaryngology Head & Neck Surgery, 2538Monash Health, Melbourne, Australia
| | - Joanne Rimmer
- Department of Otolaryngology Head & Neck Surgery, 2538Monash Health, Melbourne, Australia
- Department of Surgery, 2541Monash University, Melbourne, Australia
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2
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Kharmach O, Borahma M, Lagdali N, Benelbarhdadi I, Ajana FZ. Ischemic cholangitis during Osler-Weber-Rendu disease: a case report. EGYPTIAN LIVER JOURNAL 2022. [DOI: 10.1186/s43066-021-00163-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Osler-Weber-Rendu disease (OWRD) is a rare autosomal dominant genetic disease that causes skin and mucosal telangiectasias and visceral arteriovenous malformations. These shunts can lead to high-output heart failure, portal hypertension, biliary or mesenteric ischemia. We report the case of a patient with OWRD complicated by ischemic cholangitis and biloma.
Case presentation
A 50-year-old female patient with personal history of spontaneous epistaxis and gingival bleeding, family history of Osler-Weber-Rendu disease (OWRD) in mother, and epistaxis in siblings. She consulted for intermittent and minimal biliary colic. Physical exam found mucocutaneous telangiectasia. Abdominal Doppler ultrasound/CT angiography showed arteriovenous shunts in the liver between hepatic artery and hepatic vein, hepatic artery and portal vein. Other sites of arteriovenous malformations were found in the nostril and jejunum. The diagnosis of OWRD was made. The evolution after 1 year was marked by the appearance of a slight anicteric cholestasis. MRCP found intrahepatic bilomas with associated ischemic cholangitis of segment VII. We decided to continue monitoring only.
Conclusion
The management of OWRD is based on screening for visceral arteriovenous malformations and on symptomatic measures that are often disappointing. Ischemic cholangitis is a rare complication, the diagnosis is based on imaging, liver transplantation is the only therapeutic alternative in this cases.
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3
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Ramanandafy H, Andriamahenina FPP, Tiaray MH, Nandimbiniaina AM, Razafindrasoa AZ, Razafimpihanina S, Andriarimanga D, Ratsimbazafy JNS, Rakotomizao JR, Rakotoson JL, Vololontiana HMD. Pulmonary arteriovenous malformation revealing Osler-Weber-Rendu disease: A case report. Clin Case Rep 2022; 10:e05294. [PMID: 35070308 PMCID: PMC8762538 DOI: 10.1002/ccr3.5294] [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: 11/05/2021] [Revised: 11/26/2021] [Accepted: 12/09/2021] [Indexed: 11/09/2022] Open
Abstract
Osler-Weber-Rendu disease is a genetic disease characterized by mucocutaneous and visceral telangiectasias. Pulmonary arteriovenous malformation is one of the main visceral complications revealing Osler-Weber-Rendu disease. The present case was a 34-year-old woman with exertional dyspnea and severe hypoxemia revealing pulmonary arteriovenous malformations on chest CT scan.
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Affiliation(s)
- Herveat Ramanandafy
- Department of Internal MedicineUniversity Hospital of Joseph Raseta BefelatananaAntananarivoMadagascar
| | | | - Michel Harison Tiaray
- Department of PneumologyUniversity Hospital of Joseph Raseta BefelatananaAntananarivoMadagascar
| | | | | | - Sonia Razafimpihanina
- Department of PneumologyUniversity Hospital of Joseph Raseta BefelatananaAntananarivoMadagascar
| | - Diamondra Andriarimanga
- Department of PneumologyUniversity Hospital of Joseph Raseta BefelatananaAntananarivoMadagascar
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4
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Marcoux S, Théorêt Y, Dubois J, Essouri S, Pincivy A, Coulombe J, McCuaig C, Powell J, Soulez G, Kleiber N. Systemic, local, and sclerotherapy drugs: What do we know about drug prescribing in vascular anomalies? Pediatr Blood Cancer 2021; 68:e29364. [PMID: 34596969 DOI: 10.1002/pbc.29364] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 08/08/2021] [Accepted: 08/31/2021] [Indexed: 01/20/2023]
Abstract
Off-label drug prescribing, frequent in the treatment of vascular anomalies (VA), relies on the quality of the literature reporting drug efficacy and safety. Our objective is to review the level of evidence (LOE) surrounding drug use in VA, which is more prevalent in pediatric care. A list of drugs used in VA was created with a literature review in July 2020. For each drug listed, the article displaying the highest LOE was determined and then compared between efficacy/safety data, routes of administration, pharmacological categories and a subset of VA. The influence of research quality on study results was also explored. The median LOE for the 74 drugs identified poor methodological quality, with a predominance of retrospective studies or case reports. Drug safety is currently inadequately reported. This is alarming as many treatments display significant safety concerns. Also, current literature displays major publication bias that probably leads to overestimation of drug efficacy in VA.
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Affiliation(s)
- Simon Marcoux
- Faculty of Medicine, Université de Sherbrooke, Sherbrooke, Quebec, Canada.,Clinical Pharmacology Unit, CHU Sainte-Justine, Université de Montréal, Montréal, Quebec, Canada
| | - Yves Théorêt
- Department of Pharmacology and Physiology, Université de Montréal, Montréal, Quebec, Canada.,Clinical Pharmacology Unit, CHU Sainte-Justine, Université de Montréal, Montréal, Quebec, Canada
| | - Josée Dubois
- Department of Radiology, CHU Sainte-Justine, Université de Montréal, Montréal, Quebec, Canada.,Vascular Anomaly Team, CHU Sainte-Justine, Université de Montréal, Montréal, Quebec, Canada
| | - Sandrine Essouri
- Vascular Anomaly Team, CHU Sainte-Justine, Université de Montréal, Montréal, Quebec, Canada.,Division of General Pediatrics, Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montréal, Quebec, Canada.,Research Center, CHU Sainte-Justine, Université de Montréal, Montréal, Quebec, Canada
| | - Alix Pincivy
- Library, CHU Sainte-Justine, Université de Montréal, Montréal, Quebec, Canada
| | - Jérôme Coulombe
- Vascular Anomaly Team, CHU Sainte-Justine, Université de Montréal, Montréal, Quebec, Canada.,Division of Dermatology, Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montréal, Quebec, Canada
| | - Catherine McCuaig
- Vascular Anomaly Team, CHU Sainte-Justine, Université de Montréal, Montréal, Quebec, Canada.,Division of Dermatology, Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montréal, Quebec, Canada
| | - Julie Powell
- Vascular Anomaly Team, CHU Sainte-Justine, Université de Montréal, Montréal, Quebec, Canada.,Division of Dermatology, Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montréal, Quebec, Canada
| | - Gilles Soulez
- Department of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Quebec, Canada
| | - Niina Kleiber
- Department of Pharmacology and Physiology, Université de Montréal, Montréal, Quebec, Canada.,Clinical Pharmacology Unit, CHU Sainte-Justine, Université de Montréal, Montréal, Quebec, Canada.,Vascular Anomaly Team, CHU Sainte-Justine, Université de Montréal, Montréal, Quebec, Canada.,Division of General Pediatrics, Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montréal, Quebec, Canada.,Research Center, CHU Sainte-Justine, Université de Montréal, Montréal, Quebec, Canada
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5
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Aubignat M, Salomon A, Chivot C, Delanghe F, Lecat B, Jeanjean P, Peltier J. [Brain abscess and Osler-Weber-Rendu syndrome: Do not forget to look for pulmonary arteriovenous malformations]. Rev Med Interne 2020; 41:776-779. [PMID: 32723482 DOI: 10.1016/j.revmed.2020.06.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 06/02/2020] [Accepted: 06/20/2020] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Osler-Rendu-Weber syndrome or hereditary hemorrhagic telangiectasia affects between 1/5000 and 1/8000 people. It is characterized by presence of recurrent epistaxis, mucocutaneous telangiectasia and visceral arteriovenous malformations. It is a genetic disease with autosomal dominant transmission inducing an endothelial cells hyper-proliferation. CASE REPORT A 68-year-old women with Osler-Rendu-Weber syndrome was referred for management of general impairment with confusional syndrome and hyperthermia. Various examinations have allowed us to conclude at diagnosis of brain abscess with ventriculitis probably favored by right-left shunt secondary to pulmonary arteriovenous malformations. Evolution was favorable after antibiotic treatment and endovascular embolization. CONCLUSION In case of brain abscess without obvious promoting factor, don't forget to looking for a right-left shunt providing septic or aseptic emboli. Furthermore, diagnosis of Rendu-Osler-Weber syndrome should be considered presence of telangiectasias and/or epistaxis.
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Affiliation(s)
- M Aubignat
- Service de neurologie, CHU Amiens-Picardie, 1 Rue du Professeur Christian Cabrol, 80054 Amiens, France.
| | - A Salomon
- Unité de réanimation neurochirurgicale, CHU Amiens-Picardie, 1 Rue du Professeur Christian Cabrol, 80054 Amiens, France
| | - C Chivot
- Service de radiologie, CHU Amiens-Picardie, 1 Rue du Professeur Christian Cabrol, 80054 Amiens, France
| | - F Delanghe
- Unité de réanimation neurochirurgicale, CHU Amiens-Picardie, 1 Rue du Professeur Christian Cabrol, 80054 Amiens, France
| | - B Lecat
- Unité de réanimation neurochirurgicale, CHU Amiens-Picardie, 1 Rue du Professeur Christian Cabrol, 80054 Amiens, France
| | - P Jeanjean
- Unité de réanimation neurochirurgicale, CHU Amiens-Picardie, 1 Rue du Professeur Christian Cabrol, 80054 Amiens, France
| | - J Peltier
- Service de neurochirurgie, CHU Amiens-Picardie, 1 Rue du Professeur Christian Cabrol, 80054 Amiens, France
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6
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[An hereditary hemorrhagic telangiectasia of late revealed by a cerebral venous thrombosis: A case report]. Rev Med Interne 2020; 41:628-631. [PMID: 32565074 DOI: 10.1016/j.revmed.2020.03.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Revised: 03/09/2020] [Accepted: 03/19/2020] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Hereditary hemorrhagic telangiectasia (HHT) is an autosomal dominant disease characterized by the triad of nose bleeding, telangiectasia and familial heredity. CASE REPORT We report the case of a patient who had idiopathic venous cerebral thrombosis complicated by a cerebral infarction treated with warfarin. In the context of a psoas hematoma by warfarine overdose and immobilization, the patient had deep vein thrombosis of the left lower limb with pulmonary embolism revealing a pulmonary arteriovenous malformation. After a reexamination, the patient clinical phenotype of HHT was confirmed genetically. The patient was treated with rivaroxaban allowing clinical improvement and partial recanalization of all thrombosis after six months. Thrombotic overisk has already been studied in HHT patients but the use of anticoagulants is at higher risk in these patients. However this patient experienced no adverse event with rivaroxaban. CONCLUSION This is the first case described of cerebral venous thrombosis treated with rivaroxaban revealing an HHT.
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7
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Abcès cérébral et maladie de Rendu-Osler-Weber : pensez à rechercher des malformations artérioveineuses pulmonaires. Rev Med Interne 2018. [DOI: 10.1016/j.revmed.2018.10.152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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8
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Malthiery E, de Thierrens CF, Bouchiha K, Levallois B, Torres JH, Fauroux MA. Hereditary hemorrhagic telangiectasia, embolization, and Young’s procedure: oral surgical management. JOURNAL OF ORAL MEDICINE AND ORAL SURGERY 2018. [DOI: 10.1051/mbcb/2017037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Hereditary hemorrhagic telangiectasia (HHT) case with history of embolization and Young’s procedure: surgical management. Introduction: Osler–Weber–Rendu disease hereditary hemorrhagic telangiectasia (HHT) is a genetic vascular dysplasia. It causes hemorrhagic manifestations, cutaneous and mucosal telangiectasia and visceral vascular shunts, which sometimes lead to brain abscesses after dental avulsion. Acute epistaxis can be managed by vascular ligature or selective embolization. In rare cases, management can even go as far as nasal closure. Observation: A case of five dental avulsions is described, in a patient affected by HHT who previously underwent a bilateral embolization in the area of the facial artery as well as Young’s procedure for frequent epistaxis. Comments-Conclusion: The management of patients affected by HHT needs rigorous hemostatic methods and outpatient postoperative monitoring. Additionally, the remarkable imaging from panoramic radiography used in this case was instrumental in keeping track of embolization, by clearly highlighting the arterial pathways.
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9
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[Weakness of the left hand and pallor in a 21-year-old woman]. Rev Med Interne 2017; 39:134-137. [PMID: 28780283 DOI: 10.1016/j.revmed.2017.06.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Accepted: 06/26/2017] [Indexed: 11/21/2022]
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10
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Loukil H, Snoussi M, Fourati H, Frikha F, Salah RB, Jallouli M, Marzouk S, Mnif Z, Bahloul Z. [Liver involvement in Rendu-Osler disease: a case report and review of literature]. Pan Afr Med J 2017; 24:326. [PMID: 28154681 PMCID: PMC5267911 DOI: 10.11604/pamj.2016.24.326.9816] [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: 05/09/2016] [Accepted: 06/10/2016] [Indexed: 11/11/2022] Open
Abstract
A 48 years-old-woman was admitted for anectric cholestasis. A history of recurrent personal and familial epistaxis was noted. Biologic findings revealed iron deficiency anemia and moderate cholestasis. Viral serologic tests, antimitochondrie and anti smooth muscle antibodies were negative. Abdominal tomography showed multiple arterio-venous shunts of the liver. The diagnosis of liver involvement due to Rendu Osler disease was made. Treatment with oral ferrous iron of 150 mg/day was administered and regular biological and morphologic controls of liver was decided.
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Affiliation(s)
- Hanen Loukil
- Service de Médicine Interne CHU Hédi Chaker Sfax, Tunisie
| | - Mouna Snoussi
- Service de Médicine Interne CHU Hédi Chaker Sfax, Tunisie
| | - Hela Fourati
- Service de radiologie CHU Hédi Chaker Sfax, Tunisie
| | - Faten Frikha
- Service de Médicine Interne CHU Hédi Chaker Sfax, Tunisie
| | | | - Moez Jallouli
- Service de Médicine Interne CHU Hédi Chaker Sfax, Tunisie
| | - Sameh Marzouk
- Service de Médicine Interne CHU Hédi Chaker Sfax, Tunisie
| | - Zeineb Mnif
- Service de radiologie CHU Hédi Chaker Sfax, Tunisie
| | - Zouhir Bahloul
- Service de Médicine Interne CHU Hédi Chaker Sfax, Tunisie
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11
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Contis A, Gensous N, Viallard J, Goizet C, Léauté-Labrèze C, Duffau P. Efficacy and safety of propranolol for epistaxis in hereditary haemorrhagic telangiectasia: retrospective, then prospective study, in a total of 21 patients. Clin Otolaryngol 2017; 42:911-917. [DOI: 10.1111/coa.12821] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2016] [Indexed: 11/28/2022]
Affiliation(s)
- A. Contis
- Service de médecine interne et immunologie clinique; Hôpital Saint André; Bordeaux France
| | - N. Gensous
- Service de médecine interne et immunologie clinique; Hôpital Saint André; Bordeaux France
| | - J.F. Viallard
- Service de médecine interne; Hôpital Haut- Lévêque; Pessac France
| | - C. Goizet
- Service de génétique médicale; Hôpital Pellegrin; Bordeaux France
| | - C. Léauté-Labrèze
- Service de dermatologie pédiatrique et Centre de référence maladies rares de la peau; Hôpital Pellegrin; Bordeaux France
| | - P. Duffau
- Service de médecine interne et immunologie clinique; Hôpital Saint André; Bordeaux France
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12
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Ullmer A, Karam J, Gourguechon C, Pater F, Schmidt J, Duhaut P, Brault C, Smail A, Salle V. Maladie de Rendu-Osler et myélome multiple : une dangereuse association compliquant la prise en charge de l’hémopathie. Rev Med Interne 2016. [DOI: 10.1016/j.revmed.2016.04.162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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13
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Frantzen L, Rondeau-Lutz M, Mosquera F, Martinez C, Labani A, Weber JC. [Reversible posterior encephalopathy syndrome and cardiomyopathy after bevacizumab therapy]. Rev Med Interne 2015; 37:50-2. [PMID: 26031739 DOI: 10.1016/j.revmed.2015.04.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Revised: 03/16/2015] [Accepted: 04/28/2015] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Bevacizumab is an antibody directed against VEGF-A. It is approved for the treatment of many cancer diseases. Its side effects are currently not well known by physicians. CASE REPORT A 70-year-old female with metastatic colonic adenocarcinoma was admitted in the intensive care unit because of a coma, four days after having received a combined monthly chemotherapy containing bevacizumab, oxaliplatine, 5 fluorouracil, and folinic acid for the fourth time. On clinical examination, she presented with lower limbs spasticity and hypertension. Etiologic investigations, including cerebral tomodensitometry, cerebrospinal fluid examination, psychotropic drugs urinary testing, and electroencephalogram, were negative. Consciousness improved without any other treatment than nicardipine and urapidil, but the patient was initially confused. Cerebral magnetic resonance imaging showed changes suggestive of posterior reversible encephalopathy syndrome, but also involving frontal lobes. There were additional biological and echocardiographic changes suggestive of cardiac involvement. The patient recovered completely of both cardiac and neurologic manifestations 10 days later. CONCLUSION Physicians should be aware of cardiovascular adverse effects of bevacizumab. High blood pressure must be treated to avoid more severe complications. When a posterior reversible encephalopathy syndrome occurs, cardiac involvement should be investigated.
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Affiliation(s)
- L Frantzen
- Service de médecine interne NHC, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, 67091 Strasbourg cedex, France
| | - M Rondeau-Lutz
- Service de médecine interne NHC, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, 67091 Strasbourg cedex, France.
| | - F Mosquera
- Service de médecine interne NHC, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, 67091 Strasbourg cedex, France
| | - C Martinez
- Service de médecine interne NHC, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, 67091 Strasbourg cedex, France; Faculté de médecine de Strasbourg, université de Strasbourg, 4, rue Kirschleger, 67085 Strasbourg cedex, France
| | - A Labani
- Service de radiologie, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, 67091 Strasbourg cedex, France; Faculté de médecine de Strasbourg, université de Strasbourg, 4, rue Kirschleger, 67085 Strasbourg cedex, France
| | - J C Weber
- Service de médecine interne NHC, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, 67091 Strasbourg cedex, France; Faculté de médecine de Strasbourg, université de Strasbourg, 4, rue Kirschleger, 67085 Strasbourg cedex, France
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14
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Saji N, Kawarai T, Miyamoto R, Sato T, Morino H, Orlacchio A, Oki R, Kimura K, Kaji R. Exome sequencing identifies a novel intronic mutation in ENG that causes recurrence of pulmonary arteriovenous malformations. J Neurol Sci 2015; 352:29-33. [PMID: 25868896 DOI: 10.1016/j.jns.2015.02.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2014] [Revised: 01/16/2015] [Accepted: 02/03/2015] [Indexed: 11/16/2022]
Abstract
Hereditary hemorrhagic telangiectasia (HHT) occasionally can be discovered in patients with cerebrovascular disease. Pulmonary arteriovenous malformation (PAVM) is one of the complications in HHT and occasionally is causative for life-threatening embolic stroke. Several genetic defects have been reported in patients with HHT. The broad spectrum of phenotype and intrafamilial phenotype variations, including age-at-onset of vascular events, often make an early diagnosis difficult. We present here a Japanese family with a novel intronic heterozygous mutation of ENG, which was identified using whole exome sequencing (WES). The intronic mutation, IVS3+4delAGTG, results in in-frame deletion of exon 3 and would produce a shorter ENG protein lacking the extracellular forty-seven amino acid sequences, which is located within the orphan domain. Our findings highlight the importance of the domain for the downstream signaling pathway of transforming growth factor-beta and bone morphogenesis protein superfamily receptors. Considering the phenotype variations and the available treatment for vascular complications, an early diagnosis using genetic testing, including WES, should be considered for individuals at risk of HHT.
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Affiliation(s)
- Naoki Saji
- Department of Stroke Medicine, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama 701-0192, Japan.
| | - Toshitaka Kawarai
- Department of Clinical Neuroscience, Institute of Health Biosciences, The University of Tokushima Graduate School, Tokushima 770-8503, Japan.
| | - Ryosuke Miyamoto
- Department of Clinical Neuroscience, Institute of Health Biosciences, The University of Tokushima Graduate School, Tokushima 770-8503, Japan.
| | - Takahiro Sato
- Department of Stroke Medicine, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama 701-0192, Japan.
| | - Hiroyuki Morino
- Department of Epidemiology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan..
| | - Antonio Orlacchio
- Laboratorio di Neurogenetica, CERC-IRCCS Santa Lucia, Rome, Italy; Dipartimento di Medicina dei Sistemi, Università di Roma "Tor Vergata", Rome, Italy.
| | - Ryosuke Oki
- Department of Clinical Neuroscience, Institute of Health Biosciences, The University of Tokushima Graduate School, Tokushima 770-8503, Japan.
| | - Kazumi Kimura
- Department of Stroke Medicine, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama 701-0192, Japan.
| | - Ryuji Kaji
- Department of Clinical Neuroscience, Institute of Health Biosciences, The University of Tokushima Graduate School, Tokushima 770-8503, Japan.
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15
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Bennesser Alaoui H, Lehraiki M, Hamaz S, El Attar N, Fakhreddine N, Serraj K. [Bevacizumab: a new success in hereditary hemorrhagic telangiectasia]. Rev Med Interne 2015; 36:623-5. [PMID: 25595875 DOI: 10.1016/j.revmed.2014.11.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2014] [Revised: 10/18/2014] [Accepted: 11/23/2014] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Hereditary hemorrhagic telangiectasia (HHT), is a rare, hereditary vascular dysplasia, characterized by recurrent epistaxis, mucocutaneous telangiectasias and visceral arteriovenous malformations. The vascular endothelial growth factor VEGF seems to play a crucial role in the pathogenesis of this disease. Recently bevacizumab, a humanized monoclonal VEGF inhibitor, has shown promise in treating patients with HHT. CASE REPORT A 66-year-old man, having HHT since the age of 30 years with recurrent epistaxis related to telangiectasia at the nasal septum and chronic iron deficiency anemia requiring frequent blood transfusions with iron infusions. The assessment of his disease showed septal perforation, telangiectasis in the proximal jejunum and terminal ileum, and pulmonary arteriovenous malformations. There was no improvement, despite iron infusions, repeated blood transfusions and cauterization. The patient was treated with bevacizumab at a dose of 5mg/kg/infusion every 2 weeks and was given 6 cycles. Bevacizumab, was effective without side effects. DISCUSSION It has been hypothesized that HHT is related to an imbalanced state between antiangiogenic factors and proangiogenic factors. Mutations of 3 genes are actually identified in HHT: ENG, ACVRL1, MADH4. The management of patients with HHT currently based on screening for visceral arteriovenous malformations and symptomatic measures are often disappointing. However, the angiogenic nature of this disease suggests an interesting therapy by using angiogenesis inhibitor. Therefore, bevacizumab was introduced as a potential therapy for HHT. Some clinical cases or small series report the efficacy of bevacizumab, in HHT with recurrent epistaxis, refractory iron deficiency anemia, gastrointestinal bleeding and also in liver vascular malformations with high cardiac output failure. CONCLUSION The use of modulators of angiogenesis such as bevacizumab is a possible therapeutic target in HHT.
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Affiliation(s)
| | - M Lehraiki
- Service de médecine interne, CHU Mohammed VI, Oujda, Maroc
| | - S Hamaz
- Service de médecine interne, CHU Mohammed VI, Oujda, Maroc
| | - N El Attar
- Service de médecine interne, CHU Mohammed VI, Oujda, Maroc
| | - N Fakhreddine
- Service de médecine interne, CHU Mohammed VI, Oujda, Maroc
| | - K Serraj
- Service de médecine interne, CHU Mohammed VI, Oujda, Maroc
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Meireles SIFDC, de Andrade SMF, Gomes MF, Castro FAN, Tebcherani AJ. Syndrome in question. An Bras Dermatol 2014; 89:679-80. [PMID: 25054766 PMCID: PMC4148293 DOI: 10.1590/abd1806-4841.20142646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2013] [Accepted: 07/30/2013] [Indexed: 11/22/2022] Open
Abstract
Rendu-Osler-Weber Syndrome also known as Hereditary Hemorrhagic Telangiectasia is a rare systemic fibrovascular dysplasia, with dominant autosomal inheritance. It is characterized by recurrent epistaxis, mucocutaneous telangiectasia, visceral arteriovenous malformation and positive family history. There may be hematologic, neurologic, dermatologic and gastrointestinal complications. Therapy is supportive and aimed at preventing complications. In this article we report a case of Rendu-Osler-Weber in a 64 year-old man, with history of mucocutaneous telangiectasia since the third decade of life, recurrent epistaxis, positive family history and vascular ectasia in the gastrointestinal tract.
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