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Zhao WM, Wang ZJ, Shi R, Zhu YY, Zhang S, Wang RF, Wang DG. Environmental factors influencing the risk of ANCA-associated vasculitis. Front Immunol 2022; 13:991256. [PMID: 36119110 PMCID: PMC9479327 DOI: 10.3389/fimmu.2022.991256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 08/19/2022] [Indexed: 11/13/2022] Open
Abstract
Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is a group of diseases characterized by inflammation and destruction of small and medium-sized blood vessels. Clinical disease phenotypes include microscopic polyangiitis (MPA), granulomatosis with polyangiitis (GPA), and eosinophilic granulomatosis with polyangiitis (EGPA). The incidence of AAV has been on the rise in recent years with advances in ANCA testing. The etiology and pathogenesis of AAV are multifactorial and influenced by both genetic and environmental factors, as well as innate and adaptive immune system responses. Multiple case reports have shown that sustained exposure to silica in an occupational environment resulted in a significantly increased risk of ANCA positivity. A meta-analysis involving six case-control studies showed that silica exposure was positively associated with AAV incidence. Additionally, exposure to air pollutants, such as carbon monoxide (CO), is a risk factor for AAV. AAV has seasonal trends. Studies have shown that various environmental factors stimulate the body to activate neutrophils and expose their own antigens, resulting in the release of proteases and neutrophil extracellular traps, which damage vascular endothelial cells. Additionally, the activation of complement replacement pathways may exacerbate vascular inflammation. However, the role of environmental factors in the etiology of AAV remains unclear and has received little attention. In this review, we summarized the recent literature on the study of environmental factors, such as seasons, air pollution, latitude, silica, and microbial infection, in AAV with the aim of exploring the relationship between environmental factors and AAV and possible mechanisms of action to provide a scientific basis for the prevention and treatment of AAV.
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Noonan TP, Konstantinov KN, Echevarria L. Epstein-Barr virus reactivation induced myeloperoxidase-specific antineutrophil cytoplasmic antibody (MPO-ANCA)-associated vasculitis. BMJ Case Rep 2021; 14:e245059. [PMID: 34620637 PMCID: PMC8499269 DOI: 10.1136/bcr-2021-245059] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/23/2021] [Indexed: 11/03/2022] Open
Abstract
We present a patient with systemic symptoms including 4 months of dyspnoea worsened with exertion, fatigue, rhinorrhoea, intermittent facial swelling, generalised lymphadenopathy and weight loss. Laboratory studies demonstrated proteinuria and eosinophilia. His serology was consistent with Epstein-Barr Virus (EBV) reactivation. A lymph node biopsy was consistent with EBV-associated reactive lymphoid hyperplasia. He was told to continue symptomatic treatment for EBV infection. After several admissions, vasculitis workup and myeloperoxidase-antineutrophil cytoplasmic autoantibody (ANCA) studies were positive. Evolution of clinical symptoms, laboratory parameters and our literature review suggested the diagnosis of EBV-associated ANCA vasculitis. Steroids were started after the patient continued to deteriorate; the viral load started increasing, so we added valganciclovir with favourable clinical response and no relapse during the follow-up for 6 months. This suggests that with evidence of viraemia (primary or reactivation), antiviral treatment likely has clinical benefit while immunosuppression is being considered.
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Affiliation(s)
- Timothy Philip Noonan
- Infectious Diseases, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| | | | - Leonor Echevarria
- New Mexico Veterans Affairs Health Care System, Albuquerque, New Mexico, USA
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Jamal O, Sahel N, Saouab R, El Qatni M, Zaizaa M, El Kassimi I, Rkiouak A, Hammi S, Sekkach Y. Fatal Systemic Vasculitis Associated with Chronic Active Epstein-Barr Virus Infection. MISSOURI MEDICINE 2021; 118:226-232. [PMID: 34149082 PMCID: PMC8210988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Chronic active Epstein-Barr virus infection is a rare disease with an often fatal outcome. Cardiovascular complications are associated with a poor prognosis. We herein describe the clinical course of an adult patient with Epstein-Barr virus-associated systemic vasculitis complicated by multi-systemic aneurysmal disease. The vascular imaging showed multiple aneurysms involving coronary arteries, abdominal arteries, cerebral arteries, and vertebral arteries. Immunophenotyping analysis of peripheral blood lymphocytes revealed the presence of an increased number of double negative T cells. The patient received multiple lines of immunosuppressive therapy with no response. Unfortunately, he succumbed to a cerebral aneurysm rupture.
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Affiliation(s)
- Oumama Jamal
- Department of Internal Medicine A, Mohammed V Military Instruction Hospital, Faculty of Medicine and Pharmacy of Rabat, Mohammed V University, Rabat, Morocco
| | - Nawal Sahel
- Department of Internal Medicine A, Mohammed V Military Instruction Hospital, Faculty of Medicine and Pharmacy of Rabat, Mohammed V University, Rabat, Morocco
| | - Rachida Saouab
- Department of Radiology, Mohammed V Military Instruction Hospital, Faculty of Medicine and Pharmacy of Rabat, Mohammed V University Rabat, Morocco
| | - Mohammed El Qatni
- Department of Internal Medicine A, Mohammed V Military Instruction Hospital, Faculty of Medicine and Pharmacy of Rabat, Mohammed V University, Rabat, Morocco
| | - Meryem Zaizaa
- Department of Internal Medicine A, Mohammed V Military Instruction Hospital, Faculty of Medicine and Pharmacy of Rabat, Mohammed V University, Rabat, Morocco
| | - Ilyas El Kassimi
- Department of Internal Medicine A, Mohammed V Military Instruction Hospital, Faculty of Medicine and Pharmacy of Rabat, Mohammed V University, Rabat, Morocco
| | - Adil Rkiouak
- Department of Internal Medicine A, Mohammed V Military Instruction Hospital, Faculty of Medicine and Pharmacy of Rabat, Mohammed V University, Rabat, Morocco
| | - Salaheddine Hammi
- Department of Internal Medicine A, Mohammed V Military Instruction Hospital, Faculty of Medicine and Pharmacy of Rabat, Mohammed V University, Rabat, Morocco
| | - Youssef Sekkach
- Department of Internal Medicine A, Mohammed V Military Instruction Hospital, Faculty of Medicine and Pharmacy of Rabat, Mohammed V University, Rabat, Morocco
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Kakoullis L, Parperis K, Papachristodoulou E, Panos G. Infection-induced myeloperoxidase specific antineutrophil cytoplasmic antibody (MPO-ANCA) associated vasculitis: A systematic review. Clin Immunol 2020; 220:108595. [PMID: 32961330 DOI: 10.1016/j.clim.2020.108595] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 09/15/2020] [Accepted: 09/16/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND We conducted a systematic review to identify cases of infection-induced anti-myeloperoxidase (MPO) antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV). METHODS PubMed/Medline databases were searched from inception to July of 2020, according to PRISMA guidelines. RESULTS Among the 618 abstracts identified, 18 articles describing 23 patients (60.9% female, mean age 50.5 years) were included. Median time between infection and vasculitis development was 3 months. Five (21.7%) patients expired during follow-up. Vasculitis regressed after the resolution of infection in 12/23 (52.2%). ANCA titers decreased significantly on follow-up in 14/16 patients and in all survivors in which they were measured. Pathogens reported included Mycobacterium spp., Coccidioides spp., Rickettsia rickettsii, Staphylococcus spp., EBV, CMV and Dengue virus. CONCLUSIONS MPO-AAV can occur after infection and may regress after its resolution. Infection should be considered in cases of MPO-AAV, as immunosuppressive treatment can have catastrophic results if the infection is not adequately treated.
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Affiliation(s)
- Loukas Kakoullis
- Department of Respiratory Medicine, University of Patras General Hospital, Patras, Greece; Department of Internal Medicine, University of Cyprus Medical School, Nicosia, Cyprus
| | - Konstantinos Parperis
- Department of Medicine, Division of Rheumatology, University of Arizona College of Medicine, Phoenix, AZ, USA; Department of Internal Medicine, Division of Rheumatology, University of Cyprus Medical School, Nicosia, Cyprus
| | - Eleni Papachristodoulou
- Department of Internal Medicine, Division of Rheumatology, University of Cyprus Medical School, Nicosia, Cyprus
| | - George Panos
- Department of Internal Medicine, University of Cyprus Medical School, Nicosia, Cyprus; Department of Internal Medicine, Section of Infectious Diseases, University of Patras General Hospital, Patras, Greece.
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Naumenko V, Turk M, Jenne CN, Kim SJ. Neutrophils in viral infection. Cell Tissue Res 2018; 371:505-516. [PMID: 29327081 DOI: 10.1007/s00441-017-2763-0] [Citation(s) in RCA: 74] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 11/28/2017] [Indexed: 12/20/2022]
Abstract
Neutrophils are the first wave of recruited immune cells to sites of injury or infection and are crucial players in controlling bacterial and fungal infections. Although the role of neutrophils during bacterial or fungal infections is well understood, their impact on antiviral immunity is much less studied. Furthermore, neutrophil function in tumor pathogenesis and cancer treatment has recently received much attention, particularly within the context of oncolytic virus infection where neutrophils produce antitumor cytokines and enhance oncolysis. In this review, multiple functions of neutrophils in viral infections and immunity are discussed. Understanding the role of neutrophils during viral infection may provide insight into the pathogenesis of virus infections and the outcome of virus-based therapies.
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Affiliation(s)
- Victor Naumenko
- Department of Microbiology, Immunology and Infectious Diseases, Calvin, Phoebe and Joan Snyder Institute for Chronic Diseases, University of Calgary, HRIC 3330 Hospital Drive N.W, Calgary, Alberta, T2N 4N1, Canada.,National University of Science and Technology "MISIS", Leninskiy prospect 4, 119991, Moscow, Russia
| | - Madison Turk
- Department of Microbiology, Immunology and Infectious Diseases, Calvin, Phoebe and Joan Snyder Institute for Chronic Diseases, University of Calgary, HRIC 3330 Hospital Drive N.W, Calgary, Alberta, T2N 4N1, Canada
| | - Craig N Jenne
- Department of Microbiology, Immunology and Infectious Diseases, Calvin, Phoebe and Joan Snyder Institute for Chronic Diseases, University of Calgary, HRIC 3330 Hospital Drive N.W, Calgary, Alberta, T2N 4N1, Canada. .,Calvin, Phoebe & Joan Snyder Institute for Chronic Diseases, Department of Microbiology, Immunology and Infectious Diseases, University of Calgary, HRIC 2C26, 3280 Hospital Drive N.W., Calgary, Alberta, T2N 4N1, Canada.
| | - Seok-Joo Kim
- Department of Microbiology, Immunology and Infectious Diseases, Calvin, Phoebe and Joan Snyder Institute for Chronic Diseases, University of Calgary, HRIC 3330 Hospital Drive N.W, Calgary, Alberta, T2N 4N1, Canada. .,Calvin, Phoebe & Joan Snyder Institute for Chronic Diseases, Department of Microbiology, Immunology and Infectious Diseases, University of Calgary, HRIC 4C49, 3280 Hospital Drive N.W., Calgary, Alberta, T2N 4N1, Canada.
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Guerriero C, Moretta G, Bersani G, Valentini P, Gatto A, Rigante D. Epstein-Barr virus-related cutaneous necrotizing vasculitis in a girl heterozygous for factor V Leiden. J Dermatol Case Rep 2017; 11:25-28. [PMID: 29367870 DOI: 10.3315/jdcr.2017.1245] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2017] [Accepted: 06/11/2017] [Indexed: 11/11/2022]
Abstract
Background Necrotizing vasculitides are basically characterized by vessel wall neutrophil infiltration and necrosis and they can occur as a primary process or secondary to an underlying disease. Although Henoch-Schönlein purpura (HSp) is the more frequent primary vasculitis in childhood, sometimes it has to be distinguished from other secondary vasculitides induced by infections, drugs, vaccines, or immune-mediated disorders. Main observations We report a case of a 14-year-old girl with cutaneous necrotizing vasculitis, appearing in the course of acute Epstein-Barr virus infection. Physical examination revealed highly aching erythematous-purple lesions with reticular edges localized on the back of feet. Pain was non-responsive to ibuprofen and required administration of tapentadol and pregabalin. The patient was also heterozygous for factor V Leiden that might have contributed to the development of cutaneous painful lesions. Conclusions To our knowledge this is the first documented pediatric case of necrotizing vasculitis associated with acute EBV infection in a girl heterozygous for factor V Leiden. In this patient the severity of skin manifestations might have been influenced by the concomitant factor V Leiden, which gave rise to hypercoagulability and occlusive vasculopathy with markedly severe pain, a symptom rather infrequent in other childhood vasculitides.
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Affiliation(s)
- Cristina Guerriero
- Institute of Dermatology, Catholic University of Sacred Heart, Rome, Italy
| | - Gaia Moretta
- Institute of Dermatology, Catholic University of Sacred Heart, Rome, Italy
| | - Giulia Bersani
- Institute of Pediatrics, Catholic University of Sacred Heart, Rome, Italy
| | - Piero Valentini
- Institute of Pediatrics, Catholic University of Sacred Heart, Rome, Italy
| | - Antonio Gatto
- Institute of Pediatrics, Catholic University of Sacred Heart, Rome, Italy
| | - Donato Rigante
- Institute of Pediatrics, Catholic University of Sacred Heart, Rome, Italy
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Karakayali B, Yilmaz S, Çakir D, Günes PG, Güven S, Islek I. Henoch-Schonlein purpura associated with primary active Epstein-Barr virus infection: a case report. Pan Afr Med J 2017; 27:29. [PMID: 28761605 PMCID: PMC5516656 DOI: 10.11604/pamj.2017.27.29.10481] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Accepted: 04/28/2017] [Indexed: 11/11/2022] Open
Abstract
Henoch-Schönlein purpura (HSP) is the most common form of childhood vasculitis. Various viral and bacterial infections, drugs, vaccines, food allergy and even insect bites have been considered as triggering factors in pathogenesis of HSP. Epstein-Barr virus (EBV) infection, which is associated with HSP, have been rarely reported. Herein we present HSP patient possibly caused by EBV infection. A 8-year old boy was admitted to our department with fever, rashes on legs and arms and intermittent mild abdominal pain. Multiple purpuric rashes were on his extremities, abdomen and buttock. Laboratory investigations revealed that monospot test was positive, EBV serology tests; Anti-EA-D Ig G: 3+, Anti-VCA gp125 Ig G: 3+, Anti-VCA p19 Ig M: 2+, Anti EBNA-1 Ig M: negative, Anti EBNA-1 Ig M: negative, Anti EBNA-1 Ig G: negative. The patient was interpreted as the primary active acute EBV infection. A skin biopsy showed leucocytoclastic vasculitis. The other viral and bacterial investigations were negative. The patient was diagnosed as HSP vasculitis according to EULAR criteria and treated with intravenous hydration and ibuprofen. He was discharged after 15 days with normal laboratory findings and physical examination. We think that EBV infection may be stimulant factor for autoimmune reactions and may cause HSP vasculitis. Hence, it may be useful to investigate the EBV infection in etiology of HSP cases.
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Affiliation(s)
- Burcu Karakayali
- University of Health Sciences, Umraniye Research and Training Hospital, Department of Pediatrics, Istanbul, Turkey
| | - Sila Yilmaz
- University of Health Sciences, Umraniye Research and Training Hospital, Department of Pediatrics, Istanbul, Turkey
| | - Deniz Çakir
- University of Health Sciences, Umraniye Research and Training Hospital, Department of Pediatrics, Istanbul, Turkey
| | - Pembe Gül Günes
- Haydarpasa Numune Research and Training Hospital, Department of Pathology, Istanbul, Turkey
| | - Sirin Güven
- University of Health Sciences, Umraniye Research and Training Hospital, Department of Pediatrics, Istanbul, Turkey
| | - Ismail Islek
- University of Health Sciences, Umraniye Research and Training Hospital, Department of Pediatrics, Istanbul, Turkey
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Kerstein A, Schüler S, Cabral-Marques O, Fazio J, Häsler R, Müller A, Pitann S, Moosig F, Klapa S, Haas C, Kabelitz D, Riemekasten G, Wolters S, Lamprecht P. Environmental factor and inflammation-driven alteration of the total peripheral T-cell compartment in granulomatosis with polyangiitis. J Autoimmun 2017; 78:79-91. [DOI: 10.1016/j.jaut.2016.12.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Revised: 12/19/2016] [Accepted: 12/24/2016] [Indexed: 10/20/2022]
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