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Kilickiran Avci B, Seyahi E, Polat F, Kolak Z, Yalman H, Atahan E, Ongen HG, Ongen Z. Role of Optical Coherence Tomography in Vasculitis-Associated Pulmonary Hypertension and Chronic Thromboembolic Pulmonary Hypertension. Circ J 2024:CJ-24-0254. [PMID: 38945862 DOI: 10.1253/circj.cj-24-0254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/02/2024]
Abstract
BACKGROUND Identifying and understanding the microstructural changes within the wall of the pulmonary artery (PA) is crucial for elucidating disease mechanisms and guiding treatment strategies. We assessed the utility of optical coherence tomography (OCT) in identifying such changes within segmental/subsegmental PAs and compared the morphological variations in WHO group 4 pulmonary hypertension associated with Behcet Disease (BD), Takayasu arteritis (TA) and chronic thromboembolic pulmonary hypertension (CTEPH). Idiopathic pulmonary arterial hypertension (IPAH) patients served as controls.Methods and Results: A total of 197 cross-sectional images were analyzed from 20 consecutive patients. BD patients exhibited lower %wall area and mean wall thickness (MWT) compared with CTEPH, TA and, IPAH patients. TA patients showed a notably higher %wall area, which was significant in IPAH and BD patients. Variations in %wall area measurements were observed across distinct cross-sectional segments of the PA within individual patients (22% in CTEPH, 19% in BD, 16% in TA, 23% in IPAH patients). Intravascular webs, bands, and thrombi were observed in BD and CTEPH patients. OCT provided clear delineation of vascular wall calcifications and adventitial vasa vasorum. No procedure-related complications were observed. CONCLUSIONS PA involvement differs among the various etiologies of PH, with the PA being heterogeneously affected. OCT offers promise in elucidating microstructural vascular wall changes and providing insights into disease mechanisms and treatment effects.
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Affiliation(s)
- Burçak Kilickiran Avci
- Department of Cardiology, Cerrahpasa Faculty of Medicine, Istanbul University Cerrahpasa
| | - Emire Seyahi
- Department of Rheumatology, Cerrahpasa Faculty of Medicine, Istanbul University Cerrahpasa
| | - Fuat Polat
- Department of Cardiology, Cerrahpasa Faculty of Medicine, Istanbul University Cerrahpasa
| | - Zeynep Kolak
- Department of Cardiology, Cerrahpasa Faculty of Medicine, Istanbul University Cerrahpasa
| | - Hakan Yalman
- Department of Cardiology, Cerrahpasa Faculty of Medicine, Istanbul University Cerrahpasa
| | - Ersan Atahan
- Department of Pulmonary Medicine, Cerrahpasa Faculty of Medicine, Istanbul University Cerrahpasa
| | - Hurrem Gul Ongen
- Department of Pulmonary Medicine, Cerrahpasa Faculty of Medicine, Istanbul University Cerrahpasa
| | - Zeki Ongen
- Department of Cardiology, Cerrahpasa Faculty of Medicine, Istanbul University Cerrahpasa
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Ruffer N, Krusche M, Holl-Ulrich K, Lötscher F, Kötter I. [Hughes-Stovin syndrome: a life-threatening manifestation of Behçet's syndrome]. Z Rheumatol 2024; 83:327-333. [PMID: 37280333 PMCID: PMC11058631 DOI: 10.1007/s00393-023-01371-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2023] [Indexed: 06/08/2023]
Abstract
Hughes-Stovin syndrome (HSS) is a systemic inflammatory condition of unknown origin that is considered to be part of the Behçet's syndrome (BS) spectrum. Recurrent venous thrombosis and superficial thrombophlebitis in combination with bilateral pulmonary artery aneurysms (PAA) represent the hallmark of HSS. The diagnostic evaluation includes computed tomography pulmonary angiography to detect signs of pulmonary vasculitis. The management of HSS is based on the European Alliance of Associations for Rheumatology (EULAR) recommendations for BS and mainly comprises immunosuppressive therapy with glucocorticoids and cyclophosphamide. In addition to drug therapy, PAA should be evaluated for interventional treatment. Spontaneous PAA rupture due to fragile vessel architecture can occur even in cases of remission and/or PAA regression.
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Affiliation(s)
- Nikolas Ruffer
- III. Medizinische Klinik und Poliklinik, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland.
| | - Martin Krusche
- III. Medizinische Klinik und Poliklinik, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland
| | - Konstanze Holl-Ulrich
- Konsultations- und Referenzzentrum für Vaskulitis-Diagnostik, Labor Lademannbogen MVZ GmbH, Hamburg, Deutschland
| | - Fabian Lötscher
- Universitätsklinik für Rheumatologie und Immunologie, Inselspital, Universitätsspital Bern, Bern, Schweiz
| | - Ina Kötter
- III. Medizinische Klinik und Poliklinik, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland
- Klinik für Rheumatologie und Immunologie, Klinikum Bad Bramstedt, Bad Bramstedt, Deutschland
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Aksoy A, Kocakaya D, Demircioglu O, Cimsit NC, Yildizeli B, Karakurt S, Direskeneli H, Alibaz-Oner F. Angiographic findings of pulmonary arterial involvement in Behcet's Disease: Do they correlate with symptoms and acute phase response? Respir Med 2024; 221:107481. [PMID: 38035945 DOI: 10.1016/j.rmed.2023.107481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 11/08/2023] [Accepted: 11/24/2023] [Indexed: 12/02/2023]
Abstract
INTRODUCTION Behcet's disease (BD) is a chronic inflammatory disorder with arterial vasculitis. Although, pulmonary artery aneurysm (PAA) is accepted as the prototypic arterial disorder, an increasing presence of pulmonary artery thrombosis (PAT) with or without aneurysms was also reported in recent studies. In this study, we aimed to describe computed tomography pulmonary angiography (CTPA) findings of pulmonary involvement and its correlation with symptoms and acute phase response in BD. METHOD In this retrospective study, 153 CTPA of BD patients were assessed by two radiologists. Clinical and laboratory data were collected from the patient files. Pulmonary artery involvement (PAI) was defined as thrombus or aneurysm in CT angiography. RESULTS Most of (85.6 %) our patients were male and median age was 33.7 ± 10 years during angiographic assessments. Sixty-two (40.5 %) angiographies presented a thrombus: 14 subsegmental, 29 segmental, 13 lobar and 6 main branches. Among these, 82.3 % (n = 51) had bilateral involvement. Isolated PAT was present in 58 (93.5 %) angiographies with only 4 (2.6 %) angiographies displaying an aneurysm together with a thrombus. Pulmonary infarction was detected in 9 angiographies. Forty-four (29.3 %) patients, almost all of them under immunosuppressive treatments for other indications, were screened for asymptomatic pulmonary involvement (without any symptoms or increased acute-phase response (APR)), and one fourth of these were diagnosed as having a segmental or subsegmental PAT. CONCLUSION Our results show that isolated pulmonary thrombosis is the main form of PAI, and isolated pulmonary aneurysm formation is rare in our BD cases. In the presence of pulmonary symptoms with or without increased APRs, involvement of segmental or more proximal parts of pulmonary arteries is most commonly detected. We also observed that PAI may be seen in about one fourth of especially male BD patients without symptoms or increased APR. Our results suggest that BD patients with pulmonary symptoms should be screened by CTPA for PAI, however, further research is needed to clarify the role of routine CTPA screening in asymptomatic BD patients.
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Affiliation(s)
- Aysun Aksoy
- Department of Internal Medicine Division of Rheumatology, Faculty of Medicine, Marmara University, İstanbul, Turkey.
| | - Derya Kocakaya
- Department of Pulmonary Medicine and Critical Care, Faculty of Medicine, Marmara University, İstanbul, Turkey
| | - Ozlem Demircioglu
- Department of Radiology, Faculty of Medicine, Marmara University, İstanbul, Turkey
| | - Nuri Cagatay Cimsit
- Department of Radiology, Faculty of Medicine, Marmara University, İstanbul, Turkey
| | - Bedrettin Yildizeli
- Department of Chest Surgery, Faculty of Medicine, Marmara University, İstanbul, Turkey
| | - Sait Karakurt
- Department of Pulmonary Medicine and Critical Care, Faculty of Medicine, Marmara University, İstanbul, Turkey
| | - Haner Direskeneli
- Department of Internal Medicine Division of Rheumatology, Faculty of Medicine, Marmara University, İstanbul, Turkey
| | - Fatma Alibaz-Oner
- Department of Internal Medicine Division of Rheumatology, Faculty of Medicine, Marmara University, İstanbul, Turkey
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Qian YL, Quan RL, Chen XX, Lin YY, Jing XL, Gu Q, Xiong CM, He JG, Zhi AH. Imaging characteristics and prognostic factors of Behcet's disease with arterial involvement: A long-term follow-up study. Eur J Radiol 2024; 170:111206. [PMID: 37995514 DOI: 10.1016/j.ejrad.2023.111206] [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: 05/12/2023] [Revised: 08/22/2023] [Accepted: 11/15/2023] [Indexed: 11/25/2023]
Abstract
PURPOSE To investigate the imaging characteristics and prognostic factors for the long-term survival of Behcet's disease (BD) with arterial involvement. METHODS In this retrospective study, BD patients with arterial involvement were identified from January 2003 to January 2020. Arterial lesions were detected by ultrasonography, traditional arteriography, and/or computed tomography angiography (CTA). Cox proportional hazards regression analyses were performed to identify the prognostic factors. RESULTS Totally, 84 BD patients with arterial involvement were identified (73.8 % males). The mean age at BD diagnosis was 39.1 ± 13.1 years. Arterial involvement was the initial manifestation in 33.3 % of the patients, and the median time from BD diagnosis to arterial involvement was 6 (IQR 1-15.5) years for the rest of patients. Systemic artery involvement and pulmonary artery involvement (PAI) were found in 64 and 27 patients, respectively. Approximately 94.0 % (79/84) of the patients had more than one artery involved concurrently or successively during the course of BD. Aneurysm/dilation was the most prevalent lesion in the aorta (76.0 %), while stenosis/occlusion was the main lesion of the coronary artery (90.9 %) and other aortic branches (74.5 %). Pulmonary hypertension was found in 70.4 % (19/27) of patients with PAI. The 5- and 10-year survival rates of BD patients with arterial involvement were 87.4 % and 84.1 %, respectively. Cardiac involvement (HR: 4.34) and pulmonary artery aneurysm/dilation (HR: 4.89) were independently associated with mortality. CONCLUSIONS Arterial lesions associated with BD usually involve multiple arteries and manifest differently in different types of arteries. Cardiac involvement and pulmonary artery aneurysm/dilation are independent prognostic factors of BD patients with arterial involvement.
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Affiliation(s)
- Yu-Ling Qian
- Department of Pulmonary Vascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, State Key Laboratory of Cardiovascular Disease, 100037 Beijing, China
| | - Rui-Lin Quan
- Department of Pulmonary Vascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, State Key Laboratory of Cardiovascular Disease, 100037 Beijing, China
| | - Xiao-Xi Chen
- Department of Pulmonary Vascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, State Key Laboratory of Cardiovascular Disease, 100037 Beijing, China
| | - Yang-Yi Lin
- Department of Pulmonary Vascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, State Key Laboratory of Cardiovascular Disease, 100037 Beijing, China
| | - Xiao-Li Jing
- Department of Pulmonary Vascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, State Key Laboratory of Cardiovascular Disease, 100037 Beijing, China
| | - Qing Gu
- Department of Pulmonary Vascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, State Key Laboratory of Cardiovascular Disease, 100037 Beijing, China
| | - Chang-Ming Xiong
- Department of Pulmonary Vascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, State Key Laboratory of Cardiovascular Disease, 100037 Beijing, China
| | - Jian-Guo He
- Department of Pulmonary Vascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, State Key Laboratory of Cardiovascular Disease, 100037 Beijing, China
| | - Ai-Hua Zhi
- Department of Radiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 100037 Beijing, China; Department of Radiology, Yunnan Fuwai Cardiovascular Hospital, 650000 Kunming, China.
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Tuzun H, Ak T, Bas A, Kara O, Gulsen F, Seyahi E. Abdominal aortic aneurysm healed with calcification in a female patient with Behçet's syndrome: A case report with a 2-decade follow-up. Int J Rheum Dis 2024; 27:e14859. [PMID: 37540105 DOI: 10.1111/1756-185x.14859] [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: 06/15/2023] [Accepted: 07/19/2023] [Indexed: 08/05/2023]
Abstract
Abdominal aortic aneurysms (AAA) are rare in Behçet syndrome (BS) but may result in life-threatening complications. AAA are generally treated with surgical intervention following aggressive immunosuppressive therapy. Healing with wall calcification and mural thrombus for AAA is scarcely reported in the literature. Herein, we present a female patient who developed a large saccular aneurysm in the infra-renal abdominal aorta 6 months after the diagnosis. Endovascular intervention was not found to be possible because of the dimensions of the aneurysm and the patient did not consent for open surgery. Therefore, she received only immunosuppressive treatment. By the second year of follow-up, we detected reduction in the size of AAA, along with circumferential wall calcification and mural thrombus. The patient was followed-up for 20 years without rupture and currently doing well. This case demonstrates that calcified large saccular AAA might not necessitate surgical intervention and be followed-up for many years without any complication.
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Affiliation(s)
- Hasan Tuzun
- Department of Cardiovascular Surgery, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Tumay Ak
- Department of Internal Medicine, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Ahmet Bas
- Department of Radiology, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Ozge Kara
- Department of Internal Medicine, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Fatih Gulsen
- Department of Radiology, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Emire Seyahi
- Division of Rheumatology, Department of Internal Medicine, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul, Turkey
- Behçet's Disease Research Center, Istanbul University-Cerrahpasa, Istanbul, Turkey
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Graham BB, Hilton JF, Lee MH, Kumar R, Balladares DF, Rahaghi FN, Estépar RSJ, Mickael C, Lima RLB, Loureiro CM, Lucena J, Oliveira RK, Corrêa RDA. Is pulmonary arterial hypertension associated with schistosomiasis distinct from pulmonary arterial hypertension associated with portal hypertension? JHLT OPEN 2023; 1:100007. [PMID: 38050478 PMCID: PMC10695267 DOI: 10.1016/j.jhlto.2023.100007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/06/2023]
Abstract
Pulmonary arterial hypertension associated with schistosomiasis (SchPAH) and pulmonary arterial hypertension associated with portal hypertension (PoPAH) are lung diseases that develop in the presence of liver diseases. However, mechanistic pathways by which the underlying liver conditions and other drivers contribute to the development and progression of pulmonary arterial hypertension (PAH) are unclear for both etiologies. In turn, these unknowns limit certainty of strategies to prevent, diagnose, and reverse the resultant PAH. Here we consider specific mechanisms that contribute to SchPAH and PoPAH, identifying those that may be shared and those that appear to be unique to each etiology, in the hope that this exploration will both highlight known causal drivers and identify knowledge gaps appropriate for future research. Overall, the key pathophysiologic differences that we identify between SchPAH and PoPAH suggest that they are not variants of a single condition.
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Affiliation(s)
- Brian B. Graham
- Lung Biology Center, University of California San Francisco, San Francisco, California
- Pulmonary Division, San Francisco General Hospital, San Francisco, California
| | - Joan F. Hilton
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California
| | - Michael H. Lee
- Lung Biology Center, University of California San Francisco, San Francisco, California
- Pulmonary Division, San Francisco General Hospital, San Francisco, California
| | - Rahul Kumar
- Lung Biology Center, University of California San Francisco, San Francisco, California
- Pulmonary Division, San Francisco General Hospital, San Francisco, California
| | - Dara Fonseca Balladares
- Lung Biology Center, University of California San Francisco, San Francisco, California
- Pulmonary Division, San Francisco General Hospital, San Francisco, California
| | - Farbod N. Rahaghi
- Pulmonary Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Raúl San José Estépar
- Applied Chest Imaging Laboratory, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Claudia Mickael
- Pulmonary and Critical Care Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | | | | | - Juliana Lucena
- Division of Respiratory Diseases, Department of Medicine, Federal University of São Paulo, São Paulo, Brazil
| | - Rudolf K.F. Oliveira
- Division of Respiratory Diseases, Department of Medicine, Federal University of São Paulo, São Paulo, Brazil
| | - Ricardo de Amorim Corrêa
- Internal Medicine/Pulmonary Division, Medical School, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
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Seyahi E, Ugurlu S, Amikishiyev S, Gul A. Behçet disease, familial Mediterranean fever and MEFV variations: More than just an association. Clin Immunol 2023; 251:109630. [PMID: 37216220 DOI: 10.1016/j.clim.2023.109630] [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: 04/13/2023] [Revised: 04/20/2023] [Accepted: 04/21/2023] [Indexed: 05/24/2023]
Abstract
Behçet disease (BD) and familial Mediterranean fever (FMF) are two inflammatory disorders that share many features including historical background, ethnical distribution and inflammatory characteristics. Several studies suggested that BD and FMF might occur in the same individual more commonly than expected. Additionally, the pathogenic MEFV gene variants, especially p.Met694Val, activating the inflammasome complex have been shown to increase the risk for BD in regions where both FMF and BD are prevalent. Whether these variants are associated with certain disease subtypes and whether they may help in the planning of treatment need to be explored. This review provides a recent overview of the plausible association between FMF and BD and the role of MEFV variants in the pathogenesis of BD.
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Affiliation(s)
- Emire Seyahi
- Division of Rheumatology, Department of Internal Medicine, Istanbul University-Cerrahpasa, School of Medicine, Istanbul, Turkey.
| | - Serdal Ugurlu
- Division of Rheumatology, Department of Internal Medicine, Istanbul University-Cerrahpasa, School of Medicine, Istanbul, Turkey
| | - Shirkhan Amikishiyev
- Division of Rheumatology, Department of Internal Medicine, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Ahmet Gul
- Division of Rheumatology, Department of Internal Medicine, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey.
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8
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Polat G, Tezcan MA, Polat M, Barutçugil F, Bayram T, Sade R, Kudaş Ö, Pirimoğlu RB, İsmailova E, Yalçın A, Meletlioğlu E, Kahraman M. Quantitative analysis of lung parenchymal involvement in Behçet's disease by the novel automatic program. Int J Rheum Dis 2023; 26:917-921. [PMID: 36946548 DOI: 10.1111/1756-185x.14673] [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: 01/13/2023] [Revised: 02/18/2023] [Accepted: 03/10/2023] [Indexed: 03/23/2023]
Abstract
OBJECTIVES We aimed to quantitatively analyze lung parenchymal changes in Behçet's patients and to detect early parenchymal quantitative changes that occur in the absence of positive visual radiological findings. METHODS In our study, a total of 31 patients with Behçet's disease, 17 with positive radiological findings and 14 patients without positive radiological findings, and a control group of 33 individuals were evaluated. The automatic program determined lung volumes, lung densities, and opacity volume percentages by evaluating the contrast-enhanced lung computed tomography scans. RESULTS The total lung volume was 3632.98 ± 1100.53 mL in the Behçet's disease patient group and 4925.70 ± 1098.88 mL in the control group, and there was a significant decrease in the total lung volume in Behçet's disease patients (P < 0.0001). The mean lung density was -723.73 ± 65.16 in the Behçet's disease patient group and -767.35 ± 41.17 in the control group, and there was a significant increase in the mean density in the Behçet's patients (P = 0.0023). A significantly higher correlation was observed between lung density and lung volume in Behçet's patients (P < 0.0001, r = -0.795). The lung volume of Behçet's disease patients with negative radiological findings was significantly lower than that of the control group (P = 0.0342). CONCLUSIONS Lung volumetric changes in Behçet's disease patients are the quantitative data most affected by the disease. In addition, lung volume decreases in Behçet's patients who do not have visual parenchymal involvement.
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Affiliation(s)
- Gökhan Polat
- Department of Radiology, Medical Faculty, Ataturk University, Erzurum, Turkey
| | | | - Merve Polat
- Department of Health Physics, Health Sciences Institute, Karadeniz Technical University, Trabzon, Turkey
| | - Furkan Barutçugil
- Department of Radiology, Medical Faculty, Ataturk University, Erzurum, Turkey
| | - Tuncay Bayram
- Department of Health Physics, Health Sciences Institute, Karadeniz Technical University, Trabzon, Turkey
- Department of Physics, Karadeniz Technical University, Trabzon, Turkey
| | - Recep Sade
- Department of Radiology, Medical Faculty, Ataturk University, Erzurum, Turkey
| | - Özlem Kudaş
- Department of Rheumatology, Medical Faculty, Ataturk University, Erzurum, Turkey
| | - R Berhan Pirimoğlu
- Department of Radiology, Medical Faculty, Ataturk University, Erzurum, Turkey
| | - Elshad İsmailova
- Department of Radiology, Medical Faculty, Ataturk University, Erzurum, Turkey
| | - Ahmet Yalçın
- Department of Radiology, Medical Faculty, Ataturk University, Erzurum, Turkey
| | - Emrah Meletlioğlu
- Department of Mechanical Engineering, Institute of Science, Ataturk University, Erzurum, Turkey
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Scoping beyond pulmonary artery involvement; pulmonary involvement in Behcet's disease; a retrospective analysis of 28 patients. Clin Rheumatol 2023; 42:849-853. [PMID: 36326947 DOI: 10.1007/s10067-022-06423-5] [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: 04/04/2022] [Revised: 10/15/2022] [Accepted: 10/23/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Pulmonary involvement other than pulmonary artery involvement in Behcet's disease still remains an area of investigation. The aim of this study was to evaluate pulmonary involvement associated with Behcet's disease. METHOD We retrospectively investigated all Behcet's disease patients in terms of pulmonary involvement. Twenty-eight patients, whose radiologic examinations were consistent with Behcet's disease-related involvement after excluding other possibilities, were included in this study. Data regarding demographic characteristics, other clinical components of Behcet's disease, treatment modalities, and types of pulmonary involvement were analyzed. RESULTS Pulmonary involvement was seen more common in male (82.1% vs 17.9%). Mean age for Behcet's disease diagnosis was found 32 years (SD 10.9) and mean age for pulmonary involvement was calculated 37 years (SD 11.4). Deep vein thrombosis (DVT) was the most common associated vascular involvement (53.6%). In our study population, alveolar hemorrhage and/or ground glass appearance were seen in 46.4% (13/28) of BD patients with pulmonary involvement. Totally, pulmonary artery aneurysm (PAA), small-sized pulmonary vasculitis (sPV), and pulmonary thrombosis (PT) were seen in 7 (25%), 13 (46.3%), and 18 (64.4%) of patients, respectively. Intracardiac thrombosis (ICT) in the right ventricle was present in 5 patients. Cyclophosphamide (CYC) was the most common preferred agent (78%) followed by azathioprine (AZA) in the first line. Warfarin was used in 18 patients. Overall mortality was seen in 3 patients: 1 due to PAA bleeding and others with unknown causes. CONCLUSION Despite the importance of pulmonary artery involvement and pulmonary thrombosis in Behcet's disease, small-sized pulmonary vasculitis in the form of small vessel involvement is generally overlooked. Our study findings have shown that alveolar hemorrhage and/or ground-glass appearance in the absence of pulmonary artery aneurysm and pulmonary thrombosis are seen commonly as well. Key Points • The characteristics of pulmonary small vasculature involvement in Behcet's disease which is still an area of investigation warrant further attention. • The clinician should bear in mind that the spectrum of pulmonary involvement in Behcet's disease may be variable, but an extensive work up is still of great importance especially in atypical cases.
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Behçet's Disease: A Radiological Review of Vascular and Parenchymal Pulmonary Involvement. Diagnostics (Basel) 2022; 12:diagnostics12112868. [PMID: 36428928 PMCID: PMC9689730 DOI: 10.3390/diagnostics12112868] [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: 10/18/2022] [Revised: 11/13/2022] [Accepted: 11/15/2022] [Indexed: 11/22/2022] Open
Abstract
Behcet's disease (BD) is a chronic systemic inflammatory disorder characterized by underlying chronic vasculitis of both large- and small-caliber vessels. Thoracic involvement in BD can occur with various types of manifestations, which can be detected with contrast-enhanced MSCT scanning. In addition, MR can be useful in diagnosis. Characteristic features are aneurysms of the pulmonary arteries that can cause severe hemoptysis and SVC thrombosis that manifests as SVC syndrome. Other manifestations are aortic and bronchial artery aneurysms, alveolar hemorrhage, pulmonary infarction, and rarely pleural effusion. Achieving the right diagnosis of these manifestations is important for setting the correct therapy and improving the patient's outcome.
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11
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Chebbi D, Damak C, Frikha F, Abid W, Rebai M, Snoussi M, Salah RB, Marzouk S, Hentati A, Bahloul Z. Cavitary lung opacity of unusual cause during Behçet disease. Clin Case Rep 2022; 10:e6173. [PMID: 35990381 PMCID: PMC9376141 DOI: 10.1002/ccr3.6173] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 07/07/2022] [Accepted: 07/16/2022] [Indexed: 11/09/2022] Open
Affiliation(s)
- Donia Chebbi
- Department of Internal Medicine Hedi Chaker University Hospital Sfax Tunisia
| | - Chifa Damak
- Department of Internal Medicine Hedi Chaker University Hospital Sfax Tunisia
| | - Faten Frikha
- Department of Internal Medicine Hedi Chaker University Hospital Sfax Tunisia
| | - Walid Abid
- Department of Thoracic Surgery Habib Bourguiba University Hospital Sfax Tunisia
| | - Mohamed Rebai
- Department of Thoracic Surgery Habib Bourguiba University Hospital Sfax Tunisia
| | - Mouna Snoussi
- Department of Internal Medicine Hedi Chaker University Hospital Sfax Tunisia
| | - Raida Ben Salah
- Department of Internal Medicine Hedi Chaker University Hospital Sfax Tunisia
| | - Sameh Marzouk
- Department of Internal Medicine Hedi Chaker University Hospital Sfax Tunisia
| | - Abdessalem Hentati
- Department of Thoracic Surgery Habib Bourguiba University Hospital Sfax Tunisia
| | - Zouhir Bahloul
- Department of Internal Medicine Hedi Chaker University Hospital Sfax Tunisia
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12
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Tazi Mezalek Z, Khibri H, Chadli S, El Fari S, Ammouri W, Harmouche H, Maamar M, Adnaoui M. Vascular complications of Behçet disease. Minerva Med 2022; 112:767-778. [PMID: 35168306 DOI: 10.23736/s0026-4806.21.07490-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Behçet disease is a multi-systemic complex vasculitis with unknown etiology characterized by different clinical involvements, including mucocutaneous, ocular, vascular, articular, neurological, and gastrointestinal manifestations. Growing evidence supports that different phenotypes, characterized by clusters of co-existing involvements, can be distinguished. Namely, the vascular phenotype identifies a specific group of patients who suffer from recurrent inflammatory thrombosis and arterial involvement. Vascular disease develops in up to 40% with a definite male preponderance and is usually an early manifestation. Venous involvement is significantly more common than arterial disease, and lower extremity deep vein thrombosis is its most frequent manifestation. Arterial disease involves mostly pulmonary arteries and aorta and manifests mainly in the form of aneurysms. Glucocorticoids and immunosuppressants are the recommended first-line treatments in vasculo-Behçet. Furthermore, controlled trials are still needed to assess the role of adding anticoagulation to the treatment regimen, with an accent on new oral anticoagulants. Treatment with anti-TNF alpha agents seems promising, but the management strategies are not clear yet.
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Affiliation(s)
- Zoubida Tazi Mezalek
- Department of Internal Medicine, Ibn Sina University Hospital, Rabat, Morocco - .,Department of Clinical Hematology, Ibn Sina University Hospital, Rabat, Morocco - .,Faculty of Medicine and Pharmacy, Mohammed V. University, Rabat, Morocco -
| | - Hajar Khibri
- Department of Internal Medicine, Ibn Sina University Hospital, Rabat, Morocco.,Faculty of Medicine and Pharmacy, Mohammed V. University, Rabat, Morocco
| | - Sarra Chadli
- Department of Internal Medicine, Ibn Sina University Hospital, Rabat, Morocco
| | - Safae El Fari
- Department of Internal Medicine, Ibn Sina University Hospital, Rabat, Morocco
| | - Wafaa Ammouri
- Department of Internal Medicine, Ibn Sina University Hospital, Rabat, Morocco.,Faculty of Medicine and Pharmacy, Mohammed V. University, Rabat, Morocco
| | - Hicham Harmouche
- Department of Internal Medicine, Ibn Sina University Hospital, Rabat, Morocco.,Faculty of Medicine and Pharmacy, Mohammed V. University, Rabat, Morocco
| | - Mouna Maamar
- Department of Internal Medicine, Ibn Sina University Hospital, Rabat, Morocco.,Faculty of Medicine and Pharmacy, Mohammed V. University, Rabat, Morocco
| | - Mohamed Adnaoui
- Department of Internal Medicine, Ibn Sina University Hospital, Rabat, Morocco.,Faculty of Medicine and Pharmacy, Mohammed V. University, Rabat, Morocco
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13
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Yıldırım R, Üsküdar Cansu D, Dinler M, Korkmaz C. OUP accepted manuscript. Rheumatology (Oxford) 2022; 61:SI197-SI199. [PMID: 35438141 PMCID: PMC9383781 DOI: 10.1093/rheumatology/keac246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 04/01/2022] [Accepted: 04/08/2022] [Indexed: 11/30/2022] Open
Affiliation(s)
- Reşit Yıldırım
- Correspondence to: Reşit Yildirim, Department of Rheumatology, School of Medicine, Eskişehir Osmangazi University, Eskisehir 26480, Turkey. E-mail:
| | - Döndü Üsküdar Cansu
- Division of Rheumatology, Department of Internal Medicine, Eskişehir Osmangazi University, Eskişehir, Turkey
| | - Mustafa Dinler
- Division of Rheumatology, Department of Internal Medicine, Eskişehir Osmangazi University, Eskişehir, Turkey
| | - Cengiz Korkmaz
- Division of Rheumatology, Department of Internal Medicine, Eskişehir Osmangazi University, Eskişehir, Turkey
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Behçet's disease presenting with massive hemoptysis related to bronchovascular fistula: A case report. TURK GOGUS KALP DAMAR CERRAHISI DERGISI-TURKISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2021; 29:408-411. [PMID: 34589263 PMCID: PMC8462114 DOI: 10.5606/tgkdc.dergisi.2021.19487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 04/10/2020] [Indexed: 11/21/2022]
Abstract
A 37-year-old male patient was admitted to our hospital with recurrent hemoptysis, 50 mL per day. Thoracic computed tomography showed no pathology responsible for hemoptysis. Bronchoscopy revealed mucosal infiltrations and 2 to 3-mm blotch in the lateral wall of the right lower lobe. After punch biopsy of the suspected area, massive bleeding occurred. Right lower bilobectomy was performed urgently. A bronchovascular fistula was noticed at the specimen. Pathological examination result was compatible with clinically suspected Behçet"s disease. The patient was given high-dose steroid and cyclophosphamide treatment and received azathioprine maintenance treatment for 18 months. He has been symptom-free for three-year follow-up.
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15
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Yazgan Ç, Ertürk H, Taşkın A. Imaging Features of Thoracic Manifestations of Behçet's Disease: Beyond Pulmonary Artery Involvement. Curr Med Imaging 2021; 17:996-1002. [PMID: 33438546 PMCID: PMC8653419 DOI: 10.2174/1573405617999210112193856] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 11/05/2020] [Accepted: 11/12/2020] [Indexed: 11/22/2022]
Abstract
Background Behçet’s disease is a chronic multisystemic vasculitis affecting vessels of different sizes in various organs. Thoracic manifestations of the disease show a wide spectrum involving a variety of anatomic structures within the chest. However, pulmonary artery involvement is a typical manifestation of the disease that contributes significantly to mortality in patients. The study aimed to analyze CT features of thoracic manifestations, particularly pulmonary artery involvement, and to quantitatively assess bronchial arteries in Behçet’s disease. Methods Patients with Behçet’s disease who underwent CT scans for suspected thoracic involvement between 2010 and 2018 were included. CT findings of 52 patients were retrospectively analyzed for thoracic manifestations of the disease. Bronchial arteries were assessed regarding diameter in patients with/without pulmonary artery involvement. The pulmonary symptoms were noted. Results Of the 52 patients, 67% had thoracic manifestations including pulmonary artery involvement, parenchymal changes, superior vena cava thrombosis, and intracardiac thrombus. Pulmonary artery involvement was observed in 50% of the cohort. Peripheral pulmonary arteries (77%) were the most commonly affected branches, followed by lobar (42%) and central (35%) pulmonary arteries. Other thoracic findings were significantly correlated with pulmonary artery involvement (p<0.05). Compared to patients without pulmonary artery involvement, those with pulmonary artery involvement had a higher bronchial artery diameter (p<0.05) and occurrence rate of dilated bronchial arteries. Conclusion Involvement of peripheral pulmonary arteries is frequently encountered in Behçet’s disease and it can resemble pulmonary nodules. Dilated bronchial arteries, which can be observed in cases of pulmonary artery involvement, should be considered in patients with hemoptysis.
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Affiliation(s)
- Çisel Yazgan
- Faculty of Medicine, Department of Radiology, Kastamonu University, Kastamonu, Turkey
| | - Hakan Ertürk
- Department of Radiology, Ataturk Chest Diseases and Chest Surgery Education and Research Hospital, 06280 Ankara, Turkey
| | - Ayşenaz Taşkın
- Department of Chest Diseases, Ataturk Chest Diseases and Chest Surgery Education and Research Hospital, 06280 Ankara, Turkey
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16
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Eroglu DS, Colaklar A, Ceran A, Sezer S, Torgutalp M, Kinikli G. Behçet’s Syndrome Complicated with Pulmonary Artery Thrombosis: Response to Tocilizumab Treatment. AKTUEL RHEUMATOL 2021. [DOI: 10.1055/a-1400-2586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/30/2022]
Abstract
ZusammenfassungDie Beteiligung der Lungenarterie ist eine seltene, aber tödliche Komplikation des Morbus Behçets (MB). Hier berichten wir über einen männlichen MB-Patienten mit zwei vaskulären Komplikationen, nämlich dem Budd-Chiari-Syndrom und der Pulmonalarterienthrombose. Der Patient litt unter einer rezidivierenden Lungenarterienthrombose, die gegen mehrere immunsuppressive Medikamente, einschließlich hochdosierter Glukokortikoide und dem Anti-TNF-Mittel Infliximab, refraktär war. Infolge mehrerer Rezidive wurde er effektiv mit Tocilizumab behandelt, wodurch auch eine vollständige Rekanalisation der thrombosierten Arterien erreicht wurde.
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Affiliation(s)
- Didem Sahin Eroglu
- Department of Internal Medicine, Division of Rheumatology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Anil Colaklar
- Department of Radiology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Alparslan Ceran
- Department of Internal Medicine, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Serdar Sezer
- Department of Internal Medicine, Division of Rheumatology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Murat Torgutalp
- Department of Internal Medicine, Division of Rheumatology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Gulay Kinikli
- Department of Internal Medicine, Division of Rheumatology, Ankara University Faculty of Medicine, Ankara, Turkey
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17
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Clinical characteristics of pulmonary artery involvement in patients with Behçet's syndrome: single-centre experience of 61 patients. Clin Rheumatol 2021; 40:4127-4134. [PMID: 33907905 DOI: 10.1007/s10067-021-05748-x] [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: 01/25/2021] [Revised: 04/18/2021] [Accepted: 04/21/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To report the clinical characteristics of pulmonary artery involvement (PAI) in patients with Behçet's syndrome (BS) and to define the predictors of relapses. METHODS We performed retrospective analysis of BS patients with PAI who fulfilled international study group criteria. Among 460 patients with vascular Behçet's syndrome (VBS), 66 were diagnosed with PAI. For final analyses, 61 patients with PAI were included who had at least 2 follow-up visits (72.1% male, mean age at BS diagnosis 29.34 ± 10.1 years). The patient data were recorded. Relapse was defined as the reoccurrence of vascular event in any vascular structure. Factors associated with relapse were assessed by logistic regression analysis. RESULTS There were no differences considering demographic and clinical features of the patients with and without PAI in the VBS group, except that intracardiac thrombosis was more common in the patients with PAI (19.7% vs 0.3%). Among 61 patients, 50 (82.0%) had isolated pulmonary artery thrombosis (PAT), whereas 11 (18.0%) had pulmonary artery aneurysm with or without PAT. Twenty-four (39.3%) patients experienced vascular relapse during median follow-up of 65.9 (Q1-Q3: 20.1-109.0) months. To define the factors associated with relapses, patients with isolated PAT were analysed. On multivariable logistic regression analysis, older age at BS diagnosis and anticoagulation usage seemed to be protective (OR: 0.92, 95% CI 0.86-1.02, OR: 0.34, 95% CI 0.09-1.33, respectively). CONCLUSION Our results indicate a higher frequency of intracardiac thrombosis in BS patients with PAI and possible efficacy of anticoagulation usage in preventing relapses. Key Points • This study shows that intracardiac and intracranial thromboses are seen more frequently in patients with PAI and the prevalence of pulmonary artery thrombosis has been increasing in the case of PAI. Furthermore, our report indicates that anticoagulation might be effective in preventing further vascular relapses.
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18
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BaŞ İkİzoĞlu N, AtaĞ E, Ergenekon AP, Yilmaz YeĞİt C, GÖkdemİr Y, Erdem Eralp E, BÜge Öz A, Karadag B. An Adolescent Presented With Hemoptysis: Pulmonary Artery Aneurysm in Pediatric Behçet's Disease. Arch Rheumatol 2020; 35:283-286. [PMID: 32851380 PMCID: PMC7406172 DOI: 10.46497/archrheumatol.2020.7459] [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: 02/27/2019] [Accepted: 06/24/2019] [Indexed: 11/03/2022] Open
Abstract
Behçet's disease (BD) is a rare autoimmune and chronic inflammatory vasculitis, characterized by relapsing episodes of oral aphthous and genital ulcers, skin lesions, ocular lesions and vascular involvement. Pulmonary artery involvement is rare in BD but it carries a high mortality risk. In this article, we report a 15-year-old male patient presented with a two-month history of hemoptysis, cough, fewer and weight loss. On physical examination, auscultation revealed decreased breath sounds at left lung base. Bronchoscopy showed narrowed left lower lobe bronchus due to the external compression. Computed tomography angiography revealed multiple bilateral pulmonary artery aneurysms. Pathergy test was positive and he was diagnosed with BD. BD should be considered in the differential diagnosis of childhood hemoptysis.
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Affiliation(s)
- Nilay BaŞ İkİzoĞlu
- Department of Pediatrics, Division of Pediatric Pulmonology, Marmara University School of Medicine, Istanbul, Turkey
| | - Emine AtaĞ
- Department of Pediatrics, Division of Pediatric Pulmonology, Marmara University School of Medicine, Istanbul, Turkey
| | - Almala Pınar Ergenekon
- Department of Pediatrics, Division of Pediatric Pulmonology, Marmara University School of Medicine, Istanbul, Turkey
| | - Cansu Yilmaz YeĞİt
- Department of Pediatrics, Division of Pediatric Pulmonology, Marmara University School of Medicine, Istanbul, Turkey
| | - Yasemin GÖkdemİr
- Department of Pediatrics, Division of Pediatric Pulmonology, Marmara University School of Medicine, Istanbul, Turkey
| | - Ela Erdem Eralp
- Department of Pediatrics, Division of Pediatric Pulmonology, Marmara University School of Medicine, Istanbul, Turkey
| | - Ayşim BÜge Öz
- Department of Pathology, Istanbul University Cerrahpaşa Faculty of Medicine, Istanbul, Turkey
| | - Bulent Karadag
- Department of Pediatrics, Division of Pediatric Pulmonology, Marmara University School of Medicine, Istanbul, Turkey
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Toledo-Samaniego N, Galeano-Valle F, Pinilla-Llorente B, Del-Toro-Cervera J, Marra A, Proietti M, Demelo-Rodríguez P. Clinical features and management of venous thromboembolism in patients with Behçet's syndrome: a single-center case-control study. Intern Emerg Med 2020; 15:635-644. [PMID: 31802406 DOI: 10.1007/s11739-019-02237-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Accepted: 11/15/2019] [Indexed: 12/15/2022]
Abstract
Almost one third of patients with Behçet's syndrome (BS) display vascular involvement. However, data regarding the prevalence and management of venous thromboembolism (VTE) in BS are scanty. We assessed the differential characteristics between patients with and without VTE and the factors associated with VTE incidence. A case-control study in a cohort of patients with BS was performed. 57 patients were included (56.1% women) with a mean follow-up of 10.56 (± 10.7) years. Mean age at diagnosis of BS and diagnosis of the first VTE episode was 34.7 (± 12.1) and 31.2 (± 8.9) years, respectively. Erythema nodosum (OR 4.6, CI 95% 1.2-18.1) and fever (OR 8.2, CI 95% 1.6-42.1) were associated with a higher risk of VTE. 26 episodes of VTE were registered in 12/57 (21%) patients. 83.3% of patients were not diagnosed with BS when the first episode of VTE occurred and, among them, the episode of VTE led to the diagnosis of BS in 40% of cases. Half of patients had at least one VTE recurrence. The absence of immunosuppressive treatment was associated with a higher risk of developing a first episode of VTE (OR 20 CI 95% 19.2-166.6). All patients were treated with anticoagulation and 75% were treated with immunosuppressants after the first VTE event. The diagnosis of VTE usually precedes that of BS, with a high frequency of VTE recurrence. Erythema nodosum and fever were associated with a higher risk of VTE, while the immunosuppressants showed a protective role for the development of VTE.
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Affiliation(s)
- Neera Toledo-Samaniego
- Venous Thromboembolism Unit, Department of Internal Medicine, Hospital General Universitario Gregorio Marañón, Calle Doctor Esquerdo 46, 28007, Madrid, Spain
- School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Calle Doctor Esquerdo 46, 28007, Madrid, Spain
| | - Francisco Galeano-Valle
- Venous Thromboembolism Unit, Department of Internal Medicine, Hospital General Universitario Gregorio Marañón, Calle Doctor Esquerdo 46, 28007, Madrid, Spain.
- School of Medicine, Universidad Complutense de Madrid, Madrid, Spain.
- Instituto de Investigación Sanitaria Gregorio Marañón, Calle Doctor Esquerdo 46, 28007, Madrid, Spain.
| | - Blanca Pinilla-Llorente
- Venous Thromboembolism Unit, Department of Internal Medicine, Hospital General Universitario Gregorio Marañón, Calle Doctor Esquerdo 46, 28007, Madrid, Spain
- School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Calle Doctor Esquerdo 46, 28007, Madrid, Spain
| | - Jorge Del-Toro-Cervera
- Venous Thromboembolism Unit, Department of Internal Medicine, Hospital General Universitario Gregorio Marañón, Calle Doctor Esquerdo 46, 28007, Madrid, Spain
- School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Calle Doctor Esquerdo 46, 28007, Madrid, Spain
| | - Alberto Marra
- Department of Cardiovascular Imaging, IRCCS (Istituto Di Ricovero E Cura a Carattere Scientifico)-SDN Research Institute, Via Giovanni Amendola 209, 70126, Bari, Italy
| | - Marco Proietti
- Department of Neuroscience, Istituto Di Ricerche Farmacologiche Mario Negri IRCCS, Via Mario Negri, 2, 20156, Milan, MI, Italy
- Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Piazzale Aldo Moro, 5, 00185, Rome, RM, Italy
| | - Pablo Demelo-Rodríguez
- Venous Thromboembolism Unit, Department of Internal Medicine, Hospital General Universitario Gregorio Marañón, Calle Doctor Esquerdo 46, 28007, Madrid, Spain
- School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Calle Doctor Esquerdo 46, 28007, Madrid, Spain
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Babaie F, Hosseinzadeh R, Ebrazeh M, Seyfizadeh N, Aslani S, Salimi S, Hemmatzadeh M, Azizi G, Jadidi-Niaragh F, Mohammadi H. The roles of ERAP1 and ERAP2 in autoimmunity and cancer immunity: New insights and perspective. Mol Immunol 2020; 121:7-19. [PMID: 32135401 DOI: 10.1016/j.molimm.2020.02.020] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 02/26/2020] [Accepted: 02/27/2020] [Indexed: 02/06/2023]
Abstract
Autoimmunity and cancer affect millions worldwide and both, in principal, result from dysregulated immune responses. There are many well-known molecules involved in immunological process playing as a double-edged sword, by which associating autoimmune diseases and cancer. In this regard, Endoplasmic reticulum aminopeptidases (ERAP) 1, which belongs to the M1 family of aminopeptidases, plays a central role as a "molecular ruler", proteolyzing of N-terminal of the antigenic peptides before their loading onto HLA-I molecules for antigen presentation in the Endoplasmic Reticulum (ER). Several genome-wide association studies (GWAS) highlighted the significance of ERAP1 and ERAP2 in autoimmune diseases, including Ankylosing spondylitis, Psoriasis, Bechet's disease, and Birdshot chorioretinopathy, as well as in cancers. The expression of ERAP1/2 is mostly altered in different cancers compared to normal cells, but how this affects anti-cancer immune responses and cancer growth has been little explored. Recent studies on the immunological outcomes and the catalytic functions of ERAP1 and ERAP2 have provided a better understanding of their potential pathogenetic role in autoimmunity and cancer. In this review, we summarize the role of ERAP1 and ERAP2 in the autoimmune diseases and cancer immunity based on the recent advances in GWAS studies.
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Affiliation(s)
- Farhad Babaie
- Department of Immunology and Genetic, School of Medicine, Urmia University of Medical Sciences, Urmia, Iran; Cellular and Molecular Research Center, Urmia University of Medical Sciences, Urmia, Iran
| | - Ramin Hosseinzadeh
- Department of Immunology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehrdad Ebrazeh
- Department of Biology, Bonab Branch, Islamic Azad University, Bonab, Iran
| | - Narges Seyfizadeh
- Department of Medical Oncology, National Center for Tumor Diseases, Heidelberg University Hospital, Heidelberg, Germany
| | - Saeed Aslani
- Department of Immunology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Soraya Salimi
- Cellular and Molecular Research Center, Urmia University of Medical Sciences, Urmia, Iran
| | - Maryam Hemmatzadeh
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran; Connective Tissue Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
| | - Gholamreza Azizi
- Non-Communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran
| | - Farhad Jadidi-Niaragh
- Department of Immunology, School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran; Immunology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hamed Mohammadi
- Non-Communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran; Department of Immunology, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran.
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Is Immunosuppressive and Thrombolytic Therapy Really Effective in a Patient With Intracardiac Thrombosis and Pulmonary Artery Aneurysm due to Behçet's Disease? Arch Rheumatol 2020; 34:451-456. [PMID: 32010896 DOI: 10.5606/archrheumatol.2019.7169] [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: 09/08/2018] [Accepted: 02/23/2019] [Indexed: 11/21/2022] Open
Abstract
Behçet's disease (BD) is a rare, multisystemic, chronic vasculitic disorder with unknown etiology. Intracardiac thrombus formation and pulmonary artery aneurysm in BD are very rare. The treatment protocol in patients with vascular involvement, particularly those with pulmonary artery aneurysm accompanied by thrombosis, have not been clearly defined. In this article, we report an exceptional case, who had been treated unsuccessfully with a combination of anti-inflammatory/immunosuppressive therapy and thrombolytic agents, to discuss the poor prognosis of pulmonary artery aneurysm accompanying intracardiac thrombosis in juvenile BD.
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22
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Demir S, Sag E, Kaya Akca U, Hazirolan T, Bilginer Y, Ozen S. The Challenge of Treating Pulmonary Vasculitis in Behçet Disease: Two Pediatric Cases. Pediatrics 2019; 144:peds.2019-0162. [PMID: 31320468 DOI: 10.1542/peds.2019-0162] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/10/2019] [Indexed: 11/24/2022] Open
Abstract
Behçet disease (BD) is a multisystemic autoinflammatory disorder characterized by recurrent mucocutaneous, ocular, musculoskeletal, gastrointestinal, central nervous system, and vascular manifestations. Pulmonary arterial involvement (PAI) of BD is probably the most severe form of vasculitis, at least in children. PAI has a high mortality, morbidity, and recurrence rate. There are limited data regarding treatment and outcomes of pediatric patients with BD with PAI. Herein, we report 2 pediatric patients with BD presented with hemoptysis and support our data with a systematic review. These patients were given immunosuppressive therapy, which covered pulse methylprednisolone followed by oral prednisolone, intravenous cyclophosphamide every 3 weeks for a total of 6 cycles, and interferon-α2a concomitantly. These are the first reported cases in the literature successfully treated with this treatment modality in a complication with 50% mortality. These patients have been followed up for a period of at least 4 years without any vascular recurrence. Pediatricians should be aware that patients with BD may not present with full diagnostic criteria. They should consider BD in a child with PAI to avoid diagnostic delay and start life-saving accurate immunosuppressive treatment.
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Affiliation(s)
- Selcan Demir
- Division of Rheumatology, Department of Pediatrics, Faculty of Medicine, Hacettepe University, Ankara, Turkey; and
| | - Erdal Sag
- Division of Rheumatology, Department of Pediatrics, Faculty of Medicine, Hacettepe University, Ankara, Turkey; and
| | - Ummusen Kaya Akca
- Division of Rheumatology, Department of Pediatrics, Faculty of Medicine, Hacettepe University, Ankara, Turkey; and
| | - Tuncay Hazirolan
- Department of Radiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Yelda Bilginer
- Division of Rheumatology, Department of Pediatrics, Faculty of Medicine, Hacettepe University, Ankara, Turkey; and
| | - Seza Ozen
- Division of Rheumatology, Department of Pediatrics, Faculty of Medicine, Hacettepe University, Ankara, Turkey; and
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23
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Kaabachi W, Khaouthar M, Hamdi B, Khalfallah I, Ammar J, Hamzaoui K, Hamzaoui A. Th 9 cells in Behçet disease: Possible involvement of IL-9 in pulmonary manifestations. Immunol Lett 2019; 211:3-12. [PMID: 31075294 DOI: 10.1016/j.imlet.2019.05.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 04/24/2019] [Accepted: 05/06/2019] [Indexed: 12/18/2022]
Abstract
Behçet disease (BD) is a multisystemic disease some of whose manifestations are characterized by pulmonary involvements. The purpose of the study was to evaluate the level of T-helper type 9 (Th9) cells and the cytokine interleukin (IL)-9 in peripheral blood and in bronchoalveolar lavage (BAL) of patients with Behçet's disease (BD) affected by pulmonary manifestations. Nevertheless, until recently there have been no studies on its role in BD. The Th9 (CD4+IL-9+T) cell, transcription factor PU.1 and IL-9 mRNA levels, as well as serum and BAL IL-9 concentration, were measured in BD patients and healthy controls. The Th9 cell percentage and absolute number, PU.1 and IL-9 expression levels of BD patients were all increased significantly compared with the control group. Absolute number of Th9 cells was particularly increased in patients with active BD compared to inactive BD patients. The levels of IL-9 associated to Th9 expression depended on BD severity. These parameters were markedly expressed in the BAL of BD patients with pulmonary manifestations. IL-17 and the epithelial inflammatory cytokine TSLP were significantly correlated to IL-9 levels. This cytokine trio decreased in inactive BD patients after corticosteroïd treatment. In addition, IL-9 levels were correlated to CD4+ IL-9+ cells in BAL and in PBMCs. LPS stimulated PBMCs and macrophages induced increased secretion of IL-9 and the encoding transcription factors PU.1 and IRF4. In conclusion, the expansion of the Th9 cell subset, up-regulation of the PU.1 transcription factor and increased secretion of the IL-9 cytokine may contribute to the pathogenesis of BD, which may be supported by the increased release of IL-17 and TSLP. We provide evidence that Th9 T cells are increased in BD patients with pulmonary manifestations. This suggests an important role of IL-9 in the pathogenesis of BD particularly in patients suffering from lung involvement.
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Affiliation(s)
- Wajih Kaabachi
- Unit Research 12SP15 "Expression moléculaire des interactions cellulaires et leur mode de communication dans le poumon profond", A. Mami Hospital, 2080 Ariana, Tunisia; Université de Tunis El Manar, Faculty of Medicine of Tunis, Department of Basic Sciences, Tunis, Tunisia.
| | - Mnasria Khaouthar
- Immuno-microbiologie environnementale et cancérogenèse, faculté des sciences de Bizerte, Tunisia.
| | - Besma Hamdi
- Unit Research 12SP15 "Expression moléculaire des interactions cellulaires et leur mode de communication dans le poumon profond", A. Mami Hospital, 2080 Ariana, Tunisia; Université de Tunis El Manar, Faculty of Medicine of Tunis, Department of Basic Sciences, Tunis, Tunisia; Division of Pulmonology, Department of Paediatric and Respiratory Diseases, Abderrahman Mami Hospital, Pavillon B, Ariana, Tunisia.
| | - Ikbel Khalfallah
- Unit Research 12SP15 "Expression moléculaire des interactions cellulaires et leur mode de communication dans le poumon profond", A. Mami Hospital, 2080 Ariana, Tunisia; Université de Tunis El Manar, Faculty of Medicine of Tunis, Department of Basic Sciences, Tunis, Tunisia; Division of Pulmonology, Department of Paediatric and Respiratory Diseases, Abderrahman Mami Hospital, Pavillon B, Ariana, Tunisia.
| | - Jamel Ammar
- Unit Research 12SP15 "Expression moléculaire des interactions cellulaires et leur mode de communication dans le poumon profond", A. Mami Hospital, 2080 Ariana, Tunisia; Université de Tunis El Manar, Faculty of Medicine of Tunis, Department of Basic Sciences, Tunis, Tunisia; Division of Pulmonology, Department of Paediatric and Respiratory Diseases, Abderrahman Mami Hospital, Pavillon B, Ariana, Tunisia.
| | - Kamel Hamzaoui
- Unit Research 12SP15 "Expression moléculaire des interactions cellulaires et leur mode de communication dans le poumon profond", A. Mami Hospital, 2080 Ariana, Tunisia; Université de Tunis El Manar, Faculty of Medicine of Tunis, Department of Basic Sciences, Tunis, Tunisia.
| | - Agnès Hamzaoui
- Unit Research 12SP15 "Expression moléculaire des interactions cellulaires et leur mode de communication dans le poumon profond", A. Mami Hospital, 2080 Ariana, Tunisia; Université de Tunis El Manar, Faculty of Medicine of Tunis, Department of Basic Sciences, Tunis, Tunisia; Division of Pulmonology, Department of Paediatric and Respiratory Diseases, Abderrahman Mami Hospital, Pavillon B, Ariana, Tunisia.
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Serious Coronary Thrombosis and Pulmonary Artery Thrombosis Revealing Behçet's Disease. Arch Rheumatol 2018; 33:85-88. [PMID: 29900996 DOI: 10.5606/archrheumatol.2018.6383] [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: 02/08/2017] [Accepted: 05/02/2017] [Indexed: 11/21/2022] Open
Abstract
Behçet's disease is a multisystem inflammatory disorder. Cardiovascular involvement is rare but may present with various manifestations, resulting in high mortality. In this article, we report a young male who had chest pain accompanied by systemic involvement, and was diagnosed of Behçet's disease with serious pulmonary artery and coronary thrombosis by systemic check-up. Finally, the patient was successfully treated with a combination of prednisone and immunosuppressive agents instead of surgery. To our knowledge, this is the first report of concurrent coronary thrombosis and pulmonary artery thrombosis in Behçet's disease patients.
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Thromboembolism with Janus Kinase (JAK) Inhibitors for Rheumatoid Arthritis: How Real is the Risk? Drug Saf 2018; 41:645-653. [DOI: 10.1007/s40264-018-0651-5] [Citation(s) in RCA: 87] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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Esatoglu SN, Kutlubay Z, Ucar D, Hatemi I, Uygunoglu U, Siva A, Hatemi G. Behçet's syndrome: providing integrated care. J Multidiscip Healthc 2017; 10:309-319. [PMID: 28860798 PMCID: PMC5565245 DOI: 10.2147/jmdh.s93681] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Behçet’s syndrome (BS) is a multisystem vasculitis that presents with a variety of mucocutaneous manifestations such as oral and genital ulcers, papulopustular lesions and erythema nodosum as well as ocular, vascular, gastrointestinal and nervous system involvement. Although it occurs worldwide, it is especially prevalent in the Far East and around the Mediterranean Sea. Male gender and younger age at disease onset are associated with a more severe disease course. The management of BS depends on the severity of symptoms. If untreated, morbidity and mortality are considerably high in patients with major organ involvement. Multidisciplinary patient care is essential for the management of BS, as it is for other multisystem diseases. Rheumatologists, dermatologists, ophthalmologists, neurologists, cardiovascular surgeons and gastroenterologists are members of the multidisciplinary team. In this study, we reviewed the epidemiology, etiology, diagnostic criteria sets, clinical findings and treatment of BS and highlighted the importance of the multidisciplinary team in the management of BS.
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Affiliation(s)
| | | | | | - Ibrahim Hatemi
- Division of Gastroenterology, Department of Internal Medicine
| | - Ugur Uygunoglu
- Department of Neurology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Aksel Siva
- Department of Neurology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Gulen Hatemi
- Division of Rheumatology, Department of Internal Medicine
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27
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Behçet's disease: How to diagnose and treat vascular involvement. Best Pract Res Clin Rheumatol 2016; 30:279-295. [DOI: 10.1016/j.berh.2016.08.002] [Citation(s) in RCA: 82] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Revised: 07/27/2016] [Accepted: 07/27/2016] [Indexed: 11/20/2022]
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28
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Hamuryudan V, Seyahi E, Ugurlu S, Melikoglu M, Hatemi G, Ozguler Y, Akman C, Tuzun H, Yurdakul S, Yazici H. Pulmonary artery involvement in Behçet׳s syndrome: Effects of anti-Tnf treatment. Semin Arthritis Rheum 2015; 45:369-73. [DOI: 10.1016/j.semarthrit.2015.06.008] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Revised: 05/01/2015] [Accepted: 06/12/2015] [Indexed: 01/20/2023]
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29
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Behcet's Disease with Intracardiac Thrombus Presenting with Fever of Unknown Etiology. Case Reports Immunol 2015; 2015:149359. [PMID: 26425377 PMCID: PMC4573877 DOI: 10.1155/2015/149359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Revised: 08/26/2015] [Accepted: 08/27/2015] [Indexed: 11/18/2022] Open
Abstract
A young male was referred to us for evaluation of fever of unknown origin (FUO). He had history of recurrent painful oral ulcers for one year and moderate to high grade fever, pustulopapular rash, and recurrent genital ulcers for 6 months and hemoptysis for 3 days. He was detected to have intracardiac thrombi and pulmonary arterial thrombosis along with underlying Behcet's disease (BD). Patient responded to high dose prednisolone (1 mg/Kg/day) along with monthly parenteral cyclophosphamide therapy. This case highlights the fact that BD is an important cause for pulmonary artery vasculitis with intracardiac thrombus formation, and such patients can present with FUO.
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