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Chapuis E, Bousquet E, Viallard JF, Terrier B, Amoura Z, Batani V, Brézin A, Cacoub P, Caminati M, Chazal T, Comarmond C, Durieu I, Ebbo M, Grall M, Ledoult E, Losappio L, Mattioli I, Mékinian A, Padoan R, Regola F, Schroeder J, Seluk L, Trefond L, Wechsler ME, Lefevre G, Kahn JE, Sève P, Groh M. Ophthalmic vascular manifestations in eosinophil-associated diseases: a comprehensive analysis of 57 patients from the CEREO and EESG networks and a literature review. Front Immunol 2024; 15:1379611. [PMID: 38720897 PMCID: PMC11078014 DOI: 10.3389/fimmu.2024.1379611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 04/04/2024] [Indexed: 05/12/2024] Open
Abstract
Introduction Eosinophils have widespread procoagulant effects. In daily practice, eosinophil-related cardiovascular toxicity consists of endomyocardial damage, eosinophilic vasculitis and arterial or venous thrombosis. Here we aim to report on the clinical features and treatment outcomes of patients with unexplained ophthalmic vascular manifestations and eosinophilia. Methods We conducted a retrospective, multicenter, observational study and a literature review of patients with eosinophilia (≥0.5 x109/L) and concomitant ophthalmic vascular manifestations independent of the underlying eosinophilic disease but with no alternative cause for ophthalmic manifestations. Results Fifty-seven patients were included (20 from the observational study and 37 from the literature review). Ophthalmic vascular features were the initial manifestation of eosinophil-related disease in 34 (59%) patients and consisted of 29 central retinal artery occlusions, six branch retinal artery occlusions, five central retinal vein occlusions, two branch retinal vein occlusions, seven retinal vasculitides, two retinal vasospasms, 12 Purtscher's retinopathies, 13 anterior ischemic optic neuropathies and two posterior ischemic optic neuropathies. The median [IQR] absolute eosinophil count at onset of ophthalmic vascular manifestations was 3.5 [1.7-7.8] x109/L. Underlying eosinophil-related diseases included eosinophilic granulomatosis with polyangiitis (n=32), clonal hypereosinophilic syndrome (HES) (n=1), idiopathic HES (n=13), lymphocytic HES (n=2), adverse drug reactions (n=3), parasitosis (n=2), polyarteritis nodosa (n=1), IgG4-related disease (n=1), eosinophilic fasciitis (n=1) and primary sclerosing cholangitis (n=1). Other extra-ophthalmologic arterial or venous thromboses related to eosinophilia were reported in four (7%) and nine (16%) patients, respectively. Visual prognosis was poor: only eight (10%) patients achieved full recovery of ophthalmologic symptoms. After a median follow-up of 10.5 [1-18] months, one patient (3%) had a recurrence of an ophthalmic vascular manifestation, and three patients (10%) had a recurrence of other vascular symptoms (deep vein thrombosis in two and pulmonary embolism in one patient). At the time of recurrence, absolute eosinophil counts were above 0.5 x109/L in all cases (n=4). Discussion This study broadens the spectrum of vascular manifestations associated with hypereosinophilia by adding ophthalmic vascular manifestations. In patients with ophthalmological vascular manifestations and hypereosinophilia, aggressive treatment of the underlying pathology (and normalization of blood count) should be implemented.
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Affiliation(s)
- Elisa Chapuis
- National Reference Center for Hypereosinophilic Syndromes, CEREO, Suresnes, France
- Department of Internal Medicine, Bichat Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Elodie Bousquet
- Department of Ophthalmology, Lariboisière Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Jean-François Viallard
- National Reference Center for Hypereosinophilic Syndromes, CEREO, Suresnes, France
- Department of Internal Medicine, Bordeaux University Hospital, Bordeaux, France
| | - Benjamin Terrier
- Department of Internal Medicine, National Referral Center for Systemic and Autoimmune Diseases, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Zahir Amoura
- Department of Internal Medicine, Autoimmune and systemic diseases, La Pitié Salpetrière Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Veronica Batani
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Antoine Brézin
- Department of Ophthalmology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Patrice Cacoub
- Department of Internal Medicine and Clinical Immunology, La Pitié Salpetrière Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Marco Caminati
- Asthma Center and Allergy Unit, Center for Hyper-Eosinophilic Dysimmune Conditions, Department of Medicine, University of Verona, Verona, Italy
| | - Thibaud Chazal
- Department of Internal Medicine, Hospital Fondation Adolphe de Rothschild, Paris, France
| | - Cloé Comarmond
- Department of Internal Medicine, Competence Center for Rare Autoimmune and Inflammatory Diseases, Lariboisière Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Isabelle Durieu
- Department of Internal Medicine, Centre Hospitalier Universitaire Lyon Sud, Pierre-Bénite, France
| | - Mikael Ebbo
- National Reference Center for Hypereosinophilic Syndromes, CEREO, Suresnes, France
- Internal Medicine Department, Hopital La Timone, APHM, Aix Marseille University, Marseille, France
| | | | - Emmanuel Ledoult
- National Reference Center for Hypereosinophilic Syndromes, CEREO, Suresnes, France
- Department of Internal Medicine and Clinical Immunology, CHU Lille, Lille, France
| | - Laura Losappio
- Department of Clinical Immunology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Irene Mattioli
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Arsène Mékinian
- Department of Internal Medicine, St Antoine Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Roberto Padoan
- Unit of Rheumatology, Department of Medicine DIMED, University of Padua, Padua, Italy
| | - Francesca Regola
- Rheumatology and Clinical Immunology Unit, Department of Clinical and Experimental Sciences, ASST Spedali Civili and University of Brescia, Brescia, Italy
| | - Jan Schroeder
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Lior Seluk
- Department of Medicine, National Jewish Health, Denver, CO, United States
| | - Ludovic Trefond
- National Reference Center for Hypereosinophilic Syndromes, CEREO, Suresnes, France
- Department of Internal Medicine, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | | | - Guillaume Lefevre
- National Reference Center for Hypereosinophilic Syndromes, CEREO, Suresnes, France
- Inserm, U1286 - INFINITE - Institute for Translational Research in Inflammation, University of Lille, CHU Lille, Lille, France
| | - Jean-Emmanuel Kahn
- National Reference Center for Hypereosinophilic Syndromes, CEREO, Suresnes, France
- Department of Internal Medicine, Ambroise Pare Hospital, Assistance Publique-Hôpitaux de Paris, Boulogne, France
| | - Pascal Sève
- Department of Internal Medicine, Lyon University Hospital, Lyon, France
| | - Matthieu Groh
- National Reference Center for Hypereosinophilic Syndromes, CEREO, Suresnes, France
- Department of Internal Medicine, Foch Hospital, Suresnes, France
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Saadouli D, Ben Mansour K, Sallem S, Ammari L, El Afrit MA, Yahyaoui S. Purtscher-like retinopathy associated with idiopathic hypereosinophilic syndrome. J Fr Ophtalmol 2021; 44:e407-e409. [PMID: 33840490 DOI: 10.1016/j.jfo.2020.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 10/13/2020] [Accepted: 11/02/2020] [Indexed: 10/21/2022]
Affiliation(s)
- D Saadouli
- Service d'ophtalmologie, centre hospitalo-universitaire La Rabta, 1007 Tunis, Tunisia.
| | - K Ben Mansour
- Service d'ophtalmologie, centre hospitalo-universitaire La Rabta, 1007 Tunis, Tunisia
| | - S Sallem
- Département d'infectiologie, centre hospitalo-universitaire La Rabta, 1007 Tunis, Tunisia
| | - L Ammari
- Département d'infectiologie, centre hospitalo-universitaire La Rabta, 1007 Tunis, Tunisia
| | - M A El Afrit
- Service d'ophtalmologie, centre hospitalo-universitaire La Rabta, 1007 Tunis, Tunisia
| | - S Yahyaoui
- Faculty of medecine of Tunis, Tunis, Tunisia
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Inayat F, O'Neill SS, Zafar F, Marupudi S, Vasim I. Idiopathic hypereosinophilic syndrome with cutaneous involvement: a comparative review of 32 cases. BMJ Case Rep 2018; 11:11/1/bcr-2018-227137. [PMID: 30567176 DOI: 10.1136/bcr-2018-227137] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Although idiopathic hypereosinophilic syndrome (HES) is uncommon, we studied the clinical characteristics of this disorder in patients with cutaneous involvement. We chronicle the case of a patient with diffuse skin rash due to idiopathic HES from our clinical experience. Furthermore, a systematic literature search of the medical databases PubMed and Google Scholar was conducted. A total of 32 cases fulfilled the inclusion criteria. The data on patients' characteristics, epidemiology, clinical features, diagnosis, treatment and outcome were collected and analysed. This review illustrates that physicians should maintain a high index of clinical suspicion for idiopathic HES in patients presenting with dermatological lesions and hypereosinophilia, without an obvious cause. Randomised clinical trials are warranted to outline a generalised and efficient therapeutic approach in these patients. Additionally, this paper highlights the need for population-based studies to delineate the magnitude and scope of this association.
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Affiliation(s)
| | - Stacey S O'Neill
- Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, USA
| | - Fahad Zafar
- King Edward Medical University, Lahore, Pakistan
| | - Sindhuja Marupudi
- Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, USA
| | - Izzah Vasim
- Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, USA
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