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Fujimoto M, Miyake T, Kaku Y, Hirata M, Kabashima K, Haga H. Cutaneous arteritis with intimal fibrin ring and immature myeloid cell infiltrate: lymphocytic thrombophilic arteritis or histiocytoid polyarteritis nodosa? Virchows Arch 2023:10.1007/s00428-023-03531-8. [PMID: 36964280 DOI: 10.1007/s00428-023-03531-8] [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: 01/29/2023] [Revised: 03/14/2023] [Accepted: 03/18/2023] [Indexed: 03/26/2023]
Abstract
The ongoing debate on whether lymphocytic thrombophilic arteritis (LTA) is a separate disease or a type of polyarteritis nodosa (PAN) has yet to be settled. In this study, we analyzed the nature of infiltrating cells in LTA to resolve this controversy. Skin biopsies from five female patients (mean age 29.4 years, age range 16-45 years) diagnosed with LTA were immunostained for CD3, CD20, CD68, lysozyme, myeloid cell nuclear differentiation antigen, myeloperoxidase, and PU.1. Immunohistochemistry revealed that the majority of mononuclear cells in all five cases were not lymphocytes but myelomonocytic cells. Given that the infiltrating cells are of the myelomonocyte lineage including immature myeloid cells, PAN was deemed the more appropriate diagnosis for the five cases rather than LTA. Whether PAN with immature myeloid cells (histiocytoid PAN) is the same disease as conventional PAN with mature neutrophils requires further investigation.
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Affiliation(s)
- Masakazu Fujimoto
- Department of Diagnostic Pathology, Kyoto University Hospital, 54 Shogoin Kawahara-Cho, Sakyo-Ku, Kyoto, 606-8507, Japan.
| | - Toshiya Miyake
- Department of Dermatology, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-Cho, Sakyo-Ku, Kyoto, 606-8507, Japan
| | - Yo Kaku
- Department of Dermatology, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-Cho, Sakyo-Ku, Kyoto, 606-8507, Japan.
| | - Masahiro Hirata
- Department of Diagnostic Pathology, Kyoto University Hospital, 54 Shogoin Kawahara-Cho, Sakyo-Ku, Kyoto, 606-8507, Japan
| | - Kenji Kabashima
- Department of Dermatology, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-Cho, Sakyo-Ku, Kyoto, 606-8507, Japan
| | - Hironori Haga
- Department of Diagnostic Pathology, Kyoto University Hospital, 54 Shogoin Kawahara-Cho, Sakyo-Ku, Kyoto, 606-8507, Japan
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Ikeda T. Recent topics related to etiology and clinical manifestations of cutaneous arteritis. Front Med (Lausanne) 2022; 9:1022512. [PMID: 36300176 PMCID: PMC9589105 DOI: 10.3389/fmed.2022.1022512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 09/20/2022] [Indexed: 12/02/2022] Open
Abstract
Cutaneous polyarteritis nodosa (cPAN) was first reported by Lindberg in 1931. It has been recognized as a skin-limited vasculitis whose cutaneous histopathological features are indistinguishable from those of PAN. Cutaneous arteritis (CA) was defined as a form of single-organ vasculitis in the revised Chapel Hill Classification and was recognized as the same disease as cPAN. It became known that deficiency of adenosine deaminase 2 (DADA2) cases were included in cases that had been diagnosed with CA. Because of their similarity and differences in the treatment methods, DADA2 should be considered in CA cases, especially if they are diagnosed or developed in early childhood. Cutaneous arteritis may be classified as an immune complex-mediated vasculitis. It was reported that the pathogenesis of anti-lysosomal-associated membrane protein-2 (LAMP-2) antibodies and anti-phosphatidylserine-prothrombin complex (PS/PT) antibodies as good parameters in CA. The main skin manifestations include livedo racemosa, subcutaneous nodules, and ulcers. Although CA is recognized to have a benign clinical course, it has become known that it is easy to relapse. The existence of skin ulcers upon diagnosis or sensory neuropathies was suggested to be a predictor of poor prognosis. Cutaneous arteritis with them may need to be treated with more intensive therapies.
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Papachristodoulou E, Kakoullis L, Tiniakou E, Parperis K. Therapeutic options for cutaneous polyarteritis nodosa: a systematic review. Rheumatology (Oxford) 2021; 60:4039-4047. [PMID: 33944902 DOI: 10.1093/rheumatology/keab402] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 04/23/2021] [Accepted: 04/28/2021] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE Cutaneous polyarteritis nodosa (CPAN) is a necrotizing vasculitis of the middle-size vessels, confined to the skin. We conducted a systematic review in order to identify studies evaluating the different treatment modalities used in CPAN. METHODS This systematic review was conducted according to PRISMA guidelines, registered in PROSPERO: CRD42020222195. PubMed/Medline databases were searched from inception to December of 2020 using the terms: (Polyarteritis nodosa[Title/Abstract]) AND ((therapy[Title/Abstract]) OR (management[Title/Abstract]) OR (treatment[Title/Abstract]))' and 'Cutaneous arteritis [Title/Abstract]'. Articles evaluating pertaining to the management of CPAN in adults were eligible for inclusion. RESULTS A total of seven eligible case series with 325 unique patients were included. No study included a control population. In general, systemic corticosteroids were widely used as induction treatment. Immunosuppressive agents combined with corticosteroids were AZA, hydroxychloroquine, sulfasalazine, sulphapyridine, CYC, MTX, mycophenolate, tacrolimus, rituxima and thalidomide. Other agents utilized in the studies were dapsone, colchicine, non-steroid anti-inflammatory drugs, salicylates, warfarin and clopidogrel. In some studies, the presence of ulcerations was associated with an increased risk of relapse. CONCLUSION The evidence available regarding the management of patients with CPAN is limited at best. Further studies are needed in order to evaluate the effect of treatment on disease remission, relapses and mortality.
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Affiliation(s)
| | - Loukas Kakoullis
- Department of Medicine, University of Cyprus Medical School, Nicosia, Cyprus
| | - Eleni Tiniakou
- Department of Medicine, Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Konstantinos Parperis
- Department of Internal Medicine, Division of Rheumatology, University of Cyprus Medical School, Nicosia, Cyprus.,Department of Medicine, Division of Rheumatology, University of Arizona College of Medicine, Phoenix, AZ, USA
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Matsuda KM, Yoshizaki A, Kotani H, Kuzumi A, Fukayama M, Ebata S, Fukasawa T, Yoshizaki-Ogawa A, Sato S. Development of a prediction model of treatment response in patients with cutaneous arteritis: Insights from a cohort of 33 patients. J Dermatol 2021; 48:1021-1026. [PMID: 33768589 DOI: 10.1111/1346-8138.15868] [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: 12/28/2020] [Revised: 02/02/2021] [Accepted: 03/10/2021] [Indexed: 11/28/2022]
Abstract
Cutaneous arteritis (CA) is necrotizing vasculitis invading the small- to medium-sized arteries of the skin. The majority of patients can be favorably managed by low- to medium-dose systemic corticosteroids (prednisolone, <0.5 mg/kg/day) or other oral medications such as non-steroidal anti-inflammatory drugs, dapsone, and azathioprine. Meanwhile, some patients require more intensive therapy including high-dose systemic corticosteroids (prednisolone, ≥0.5 mg/kg/day), i.v. immunoglobulin, and i.v. cyclophosphamide therapy. Although predicting such treatment response among CA patients is critical in clinical decision-making, prediction rules have not yet been established. Herein, we retrospectively reviewed 33 patients regularly visiting our clinic to reveal predictive factors of their treatment response. Clinical data were collected from electronic medical records. Association between each factor and treatment response was examined by logistic regression analysis. Progression-free time was calculated by Kaplan-Meier's method and analyzed by log-rank test and Cox progression hazard model. Potential predictive factors were selected, given 1 point for each, and integrated into a classification model. Discrimination of the model was examined by the receiver operating characteristic (ROC) curve analysis. In total, 33 CA patients were enrolled in our study. Of these, 11 patients required intensive therapy, classified as treatment non-responders. Logistic analyses revealed that treatment response was significantly associated with male sex, presence of skin ulcers, and elevated serum levels of C-reactive protein at the initial work-up. Kaplan-Meier analyses also demonstrated that those factors are predictive of progression-free time. The area under the ROC curve of our classification model was 0.92 (95% confidence interval, 0.83-1.00), which classified non-responders from the others with a sensitivity of 90.9% and specificity of 81.8% at the cut-off point of 2 or more. Collectively, treatment response of CA could be predictable by a combination of sex, presence of skin ulcers, and serum levels of C-reactive protein.
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Affiliation(s)
- Kazuki Mitsuru Matsuda
- Department of Dermatology, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Ayumi Yoshizaki
- Department of Dermatology, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Hirohito Kotani
- Department of Dermatology, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Ai Kuzumi
- Department of Dermatology, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Maiko Fukayama
- Department of Dermatology, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Satoshi Ebata
- Department of Dermatology, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Takemichi Fukasawa
- Department of Dermatology, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Asako Yoshizaki-Ogawa
- Department of Dermatology, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Shinichi Sato
- Department of Dermatology, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
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Munera-Campos M, Bielsa I, Martínez-Morillo M, Aparicio G, Olivé A, Ferrándiz C. Manifestationen, Krankheitsverlauf und prognostische Parameter bei kutaner Polyarteriitis nodosa. J Dtsch Dermatol Ges 2020; 18:1250-1260. [PMID: 33251748 DOI: 10.1111/ddg.14271_g] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 05/21/2020] [Indexed: 01/14/2023]
Affiliation(s)
- Mónica Munera-Campos
- Department of Dermatology, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Barcelona, Spain
| | - Isabel Bielsa
- Department of Dermatology, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Barcelona, Spain
| | - Melania Martínez-Morillo
- Department of Rheumatology, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Barcelona, Spain
| | - Gloria Aparicio
- Department of Dermatology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Alejandro Olivé
- Department of Rheumatology, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Barcelona, Spain
| | - Carlos Ferrándiz
- Department of Dermatology, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Barcelona, Spain
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Munera‐Campos M, Bielsa I, Martínez‐Morillo M, Aparicio G, Olivé A, Ferrándiz C. Manifestations, clinical course and prognostic markers in cutaneous polyarteritis nodosa. J Dtsch Dermatol Ges 2020; 18:1250-1259. [DOI: 10.1111/ddg.14271] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 05/21/2020] [Indexed: 12/29/2022]
Affiliation(s)
- Mónica Munera‐Campos
- Department of Dermatology Hospital Universitari Germans Trias i Pujol Universitat Autònoma de Barcelona Badalona Barcelona Spain
| | - Isabel Bielsa
- Department of Dermatology Hospital Universitari Germans Trias i Pujol Universitat Autònoma de Barcelona Badalona Barcelona Spain
| | - Melania Martínez‐Morillo
- Department of Rheumatology Hospital Universitari Germans Trias i Pujol Universitat Autònoma de Barcelona Badalona Barcelona Spain
| | - Gloria Aparicio
- Department of Dermatology Hospital Universitari Vall d’Hebron Universitat Autònoma de Barcelona Barcelona Spain
| | - Alejandro Olivé
- Department of Rheumatology Hospital Universitari Germans Trias i Pujol Universitat Autònoma de Barcelona Badalona Barcelona Spain
| | - Carlos Ferrándiz
- Department of Dermatology Hospital Universitari Germans Trias i Pujol Universitat Autònoma de Barcelona Badalona Barcelona Spain
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Tous-Romero F, Rodríguez-Almaraz E, Rodríguez-Peralto J, Postigo-Llorente C. Polyarteritis Nodosa with a Systemic Inflammatory Response Pattern: Effectiveness of anti-TNF. ACTAS DERMO-SIFILIOGRAFICAS 2017. [DOI: 10.1016/j.adengl.2017.07.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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9
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Tous-Romero F, Rodríguez-Almaraz E, Rodríguez-Peralto JL, Postigo-Llorente C. Polyarteritis Nodosa with a Systemic Inflammatory Response Pattern: Effectiveness of anti-TNF. ACTAS DERMO-SIFILIOGRAFICAS 2017; 108:787-790. [PMID: 28372782 DOI: 10.1016/j.ad.2017.01.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2016] [Revised: 01/02/2017] [Accepted: 01/04/2017] [Indexed: 10/19/2022] Open
Affiliation(s)
- F Tous-Romero
- Servicio de Dermatología, Hospital Universitario 12 de Octubre, Madrid, España.
| | - E Rodríguez-Almaraz
- Servicio de Reumatología, Hospital Universitario 12 de Octubre, Madrid, España
| | - J L Rodríguez-Peralto
- Servicio de Anatomía Patológica, Hospital Universitario 12 de Octubre, Madrid, España
| | - C Postigo-Llorente
- Servicio de Dermatología, Hospital Universitario 12 de Octubre, Madrid, España
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Kawakami T, Okano T, Takeuchi S, Kimura S, Soma Y. Complete resolution of refractory cutaneous arteritis by intravenous cyclophosphamide pulse therapy. Int J Dermatol 2015; 54:e323-5. [DOI: 10.1111/ijd.12863] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2014] [Revised: 08/13/2014] [Accepted: 09/08/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Tamihiro Kawakami
- Department of Dermatology; St. Marianna University School of Medicine; Kawasaki Japan
| | - Tatsuro Okano
- Department of Dermatology; St. Marianna University School of Medicine; Kawasaki Japan
| | - Sora Takeuchi
- Department of Dermatology; St. Marianna University School of Medicine; Kawasaki Japan
| | - Satoko Kimura
- Department of Dermatology; St. Marianna University School of Medicine; Kawasaki Japan
| | - Yoshinao Soma
- Department of Dermatology; St. Marianna University School of Medicine; Kawasaki Japan
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Merman E, Rosen C, Ghazarian D, Habeeb AA, Siddha S. Cutaneous Polyarteritis Nodosa Sine Nodosa. J Cutan Med Surg 2014; 18:420-3. [DOI: 10.2310/7750.2014.13165] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background and Objective: Cutaneous polyarteritis nodosa, a form of vasculitis affecting the small to medium sized arteries, most commonly presents as tender subcutaneous nodules over the lower legs and feet. Other features include livedo reticularis, skin ulcers and tender indurated plaques. Conclusion: We report a 51-year old woman with a primarily livedo reticularis presentation of cutaneous polyarteritis nodosa without a nodular component.
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Affiliation(s)
- Erica Merman
- From Undergraduate Medicine, University of Toronto; Division of Dermatology, and Department of Pathology, University Health Network Hospitals, Toronto, ON
| | - Cheryl Rosen
- From Undergraduate Medicine, University of Toronto; Division of Dermatology, and Department of Pathology, University Health Network Hospitals, Toronto, ON
| | - Danny Ghazarian
- From Undergraduate Medicine, University of Toronto; Division of Dermatology, and Department of Pathology, University Health Network Hospitals, Toronto, ON
| | - Ayman Al Habeeb
- From Undergraduate Medicine, University of Toronto; Division of Dermatology, and Department of Pathology, University Health Network Hospitals, Toronto, ON
| | - Sanjay Siddha
- From Undergraduate Medicine, University of Toronto; Division of Dermatology, and Department of Pathology, University Health Network Hospitals, Toronto, ON
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