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Takimoto-Ito R, Kambe N, Kogame T, Nomura T, Izawa K, Jo T, Kazuma Y, Yoshifuji H, Tabuchi Y, Abe H, Yamamoto M, Nakajima K, Tomita O, Yagi Y, Katagiri K, Matsuzaka Y, Takeuchi Y, Hatanaka M, Kanekura T, Takeuchi S, Kadono T, Fujita Y, Migita K, Fujino T, Akagi T, Mukai T, Nagano T, Kawano M, Kimura H, Okubo Y, Morita A, Hide M, Satoh T, Asahina A, Kanazawa N, Kabashima K. Summary of the current status of clinically diagnosed cases of Schnitzler syndrome in Japan. Allergol Int 2022; 72:297-305. [PMID: 36470790 DOI: 10.1016/j.alit.2022.11.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 10/16/2022] [Accepted: 10/31/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Schnitzler syndrome is a rare disorder with chronic urticaria, and there is no report summarizing the current status in Japan. METHODS A nationwide survey of major dermatology departments in Japan was conducted in 2019. We further performed a systematic search of PubMed and Ichushi-Web, using the keywords "Schnitzler syndrome" and "Japan" then contacted the corresponding authors or physicians for further information. RESULTS Excluding duplicates, a total of 36 clinically diagnosed cases were identified from 1994 through the spring of 2022, with a male to female ratio of 1:1. The median age of onset was 56.5 years. It took 3.3 years from the first symptom, mostly urticaria, to reach the final diagnosis. The current status of 30 cases was ascertained; two patients developed B-cell lymphoma. SchS treatment was generally effective with high doses of corticosteroids, but symptoms sometimes recurred after tapering. Colchicine was administered in 17 cases and was effective in 8, but showed no effect in the others. Tocilizumab, used in six cases, improved laboratory abnormalities and symptoms, but lost its efficacy after several years. Rituximab, used in five cases, was effective in reducing serum IgM levels or lymphoma mass, but not in inflammatory symptoms. Four cases were treated with IL-1 targeting therapy, either anakinra or canakinumab, and achieved complete remission, except one case with diffuse large B-cell lymphoma. CONCLUSIONS Since Schnitzler syndrome is a rare disease, the continuous collection and long-term follow-up of clinical information is essential for its appropriate treatment and further understanding of its pathophysiology.
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Kecelj Žgank B, Benko M. A patient with urticarial lesions, recurrent fever, and IgM-type monoclonal gammopathy. ACTA DERMATOVENEROLOGICA ALPINA PANNONICA ET ADRIATICA 2022. [DOI: 10.15570/actaapa.2022.s9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Abstract
PURPOSE OF REVIEW We focus on recent advances in diagnosis and therapeutic strategies, as well as on pathogenesis of Schnitzler syndrome. RECENT FINDINGS New diagnostic criteria were established, and their external validity was assessed in a retrospective cohort study. The cytokine interleukin-1 (IL-1) plays a crucial role in the pathogenesis of the Schnitzler syndrome, and this explains the spectacular efficiency of IL-1 blocking therapies. The Schnitzler syndrome is now considered as a late-onset acquired autoinflammatory syndrome in which the cytokine IL-1 plays a crucial role. IL-1 blocking therapies are efficient on the inflammation-linked symptoms but not on the monoclonal component. Therefore, they probably don't reduce the risk of the development of lymphoproliferative disorders that remains the main prognostic issue. The link between autoinflammation and the monoclonal component needs to be further elucidated.
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Gusdorf L, Asli B, Barbarot S, Néel A, Masseau A, Puéchal X, Gottenberg JE, Grateau G, Blanchard-Delaunay C, Rizzi R, Lifermann F, Kyndt X, Aubin F, Bessis D, Boye T, Gayet S, Rongioletti F, Sauleau E, Fermand JP, Lipsker D. Schnitzler syndrome: validation and applicability of diagnostic criteria in real-life patients. Allergy 2017; 72:177-182. [PMID: 27564982 DOI: 10.1111/all.13035] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Schnitzler syndrome is characterized by an urticarial rash, a monoclonal gammopathy, and clinical, histological, and biological signs of neutrophil-mediated inflammation. The aim of this study was to assess the applicability and validity of the existing diagnostic criteria in real-life patients. METHODS This multicentric study was conducted between 2009 and 2014 in 14 hospitals in which patients with Schnitzler syndrome or controls with related disorders were followed up. We compared the sensitivities and specificities and calculated the positive and negative predictive values of the Lipsker and of the Strasbourg criteria for the patients with Schnitzler syndrome and for the controls. We included 42 patients with Schnitzler syndrome, 12 with adult-onset Still's disease, 7 with cryopyrin-associated periodic disease, 9 with Waldenström disease, and 10 with chronic spontaneous urticaria. RESULTS All patients with Schnitzler syndrome met the Lipsker criteria. According to the Strasbourg criteria, 34 patients had definite Schnitzler syndrome, five had probable Schnitzler syndrome, and three did not meet the criteria. One control met the Lipsker criteria and had probable Schnitzler syndrome according to the Strasbourg criteria. Sensitivity and specificity of the Lipsker criteria were 100% and 97%, respectively. For the Strasbourg criteria, sensitivity for definite and probable diagnosis was 81% and 93%, respectively, with a corresponding specificity of 100% and 97%. CONCLUSION Diagnostic criteria currently in use to diagnose Schnitzler syndrome are reliable. More investigations must be done to attest their efficiency in patients with recent-onset manifestations.
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Affiliation(s)
- L. Gusdorf
- Clinique Dermatologique; Hôpitaux Universitaires de Strasbourg; Strasbourg France
| | - B. Asli
- Unité d'Immuno-Hématologie; Hôpital Saint-Louis; Assistance Publique-Hôpitaux de Paris; Paris France
| | - S. Barbarot
- Service de Dermatologie; CHU Hôtel-Dieu; Nantes France
| | - A. Néel
- Service de Médecine Interne; CHU Hôtel Dieu; Nantes France
| | - A. Masseau
- Service de Médecine Interne; CHU Hôtel Dieu; Nantes France
| | - X. Puéchal
- Service de Médecine Interne; Hôpital Cochin; Assistance Publique-Hôpitaux de Paris; Paris France
| | - J-E. Gottenberg
- Service de Rhumatologie; Hôpitaux Universitaires de Strasbourg; Strasbourg France
| | - G. Grateau
- Service de Médecine Interne; Hôpital Tenon; Assistance Publique-Hôpitaux de Paris; Paris France
| | | | - R. Rizzi
- Department of Emergency and Organ Transplantation; Section of Hematology with Transplantation; University of Bari; Bari Italy
| | - F. Lifermann
- Service de Médecine Interne; Centre Hospitalier; Dax France
| | - X. Kyndt
- Service de Médecine Interne; Centre Hospitalier; Valenciennes France
| | - F. Aubin
- Service de Dermatologie; CHU de Besançon; Besançon France
| | - D. Bessis
- Service de Dermatologie; CHU Saint-Eloi; Montpellier France
| | - T. Boye
- Service de Dermatologie; Hôpital d'Instruction des Armées Sainte-Anne; Toulon France
| | - S. Gayet
- Service de Médecine Interne; Gériatrie et Thérapeutique; CHU de la Timone; Marseille France
| | - F. Rongioletti
- Department of Dermatology; University of Genova; Genova Italy
| | - E. Sauleau
- Service de Santé Publique; Hôpitaux Universitaires de Strasbourg; Strasbourg France
| | - J-P. Fermand
- Unité d'Immuno-Hématologie; Hôpital Saint-Louis; Assistance Publique-Hôpitaux de Paris; Paris France
| | - D. Lipsker
- Clinique Dermatologique; Hôpitaux Universitaires de Strasbourg; Strasbourg France
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Criado RFJ, Criado PR, Vasconcellos C, Szajubok JCM, Michalany NS, Kadunc BV, Costa Martins JE. Urticaria as a Cutaneous Sign of Adult-Onset Still's Disease. J Cutan Med Surg 2016; 10:99-103. [PMID: 17241583 DOI: 10.2310/7750.2006.00017] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background: The cardinal signs and symptoms of adult-onset Still's disease (AOSD) include periodic fever, arthralgia and arthritis, lymphadenopathy, hepatosplenomegaly, an evanescent rash accompanied by neutrophilic granulocytosis, and a negative rheumatoid factor and antinuclear antibody test. Objective: To alert clinicians and dermatologists to internal diseases such as AOSD when assisting patients with urticarial eruptions and systemic symptoms. Methods: A case report of a 52-year-old white woman who received conventional therapy for urticaria for 3 years, with no improvement. Following this period, a diagnosis of AOSD was performed based on the presence of systemic symptoms. Results: The inflammatory activity markers decreased by the second month of methotrexate therapy; however, the cutaneous lesions failed to disappear. Thalidomide was initiated, and total improvement of the cutaneous lesions was observed after 2 weeks. Conclusion: Urticarial rash is an uncommon presentation of AOSD, and clinicians must be alert to the possibility of a misdiagnosis in these cases.
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Affiliation(s)
- Roberta F J Criado
- Allergy Unit, Dermatology Department of Faculdade de Medicina do ABC, Santo André, Brazil
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[Dermatological manifestations of monoclonal gammopathies: contribution of cutaneous histopathology]. Ann Pathol 2015; 35:281-93. [PMID: 26188671 DOI: 10.1016/j.annpat.2015.05.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Accepted: 05/06/2015] [Indexed: 12/19/2022]
Abstract
Skin manifestations associated with monoclonal gammapathy are common and can present with various clinical and pathological aspects. They can be the first events leading to the diagnosis of monoclonal gammapathy. They may be present either as specific lesions, including lymphoplasmacytic or pure plasma cell neoplastic infiltrates and monoclonal immunoglobulin deposits, or as non-specific dermatitis, such as leukocytoclastic vasculitis, neutrophilic dermatoses, mucinoses or xanthomatosis, giving little clues for the diagnosis of the underlying disease.
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Longhurst H, Yong P, Manson A, Cavenagh J, Grigoriadou S, Buckland M. Mullins' syndrome: a new gammopathy-related autoinflammatory syndrome resistant to anakinra. QJM 2015; 108:497-501. [PMID: 23108029 PMCID: PMC4446788 DOI: 10.1093/qjmed/hcs208] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- H.J. Longhurst
- From the Department of Immunology and Department of Haemato-Oncology, Barts Health NHS Trust, 2nd Floor, Pathology and Pharmacy Building, The Royal London Hospital, 80 Newark Street, London E1 2ES, UK
| | - P.F.K. Yong
- From the Department of Immunology and Department of Haemato-Oncology, Barts Health NHS Trust, 2nd Floor, Pathology and Pharmacy Building, The Royal London Hospital, 80 Newark Street, London E1 2ES, UK
| | - A.L. Manson
- From the Department of Immunology and Department of Haemato-Oncology, Barts Health NHS Trust, 2nd Floor, Pathology and Pharmacy Building, The Royal London Hospital, 80 Newark Street, London E1 2ES, UK
| | - J.D. Cavenagh
- From the Department of Immunology and Department of Haemato-Oncology, Barts Health NHS Trust, 2nd Floor, Pathology and Pharmacy Building, The Royal London Hospital, 80 Newark Street, London E1 2ES, UK
| | - S. Grigoriadou
- From the Department of Immunology and Department of Haemato-Oncology, Barts Health NHS Trust, 2nd Floor, Pathology and Pharmacy Building, The Royal London Hospital, 80 Newark Street, London E1 2ES, UK
| | - M.S. Buckland
- From the Department of Immunology and Department of Haemato-Oncology, Barts Health NHS Trust, 2nd Floor, Pathology and Pharmacy Building, The Royal London Hospital, 80 Newark Street, London E1 2ES, UK
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Gallo J, Paira S. Schnitzler syndrome. REUMATOLOGIA CLINICA 2015; 11:124-125. [PMID: 25441494 DOI: 10.1016/j.reuma.2014.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Revised: 06/28/2014] [Accepted: 07/02/2014] [Indexed: 06/04/2023]
Affiliation(s)
- Jesica Gallo
- Sección de Reumatología, Hospital Cullen, Santa Fe, Argentina.
| | - Sergio Paira
- Sección de Reumatología, Hospital Cullen, Santa Fe, Argentina.
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Abstract
Schnitzler’s syndrome is an autoinflammatory disorder characterized by the association of a monoclonal IgM (or IgG) gammopathy, a chronic urticarial rash, and signs and symptoms of systemic inflammation, including fever, arthralgias and bone pain. It was first described in 1972. This review summarizes the clinical features, efficacy of therapies, and follow-up data of the 281 cases that have been reported to date. Also, the results of skin histology, bone imaging, laboratory investigations, and studies of the pathogenesis will be discussed, including the pivotal role of interleukin-1 beta in this disorder.
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Abstract
Schnitzler's syndrome is an extremely rare entity that poses a challenge for the clinician not only due to its difficult diagnosis but also due to its management. In this article we report a new case and briefly review the current treatment options.
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Lee K, Grattan C. Intracostal neuralgia as a previously undescribed symptom of Schnitzler’s syndrome. Br J Dermatol 2012; 167:1392-3. [DOI: 10.1111/j.1365-2133.2012.11057.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- K.Y.C. Lee
- Department of Dermatology, Norfolk and Norwich University Hospital, Colney Lane, Norwich NR4 7UY, U.K.
E‐mail:
| | - C.E.H. Grattan
- Department of Dermatology, Norfolk and Norwich University Hospital, Colney Lane, Norwich NR4 7UY, U.K.
E‐mail:
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Tinazzi E, Puccetti A, Patuzzo G, Sorleto M, Barbieri A, Lunardi C. Schnitzler syndrome, an autoimmune–autoinflammatory syndrome: Report of two new cases and review of the literature. Autoimmun Rev 2011; 10:404-9. [DOI: 10.1016/j.autrev.2011.01.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2010] [Accepted: 01/07/2011] [Indexed: 12/12/2022]
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Kieffer C, Cribier B, Lipsker D. Neutrophilic urticarial dermatosis: a variant of neutrophilic urticaria strongly associated with systemic disease. Report of 9 new cases and review of the literature. Medicine (Baltimore) 2009; 88:23-31. [PMID: 19352297 DOI: 10.1097/md.0b013e3181943f5e] [Citation(s) in RCA: 149] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
We conducted the current study to define within the spectrum of the neutrophilic dermatoses a group of patients with an urticarial rash clinically and a neutrophilic dermatosis histopathologically. We reviewed the literature on neutrophilic urticaria and we report here a series of patients with this unique presentation. We reviewed all cutaneous biopsies submitted to our department between 2000 and 2006 in which histopathologic evaluation was compatible with this entity. We then retrieved the patient medical records and obtained information about follow-up and associated diseases. This allowed us to identify 9 patients with an urticarial eruption that was characterized histopathologically by a perivascular and interstitial neutrophilic infiltrate with intense leukocytoclasia but without vasculitis and without dermal edema. Four patients also had small foci of necrobiotic collagen bundles. The eruption consisted of pale, flat or only slightly raised, nonpruritic macules, papules, or plaques. Elementary lesions resolved within 24 hours. Purpura, angioedema, and facial swelling were not seen, but dermographism was present in 1 patient. Six patients had fever, 7 had polyarthritis, and 6 had leukocytosis. Seven patients had associated systemic diseases: adult-onset Still disease (3 patients), systemic lupus erythematosus (3 patients), and Schnitzler syndrome (1 patient).A similar rash has been reported previously in the literature, mostly in patients with systemic inflammatory diseases, but the majority of patients reported under the undefined designation of "neutrophilic urticaria" did have a different clinicopathologic presentation. Thus, we suggest naming this eruption "neutrophilic urticarial dermatosis," to emphasize that this entity expands the broad group of cutaneous manifestations of neutrophilic aseptic disease. This entity bears important medical significance as it is strongly indicative of an associated systemic disease, mainly Schnitzler syndrome, adult-onset Still disease, lupus erythematosus, and the hereditary autoinflammatory fever syndromes.
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Affiliation(s)
- Carine Kieffer
- From the Université Louis Pasteur, Faculté de Médecine et Clinique Dermatologique, Hôpitaux Universitaires, Strasbourg, France
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Eiling E, Schröder JO, Gross WL, Kreiselmaier I, Mrowietz U, Schwarz T. The Schnitzler syndrome: Chronic urticaria and monoclonal gammopathy - an autoinflammatory syndrome? J Dtsch Dermatol Ges 2008; 6:626-31. [DOI: 10.1111/j.1610-0387.2008.06627.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Rongioletti F, Patterson JW, Rebora A. The histological and pathogenetic spectrum of cutaneous disease in monoclonal gammopathies. J Cutan Pathol 2008; 35:705-21. [DOI: 10.1111/j.1600-0560.2007.00884.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Abstract
The term autoinflammatory syndromes describes a distinct group of systemic inflammatory diseases apparently different from infectious, autoimmune, allergic and immunodeficient ones. Originally, it was almost synonymous with clinically defined hereditary periodic fever syndromes, including familial Mediterranean fever, hyper immunoglobulin D syndrome with periodic fever and tumor necrosis factor receptor-associated periodic syndrome. Similar but distinct periodic fever syndromes accompanied by urticarial rash, familial cold autoinflammatory syndrome, Muckle-Wells syndrome and chronic infantile neurological cutaneous articular syndrome, have all been reportedly associated with CIAS1 mutations and are collectively called cryopyrin-associated periodic syndromes. Consequently, the concept of autoinflammatory syndromes has been spread to contain other systemic inflammatory diseases: rare hereditary diseases with or without periodic fevers, such as pyogenic sterile arthritis, pyoderma gangrenosum and acne syndrome, Blau syndrome and chronic recurrent multifocal osteomyelitis, and the more common collagen disease-like diseases, such as Behcet's disease, Crohn's disease, sarcoidosis and psoriatic arthritis. These diseases are all caused by or associated with mutations of genes regulating innate immunity and have common clinical features accompanied with activation of neutrophils and/or monocytes/macrophages. In this review, major autoinflammatory syndromes are summarized and the pathophysiology of related skin disorders is discussed in association with dysregulated innate immune signaling.
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Affiliation(s)
- Nobuo Kanazawa
- Department of Dermatology, Wakayama Medical University, Wakayama, Japan.
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de Koning HD, Bodar EJ, van der Meer JWM, Simon A. Schnitzler syndrome: beyond the case reports: review and follow-up of 94 patients with an emphasis on prognosis and treatment. Semin Arthritis Rheum 2007; 37:137-48. [PMID: 17586002 DOI: 10.1016/j.semarthrit.2007.04.001] [Citation(s) in RCA: 168] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2006] [Revised: 03/16/2007] [Accepted: 04/16/2007] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Schnitzler syndrome is a rare disorder characterized by a chronic urticarial rash and monoclonal gammopathy, accompanied by intermittent fever, arthralgia or arthritis, bone pain, and lymphadenopathy. Our objectives are to systematically review disease characteristics of Schnitzler syndrome and collect follow-up information to gain insight into treatment efficacy and long-term prognosis. METHODS PubMed and MEDLINE databases (1966-2006) were searched, using the key words "Schnitzler syndrome," and the combination of "urticaria" with "monoclonal gammopathy," "immunoglobulin M (IgM)," or "paraproteinemia," as well as secondary references. Data on a total of 94 patients who met the criteria for Schnitzler syndrome were reviewed. Questionnaires sent to all authors retrieved additional follow-up data on 43 patients, resulting in a mean follow-up of 9.5 years after onset of symptoms, and a follow-up of 20 years or more in 10 patients. RESULTS Symptoms, signs, and laboratory findings as found in the 94 patients are reviewed in detail. There have been promising developments in therapeutic options, especially antiinterleukin-1 treatment, which induced complete remission in all 8 patients treated so far. To date, no spontaneous complete remissions have been reported. Patients with Schnitzler syndrome showed no increased mortality during the present follow-up. However, they had a 10-year risk of 15% of developing a lymphoproliferative disorder, most notably Waldenström's macroglobulinemia. Three cases of type amyloid A (AA) amyloidosis associated with Schnitzler syndrome were reported. CONCLUSIONS Schnitzler syndrome is a disabling disorder which affects multiple systems and which can be considered as an autoinflammatory syndrome. There are new, effective treatment options, but close monitoring remains warranted because of the increased risk of lymphoproliferative disease.
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Affiliation(s)
- Heleen D de Koning
- Division of General Internal Medicine, Department of Internal Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
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Dalle S, Balme B, Sebban C, Pariset C, Berger F, Thomas L. Schnitzler syndrome associated with systemic marginal zone B-cell lymphoma. Br J Dermatol 2007; 155:827-9. [PMID: 16965436 DOI: 10.1111/j.1365-2133.2006.07417.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Schnitzler syndrome is a rare condition defined by chronic urticaria and monoclonal IgM gammopathy. Malignant evolution to Waldenström disease (WD) has been reported in several cases. We report a 49-year-old man who developed a marginal zone B-cell lymphoma (MZL) 3 years after the beginning of Schnitzler syndrome. This is the first report of MZL in association with Schnitzler syndrome. IgM gammopathy is a clue for the diagnosis of Schnitzler syndrome. This condition needs to be closely monitored; it can precede the onset of an authentic lymphoproliferative disorder including WD and rarely MZL.
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Affiliation(s)
- S Dalle
- Service d'Hématologie, Centre Léon Bérard, Lyon, France.
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Varella TCN, Nishimura MY, Machado MCR, de Moraes-Vasconcelos D, Rivitti EA. Schnitzler's syndrome without monoclonal gammopathy. Acta Derm Venereol 2005; 85:272-3. [PMID: 16040423 DOI: 10.1080/00015550410026119] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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de Koning HD, Bodar EJ, Simon A, van der Hilst JCH, Netea MG, van der Meer JWM. Beneficial response to anakinra and thalidomide in Schnitzler's syndrome. Ann Rheum Dis 2005; 65:542-4. [PMID: 16096327 PMCID: PMC1798111 DOI: 10.1136/ard.2005.045245] [Citation(s) in RCA: 114] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Schnitzler's syndrome is an inflammatory disorder characterised by chronic urticarial rash and monoclonal gammopathy, accompanied by periodic fever, arthralgia or arthritis, and bone pain. The cause and treatment are still unknown. OBJECTIVE To assess treatment with thalidomide and an interleukin 1 receptor antagonist, anakinra, in Schnitzler's syndrome. CASE REPORTS Three patients with Schnitzler's syndrome are described, one with IgM gammopathy, two with IgG type. In one patient, thalidomide induced complete remission, but was stopped because of polyneuropathy. Anakinra 100 mg daily in all three patients led to disappearance of fever and skin lesions within 24 hours. After a follow up of 6-18 months, all patients are free of symptoms. CONCLUSION Anakinra proved to be effective in three patients with Schnitzler's syndrome. This treatment is preferable to thalidomide, which induced a complete remission in one of our patients, as it has fewer side effects.
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Affiliation(s)
- H D de Koning
- Radboud University Nijmegen Medical Centre, Department of General Internal Medicine, 6500 HB Nijmegen, The Netherlands
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