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Kira YI, Yoshikawa Y, Tashiro T, Maeda N. Granulomatosis with Polyangiitis Presenting with Thrombovasculitic and Necrotizing Pachy- and Leptomeningitis Accompanied by a Brain Tumor-like Lesion. Intern Med 2023; 62:3241-3246. [PMID: 36948617 PMCID: PMC10686742 DOI: 10.2169/internalmedicine.0833-22] [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: 08/13/2022] [Accepted: 02/01/2023] [Indexed: 03/24/2023] Open
Abstract
We report a case of granulomatosis with polyangiitis (GPA) presenting with hypertrophic pachymeningitis with a huge brain tumor-like lesion. A 57-year-old man acutely developed consciousness disturbance. Magnetic resonance imaging revealed a right frontal lobe mass with thickened, contrast-enhanced dura. Computed tomography revealed sinusitis and multiple lung nodules. The presence of proteinase 3-anti-neutrophil cytoplasmic antibody indicated GPA. Histopathology of the excised brain tissues revealed thrombovasculitis with heavy neutrophilic infiltration in the pachy- and leptomeninges covering an ischemic cerebral cortex. The patient improved with corticosteroids and rituximab. Our case warrants considering GPA as a cause of hypertrophic pachymeningitis with brain-tumor like lesions.
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Affiliation(s)
- Yuu-Ichi Kira
- Department of Neurology, National Hospital Organization Beppu Medical Center, Japan
| | - Yasuji Yoshikawa
- Department of Pathology, National Hospital Organization Beppu Medical Center, Japan
| | - Takumi Tashiro
- Department of Neurology, National Hospital Organization Beppu Medical Center, Japan
| | - Norihisa Maeda
- Department of Neurology, National Hospital Organization Beppu Medical Center, Japan
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Wang CR, Tsai YS, Lee CH. Mepolizumab therapy improves endomyocarditis in seropositive eosinophilic granulomatosis with polyangiitis. Arch Rheumatol 2023; 38:159-161. [PMID: 37235127 PMCID: PMC10208624 DOI: 10.46497/archrheumatol.2023.9559] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Accepted: 04/23/2022] [Indexed: 03/04/2024] Open
Affiliation(s)
- Chrong-Reen Wang
- Department of Internal Medicine, Division of Rheumatology, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Yi-Shan Tsai
- Department of Medical Imaging, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Cheng-Han Lee
- Department of Internal Medicine, Division of Cardiology, National Cheng Kung University Hospital, Tainan, Taiwan
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Egorova ON, Kharlamova EN, Tarasova GM. Differential diagnosis of a local form of granulomatosis with polyangiitis: nasal cavity and paranasal sinuses lesions (part 1). MODERN RHEUMATOLOGY JOURNAL 2023. [DOI: 10.14412/1996-7012-2023-1-7-15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
Granulomatosis with polyangiitis (GPA) is a primary vasculitis associated with antineutrophil cytoplasmic antibodies, characterized by necrotizing vasculitis with predominant involvement of small vessels of various localizations and necrotizing granulomatous inflammation with multiple clinical manifestations. GPA remains one of the most severe systemic vasculitis with unfavorable prognosis. When analyzing the course of the disease, there are two variants of GPA, local (with lesions of the upper respiratory tract, URT, organs of vision and hearing) and generalized (with lesions of the URT, organs of vision and hearing in combination with the lungs and/or kidneys, gastrointestinal tract, nervous systems, skin involvement).The article discusses the differential diagnosis of the disease with the nasal cavity and paranasal sinuses lesions onset, which requires an interdisciplinary approach and interaction of doctors of different specialties.
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Nakamura Y, Okumura F, Nihei M, Chubachi K, Sakamoto H, Ishioka Y, Makiguchi T, Tanaka H, Taima K, Yajima N, Kurose A, Tasaka S. Granulomatosis with Polyangiitis following COVID-19 in an Adolescent. Intern Med 2023; 62:589-593. [PMID: 36792217 PMCID: PMC10017231 DOI: 10.2169/internalmedicine.1109-22] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/16/2023] Open
Abstract
Granulomatosis with polyangiitis (GPA) is a systemic disease that causes vasculitis in various organs. Although the mechanism of pathogenesis remains unclear, infection has been reported to be a causative factor. We herein report a case of GPA that developed following coronavirus disease 2019 (COVID-19) in an adolescent girl. One month after contracting mild COVID-19, the patient had facial allodynia, a fever, and weight loss and was admitted for multiple nodular shadows on a chest roentgenogram. GPA was diagnosed based on pathological findings of the lung and nasal mucosal biopsies. She received methylprednisolone and rituximab, and her symptoms and radiological findings improved.
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Affiliation(s)
- Yume Nakamura
- Department of Respiratory Medicine, Hirosaki University Graduate School of Medicine, Japan
- Department of Respiratory Medicine, Hachinohe City Hospital, Japan
| | - Fumihiko Okumura
- Department of Respiratory Medicine, Hirosaki University Graduate School of Medicine, Japan
- Department of Respiratory Medicine, Hachinohe City Hospital, Japan
| | - Mayumi Nihei
- Department of Respiratory Medicine, Hachinohe City Hospital, Japan
| | - Kei Chubachi
- Department of Respiratory Medicine, Hirosaki University Graduate School of Medicine, Japan
| | - Hiroaki Sakamoto
- Department of Respiratory Medicine, Hirosaki University Graduate School of Medicine, Japan
| | - Yoshiko Ishioka
- Department of Respiratory Medicine, Hirosaki University Graduate School of Medicine, Japan
| | - Tomonori Makiguchi
- Department of Respiratory Medicine, Hirosaki University Graduate School of Medicine, Japan
| | - Hisashi Tanaka
- Department of Respiratory Medicine, Hirosaki University Graduate School of Medicine, Japan
| | - Kageaki Taima
- Department of Respiratory Medicine, Hirosaki University Graduate School of Medicine, Japan
| | - Nobuhisa Yajima
- Department of Pathology and Laboratory Medicine, Hachinohe City Hospital, Japan
| | - Akira Kurose
- Department of Anatomic Pathology, Hirosaki University Hospital, Japan
| | - Sadatomo Tasaka
- Department of Respiratory Medicine, Hirosaki University Graduate School of Medicine, Japan
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Kuwabara G, Yamada K, Tanaka K, Nozuchi S, Imoto W, Shibata W, Tohda M, Kyoh S, Itoh Y, Hashimoto M, Kakeya H. Muscle Biopsy-proven Drug-induced Microscopic Polyangiitis in a Patient with Tuberculosis. Intern Med 2023; 62:129-133. [PMID: 35650134 PMCID: PMC9876704 DOI: 10.2169/internalmedicine.9599-22] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 04/13/2022] [Indexed: 02/04/2023] Open
Abstract
We herein report a case of muscle biopsy-proven microscopic polyangiitis (MPA) in a patient with tuberculosis. The patient had developed a persistent fever after the initiation of treatment for tuberculosis and was positive for myeloperoxidase-antineutrophil cytoplasmic antibody (ANCA). However, because conventional symptoms were lacking, determination of the biopsy site was difficult. Based on the findings of a biopsy of the biceps femoris, which confirmed small vessel vasculitis, the patient was diagnosed with MPA. The fever was alleviated by glucocorticoids. Tuberculosis and antituberculosis drugs can cause ANCA-associated vasculitis (AAV). A muscle biopsy is useful for the diagnosis of AAV.
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Affiliation(s)
- Gaku Kuwabara
- Department of Infection Control Science, Graduate School of Medicine, Osaka City University, Japan
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka City University, Japan
| | - Koichi Yamada
- Department of Infection Control Science, Graduate School of Medicine, Osaka City University, Japan
| | - Kiyomi Tanaka
- Post Graduate Medical Training Center, Osaka City University Hospital, Japan
| | - Satoshi Nozuchi
- Department of Neurology, Graduate School of Medicine, Osaka City University, Japan
| | - Waki Imoto
- Department of Infection Control Science, Graduate School of Medicine, Osaka City University, Japan
| | - Wataru Shibata
- Department of Infection Control Science, Graduate School of Medicine, Osaka City University, Japan
| | - Mitsunori Tohda
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka City University, Japan
| | - Shigenori Kyoh
- Department of Respiratory Medicine, Wakakusa-Daiichi Hospital, Japan
| | - Yoshiaki Itoh
- Department of Neurology, Graduate School of Medicine, Osaka City University, Japan
| | - Motomu Hashimoto
- Department of Clinical Immunology, Graduate School of Medicine, Osaka City University, Japan
| | - Hiroshi Kakeya
- Department of Infection Control Science, Graduate School of Medicine, Osaka City University, Japan
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Zarbl J, Eimer E, Gigg C, Bendzuck G, Korinth M, Elling-Audersch C, Kleyer A, Simon D, Boeltz S, Krusche M, Mucke J, Muehlensiepen F, Vuillerme N, Krönke G, Schett G, Knitza J. Remote self-collection of capillary blood using upper arm devices for autoantibody analysis in patients with immune-mediated inflammatory rheumatic diseases. RMD Open 2022; 8:rmdopen-2022-002641. [PMID: 36104118 PMCID: PMC9476144 DOI: 10.1136/rmdopen-2022-002641] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 08/31/2022] [Indexed: 12/14/2022] Open
Abstract
Objectives To evaluate the feasibility, accuracy, usability and acceptability of two upper arm self-sampling devices for measurement of autoantibodies and C reactive protein (CRP) levels in patients with immune-mediated rheumatic diseases (IMRDs). Methods 70 consecutive patients with IMRD with previously documented autoantibodies were assigned to supervised and unsupervised self-collection of capillary blood with the Tasso+ or TAP II device. Interchangeability of 17 biomarkers with standard venesection was assessed by: concordance, correlation, paired sample hypothesis testing and Bland-Altman plots. Patients completed an evaluation questionnaire, including the System Usability Scale (SUS) and Net Promoter Score (NPS). Results While 80.0% and 77.0% were able to safely and successfully collect capillary blood using the Tasso+ and TAP II within the first attempt, 69 of 70 (98.6%) patients were successful in collecting capillary blood within two attempts. Concordance between venous and capillary samples was high; 94.7% and 99.5% for positive and negative samples, respectively. For connective tissue disease screen, anti-Ro52 and anti-proteinase 3 autoantibody levels, no significant differences were observed. Self-sampling was less painful than standard venesection for the majority of patients (Tasso+: 71%; TAP II: 63%). Both devices were well accepted (NPS; both: +28%), usability was perceived as excellent (SUS; Tasso+: 88.6 of 100; TAP II: 86.0 of 100) and 48.6 %/62.9% of patients would prefer to use the Tasso+/TAP II, respectively, instead of a traditional venous blood collection. Conclusions Remote self-collection of capillary blood using upper arm-based devices for autoantibody and CRP analysis in patients with autoimmune rheumatic diseases is feasible, accurate and well accepted among patients. Trial registration number WHO International Clinical Trials Registry (DRKS00024925).
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Affiliation(s)
- Joshua Zarbl
- Department of Internal Medicine 3, Rheumatology and Immunology, Friedrich-Alexander University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany.,Deutsches Zentrum für Immuntherapie, Friedrich-Alexander University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | | | | | | | | | | | - Arnd Kleyer
- Department of Internal Medicine 3, Rheumatology and Immunology, Friedrich-Alexander University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany.,Deutsches Zentrum für Immuntherapie, Friedrich-Alexander University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - David Simon
- Department of Internal Medicine 3, Rheumatology and Immunology, Friedrich-Alexander University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany.,Deutsches Zentrum für Immuntherapie, Friedrich-Alexander University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Sebastian Boeltz
- Department of Internal Medicine 3, Rheumatology and Immunology, Friedrich-Alexander University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany.,Deutsches Zentrum für Immuntherapie, Friedrich-Alexander University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | | | - Johanna Mucke
- Policlinic and Hiller Research Unit for Rheumatology, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Felix Muehlensiepen
- Centre for Health Services Research Brandenburg, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany.,Université Grenoble Alpes, Grenoble, France
| | | | - Gerhard Krönke
- Department of Internal Medicine 3, Rheumatology and Immunology, Friedrich-Alexander University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany.,Deutsches Zentrum für Immuntherapie, Friedrich-Alexander University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Georg Schett
- Department of Internal Medicine 3, Rheumatology and Immunology, Friedrich-Alexander University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany.,Deutsches Zentrum für Immuntherapie, Friedrich-Alexander University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Johannes Knitza
- Department of Internal Medicine 3, Rheumatology and Immunology, Friedrich-Alexander University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany .,Deutsches Zentrum für Immuntherapie, Friedrich-Alexander University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany.,Université Grenoble Alpes, Grenoble, France
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Kostelníková P, Skácelová M, Špíšek M, Šimíček M, Horák P. Diffuse alveolar hemorrhage as a life threatening manifestation of newly diagnosed granulomatosis with polyangiitis following COVID-19 infection - a case report. VNITRNI LEKARSTVI 2022; 68:290-294. [PMID: 36283819 DOI: 10.36290/vnl.2022.062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
A case report of a patient with newly diagnosed granulomatosis with polyangiitis (GPA) after undergoing COVID-19 (Coronavirus Disease 2019) is discussed. GPA is one of the ANCA-associated vasculitis, which is characterized by the presence of autoantibodies against cytoplasmic enzymes neutrophils (Anti Neutrophil Cytoplasmatic Antibodies). It is a vasculitis that mainly affects small blood vessels, leading to damage to the kidneys, lungs, and upper respiratory tract, including the paranasal sinuses and orbits. This disease can result in an acute life-threatening condition. Such complications include diffuse alveolar hemorrhage (DAH), a condition characterized by blood leakage from the pulmonary vessels into the alveoli, often leading to acute vital signs and even respiratory failure. DAH can have many causes - autoimmune diseases including vasculitides as well as non-immunological causes. Early and adequate comprehensive therapy including immunosuppressive treatment (cyclophosphamide/rituximab and glucocorticoids) can be life-saving.
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