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Monghal V, Puéchal X, Smets P, Vandergheynst F, Michel M, Diot E, Ramdani Y, Moulinet T, Dhote R, Hautcoeur A, Lelubre C, Dominique S, Lebourg L, Melboucy S, Wauters N, Carlotti A, Cachin F, Ebbo M, Jourde-Chiche N, Iudici M, Aumaitre O, Andre M, Terrier B, Trefond L. Large-vessel involvement in ANCA-associated vasculitis: A multicenter case-control study. Semin Arthritis Rheum 2024; 67:152475. [PMID: 38810568 DOI: 10.1016/j.semarthrit.2024.152475] [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: 01/22/2024] [Revised: 04/08/2024] [Accepted: 04/15/2024] [Indexed: 05/31/2024]
Abstract
OBJECTIVE Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) primarily affects small vessels. Large-vessel involvement (LVI) is rare. We aimed to describe the characteristics of LVI, to identify associated risk factors, and to describe its therapeutic management. METHODS This multicenter case-control (1:2) study included patients with AAV according to the ACR/EULAR classification and LVI as defined by the Chapel Hill nomenclature, together with controls matched for age, sex, and AAV type. RESULTS We included 26 patients, 15 (58 %) of whom were men, with a mean age of 56.0 ± 17.1 years. The patients had granulomatosis with polyangiitis (n = 20), or microscopic polyangiitis (n = 6). The affected vessels included the aorta (n = 18; 69 %) supra-aortic trunks (n = 9; 35 %), lower-limb arteries (n = 5; 19 %), mesenteric arteries (n = 5; 19 %), renal arteries (n = 4; 15 %), and upper-limb arteries (n = 2; 8 %). Imaging showed wall thickening (n = 10; 38 %), perivascular inflammation (n = 8; 31 %), aneurysms (n = 5; 19 %), and stenosis (n = 4; 15 %). Comparisons with the control group revealed that LVI was significantly associated with neurological manifestations (OR=3.23 [95 % CI: 1.11-10.01, p = 0.03]), but not with cardiovascular risk factors (OR=0.70 [95 % CI: 0.23-2.21, p = 0.60]), or AAV relapse (OR=2.01 [95 % CI: 0.70-5.88, p = 0.16]). All patients received corticosteroids, in combination with an immunosuppressant in 24 (92 %), mostly cyclophosphamide (n = 10, 38 %) or rituximab (n = 9, 35 %). CONCLUSION Regardless of distinctions based on vessel size, clinicians should consider LVI as a potential manifestation of AAV, with the aorta commonly affected. The risk of developing LVI appears to be greater for clinical phenotypes of AAV with neurological involvement. Standard AAV treatment can be used to manage LVI.
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Affiliation(s)
- V Monghal
- Médecine Interne, Centre Hospitalier Universitaire Gabriel-Montpied, 63000 Clermont-Ferrand, France
| | - X Puéchal
- National Referral Center for Rare Systemic Autoimmune Diseases, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP). Centre, Université Paris Cité, Paris, France
| | - P Smets
- Médecine Interne, Centre Hospitalier Universitaire Gabriel-Montpied, 63000 Clermont-Ferrand, France
| | - F Vandergheynst
- General Internal Medicine Department, Erasme University Hospital, Brussels, Belgium
| | - M Michel
- Centre de Référence des Cytopénies Auto-Immunes de l'Adulte, Service de Médecine Interne, CHU Henri Mondor, AP-HP, Université Paris-Est Créteil, Créteil, France
| | - E Diot
- Service de Médecine Interne Immunologie Clinique, CHU de Tours, F-37032 Tours, France
| | - Y Ramdani
- Service de Médecine Interne Immunologie Clinique, CHU de Tours, F-37032 Tours, France
| | - T Moulinet
- Systemic and Autoimmune Rare Diseases, Nancy University Hospital, UMR 7365, IMoPA, Lorraine University, CNRS, Vandoeuvre-lès-Nancy, France
| | - R Dhote
- Department of Internal Medicine, Assistance Publique-Hôpitaux de Paris (APHP), Avicenne Hospital, Paris, France
| | - A Hautcoeur
- Department of Internal Medicine, Assistance Publique-Hôpitaux de Paris (APHP), Avicenne Hospital, Paris, France
| | - C Lelubre
- Department of Internal Medicine, CHU-Charleroi Marie-Curie, 6042 Charleroi, Belgium
| | - S Dominique
- CHU Rouen, Department of Pulmonology, F-76000 Rouen, France
| | - L Lebourg
- Department of Nephrology, Kidney Transplantation and Hemodialysis, Rouen University Hospital, Rouen, France
| | - S Melboucy
- Service de médecine interne et polyvalente, centre hospitalier de Saint-Quentin, 1, avenue Michel de l'Hospital, 02100, Saint-Quentin, France
| | - N Wauters
- General Internal Medicine Department, Erasme University Hospital, Brussels, Belgium
| | - A Carlotti
- Department of Pathology, Assistance Publique - Hôpitaux de Paris, Cochin Hospital, 75014, Paris, France
| | - F Cachin
- Service de Médecine Nucléaire, Centre Jean PERRIN, Clermont-Ferrand, France
| | - M Ebbo
- Département de Medecine Interne, CHU Timone, AP-HM, Aix Marseille Université, France
| | - N Jourde-Chiche
- Aix-Marseille Université, Faculté des Sciences Médicales et Paramédicales, C2VN, INRA 1260, INSERM 1263, AP-HM Hôpital de la Conception, Centre de Néphrologie et Transplantation Rénale, Marseille, France
| | - M Iudici
- National Referral Center for Rare Systemic Autoimmune Diseases, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP). Centre, Université Paris Cité, Paris, France
| | - O Aumaitre
- Médecine Interne, Centre Hospitalier Universitaire Gabriel-Montpied, 63000 Clermont-Ferrand, France; Université Clermont Auvergne Inserm U1071, Microbes, Intestin, Inflammation et Susceptibilité de l'Hôte (M2iSH), USC-INRA 2018, Clermont-Ferrand, France
| | - M Andre
- Médecine Interne, Centre Hospitalier Universitaire Gabriel-Montpied, 63000 Clermont-Ferrand, France; Université Clermont Auvergne Inserm U1071, Microbes, Intestin, Inflammation et Susceptibilité de l'Hôte (M2iSH), USC-INRA 2018, Clermont-Ferrand, France
| | - B Terrier
- National Referral Center for Rare Systemic Autoimmune Diseases, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP). Centre, Université Paris Cité, Paris, France
| | - L Trefond
- Médecine Interne, Centre Hospitalier Universitaire Gabriel-Montpied, 63000 Clermont-Ferrand, France; Université Clermont Auvergne Inserm U1071, Microbes, Intestin, Inflammation et Susceptibilité de l'Hôte (M2iSH), USC-INRA 2018, Clermont-Ferrand, France.
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Wang J, Xu Y, Wang G. ANCA-associated vasculitis with abdominal aortic aneurysm : Case report and literature review. Vascular 2023; 31:1082-1085. [PMID: 35593219 DOI: 10.1177/17085381221100384] [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] [Indexed: 11/17/2022]
Abstract
INTRODUCTION ANCA-associated vasculitis is an autoimmune disease that usually involves the small vessel walls. It is difficult to find the presence of ANCA-associated vasculitis in the great arteries, especially the thoracic and abdominal aorta. METHODS This is an 86-year-old Chinese man with ANCA-associated vasculitis and abdominal aortic aneurysm who presented with epigastric pain. Considering his age and physical condition, the patient was treated with methylprednisolone and mycophenolate mofetil instead of surgery. RESULTS The patient's epigastric pain symptoms were relieved after 2 months of conservative treatment. Imaging at follow-up 2 years later showed signs of aneurysm enlargement because of irregular medication. CONCLUSIONS Patients with ANCA-associated vasculitis combined with aortic aneurysm often require surgical management. But for patients with stable disease and poor physical conditions, conservative treatment is also an effective treatment method, which can bring benefits to the patient's survival.
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Affiliation(s)
- Jiawei Wang
- Department of Urology, Zhuzhou Hospital Affiliated to Xiangya Medical College, Central South University, Zhuzhou, China
| | - Yong Xu
- Department of Urology, Zhuzhou Hospital Affiliated to Xiangya Medical College, Central South University, Zhuzhou, China
| | - Gang Wang
- Department of Rheumatology and Immunology, Zhuzhou Hospital Affiliated to Xiangya Medical College, Central South University, Zhuzhou, China
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3
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Gravos A, Katsifa K, Tselioti P, Grammatikopoulou V, Sakellaridis K, Kanakaki S, Tsapas C, Destounis A, Moschouris H, Athanasiadou I, Chatzivasiloglou F, Ivanova E, Prekates A. Ruptured arterial aneurysm in Wegener's granulomatosis: a case report. J Med Case Rep 2021; 15:343. [PMID: 34247654 PMCID: PMC8274053 DOI: 10.1186/s13256-021-02955-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 06/14/2021] [Indexed: 12/24/2022] Open
Abstract
Background Aneurysm formation is a possible, but rare, complication of granulomatosis with polyangiitis, known as Wegener’s granulomatosis. Urgent diagnosis and therapy is very important because a ruptured aneurysm could be life threatening. Case presentation We, therefore, present the case of a 63-year-old Greek man who was diagnosed with granulomatosis with polyangiitis and retroperitoneal hematoma due to ruptured aneurysm in renal artery and upper pancreaticoduodenal artery. His clinical course was complicated by acute renal failure and acute respiratory failure due to alveolar hemorrhage. Emergency coil embolization was performed. Postembolization recovery was uneventful; no bleeding occurred. The patient underwent mechanical ventilation and continuous veno-venous hemofiltration and received combined immunosuppression and supportive therapy, but eventually died 30 days after admission to hospital from severe septic shock and multiple organ failure. Conclusion Endovascular treatment is the therapy of choice, especially for patients with ruptured aneurysms that are hemodynamically stable. Early diagnosis is very important, as urgent embolization and early initiation of immunosuppression therapy are the treatment of choice.
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Affiliation(s)
- A Gravos
- Intensive Care Unit (ICU), Tzaneio General Hospital of Piraeus, Dodonis 26, Kamatero, PC: 13451, Greece.
| | - K Katsifa
- Intensive Care Unit (ICU), Tzaneio General Hospital of Piraeus, Dodonis 26, Kamatero, PC: 13451, Greece
| | - P Tselioti
- Intensive Care Unit (ICU), Tzaneio General Hospital of Piraeus, Dodonis 26, Kamatero, PC: 13451, Greece
| | - V Grammatikopoulou
- Intensive Care Unit (ICU), Tzaneio General Hospital of Piraeus, Dodonis 26, Kamatero, PC: 13451, Greece
| | - K Sakellaridis
- Intensive Care Unit (ICU), Tzaneio General Hospital of Piraeus, Dodonis 26, Kamatero, PC: 13451, Greece
| | - S Kanakaki
- Intensive Care Unit (ICU), Tzaneio General Hospital of Piraeus, Dodonis 26, Kamatero, PC: 13451, Greece
| | - C Tsapas
- Intensive Care Unit (ICU), Tzaneio General Hospital of Piraeus, Dodonis 26, Kamatero, PC: 13451, Greece
| | - A Destounis
- Intensive Care Unit (ICU), Tzaneio General Hospital of Piraeus, Dodonis 26, Kamatero, PC: 13451, Greece
| | - H Moschouris
- Radiology Department, Tzaneio General Hospital of Piraeus, Kamatero, Greece
| | - I Athanasiadou
- Intensive Care Unit (ICU), Tzaneio General Hospital of Piraeus, Dodonis 26, Kamatero, PC: 13451, Greece
| | - F Chatzivasiloglou
- Intensive Care Unit (ICU), Tzaneio General Hospital of Piraeus, Dodonis 26, Kamatero, PC: 13451, Greece
| | - E Ivanova
- Intensive Care Unit (ICU), Tzaneio General Hospital of Piraeus, Dodonis 26, Kamatero, PC: 13451, Greece
| | - A Prekates
- Intensive Care Unit (ICU), Tzaneio General Hospital of Piraeus, Dodonis 26, Kamatero, PC: 13451, Greece
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Tariq E, Nishanth K, Arshid A, Miqdad M, Cancarevic I. Aortic Involvement in Antineutrophil Cytoplasmic Antibodies Vasculitis, a Coincidence or a Real Association? Cureus 2020; 12:e9690. [PMID: 32923282 PMCID: PMC7486114 DOI: 10.7759/cureus.9690] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Antineutrophil cytoplasmic antibodies (ANCA)-associated vasculitis (AAV) is a type of small-vessel vasculitis. It is unusual for ANCA to involve aorta. However, multiple cases have been found where ANCA involved large vessels, particularly the aorta. Among vasculitides, aortic vasculitis is a part of Takayasu arteritis (TAK). In this review article, we tried to find the mechanism behind the aortic involvement in AAV. PubMed was used as a primary search engine, and all the available cases of aortic, as well as large-vessel involvement in ANCA-associated vasculitis, were thoroughly reviewed. Very limited data was available that could provide the mechanism behind this involvement. It is observed that ANCA-associated aortitis is more common in immunocompromised people; however, cases in previously healthy individuals have also been found. Pathogenesis of ANCA-related aortitis is different from Takayasu arteritis and is more close to ANCA-associated small vasculitis. ANCA-related aortitis involves the aorta through the same mechanism as it uses to involve small vessels. This rare manifestation of ANCA-associated vasculitis could be life-threatening but has a good prognosis if timely diagnosed and treated. ANCA-associated vasculitis must be considered as a differential diagnosis while treating a case of aortitis. We believe that there is a need to revise the classification of different types of vasculitides, and physicians should be aware of the possible overlap between different forms of vasculitides.
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Affiliation(s)
- Ezza Tariq
- Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA.,Medicine, Nishtar Medical College, Multan, PAK
| | - Katukuri Nishanth
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Assam Arshid
- Surgery, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Mohammed Miqdad
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, SAU
| | - Ivan Cancarevic
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
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5
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Mozaffar M, Shahrbaf MA, Azimi B, Arabzadeh A. Management of celiac trunk and superior mesenteric artery synchronous aneurysms as an extremely rare manifestation of Wegener granulomatosis. JOURNAL OF VASCULAR SURGERY CASES INNOVATIONS AND TECHNIQUES 2019; 5:525-528. [PMID: 31799479 PMCID: PMC6883309 DOI: 10.1016/j.jvscit.2019.05.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 05/15/2019] [Indexed: 01/16/2023]
Abstract
Large-vessel aneurysm is an extremely rare complication of Wegener granulomatosis. We report a case of Wegener granulomatosis in a 49-year-old woman with large synchronous aneurysms of the celiac trunk (54 mm) and superior mesenteric artery (42 mm) who presented with abdominal pain. Because of the large diameter of the aneurysms and their proximity to each other, a combination of endovascular and hybrid repair was used for management. After surgical debranching and endovascular repair, the patient was discharged in good general condition. We concluded that abdominal pain in Wegener granulomatosis can be a rare manifestation of a large visceral aneurysm.
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Affiliation(s)
- Mohammad Mozaffar
- Department of General and Vascular Surgery, Shohada-E-Tajrish Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Behzad Azimi
- Department of General and Vascular Surgery, Shohada-E-Tajrish Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - AmirAhmad Arabzadeh
- Department of General and Vascular Surgery, Shohada-E-Tajrish Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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6
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Gastroduodenal Artery Aneurysm in a Patient With Granulomatosis With Polyangiitis. J Clin Rheumatol 2019; 25:e81. [DOI: 10.1097/rhu.0000000000000680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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7
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Pan L, Yan JH, Gao FQ, Li H, Han SS, Cao GH, Lv CJ, Wang XZ. Case report of a 28-year-old man with aortic dissection and pulmonary shadow due to granulomatosis with polyangiitis. BMC Pulm Med 2019; 19:122. [PMID: 31286925 PMCID: PMC6615146 DOI: 10.1186/s12890-019-0884-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Accepted: 06/24/2019] [Indexed: 12/25/2022] Open
Abstract
Background Granulomatosis with polyangiitis (GPA) is characterised by the main violation of the upper and lower respiratory tract and kidney. GPA is considered a systemic vasculitis of medium-sized and small blood vessels where aortic involvement is extremely rare. Case presentation A 28-year-old male was admitted to the hospital due to 4 h of chest pain. Computed tomography scan of the aorta showed a thickened aortic wall, pulmonary lesions, bilateral pleural effusion and pericardial effusion. The aortic dissection should be considered. An emergency operation was performed on the patient. Surgical biopsies obtained from the aortic wall showed destructive changes, visible necrosis, granulation tissue hyperplasia and a large number of acute and chronic inflammatory cells. Nearly a year later, the patient was re-examined for significant pulmonary lesions. His laboratory studies were significantly positive for anti-neutrophilic antibody directed against proteinase 3. Finally, the diagnosis of GPA was obviously established. Conclusions Although GPA rarely involves the aorta, we did not ignore the fact that GPA may involve large blood vessels. In addition, GPA should be included in the systemic vasculitis that can give rise to aortitis and even aortic dissection. Electronic supplementary material The online version of this article (10.1186/s12890-019-0884-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Lei Pan
- Department of Respiratory and Critical Care Medicine, Binzhou Medical University Hospital, 661 Yellow River Road, Binzhou, 256603, China
| | - Jun-Hong Yan
- Department of Ultrasonography, Binzhou Medical University Hospital, Binzhou, 256603, China
| | - Fu-Quan Gao
- Department of Respiratory and Critical Care Medicine, Binzhou Medical University Hospital, 661 Yellow River Road, Binzhou, 256603, China
| | - Hong Li
- Department of Pathology, Binzhou Medical University Hospital, Binzhou, 256603, China
| | - Sha-Sha Han
- Department of Respiratory and Critical Care Medicine, Binzhou Medical University Hospital, 661 Yellow River Road, Binzhou, 256603, China
| | - Guo-Hong Cao
- Department of Respiratory and Critical Care Medicine, Binzhou Medical University Hospital, 661 Yellow River Road, Binzhou, 256603, China
| | - Chang-Jun Lv
- Department of Respiratory and Critical Care Medicine, Binzhou Medical University Hospital, 661 Yellow River Road, Binzhou, 256603, China
| | - Xiao-Zhi Wang
- Department of Respiratory and Critical Care Medicine, Binzhou Medical University Hospital, 661 Yellow River Road, Binzhou, 256603, China.
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Tomosugi T, Takahashi T, Kawase Y, Yoshida K, Hayashi S, Sugiyama T, Shimizu M, Shoka M, Sawaki K, Onishi E, Hayashi N, Matsushita H, Okochi O. Accessory left gastric artery aneurysms in granulomatosis with polyangiitis: a case report and literature review. NAGOYA JOURNAL OF MEDICAL SCIENCE 2018; 79:75-83. [PMID: 28303064 PMCID: PMC5346623 DOI: 10.18999/nagjms.79.1.75] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Aneurysm formation is a potential complication of granulomatosis with polyangiitis (GPA), previously known as Wegener’s granulomatosis. It is a very rare complication, but immediate diagnosis and therapy should be performed because an aneurysm can be life-threatening if it ruptures. An accessory left gastric artery (ALGA) is also a rare variant gastric artery that may obtain its blood supply from the left hepatic artery and left gastric artery. We herein describe a 57-year-old Japanese man who was diagnosed with GPA complicated by aneurysm rupture in an ALGA. Emergency surgery was performed after failure of arterial coil embolization to interrupt blood flow in the ALGA. The patient underwent partial resection of the lesser omentum, which contained all aneurysms. During partial resection of the lesser omentum, both the left gastric artery and ALGA were ligated because they were thought to be feeders of the aneurysms. Postoperative recovery was uneventful; no bleeding or recurrence of the aneurysms occurred. Immediate diagnosis and therapy should be performed for patients with GPA with symptoms of vascular ischemia or aortitis. Endovascular intervention is the first-choice therapy especially for hemodynamically stable patients with ruptured aneurysms or aneurysms located on variant arteries, which may have multiple blood supplies. In the present case, although endovascular treatment failed, the approach described herein was helpful during open surgery.
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Affiliation(s)
| | | | | | - Koichi Yoshida
- Department of Surgery, Tosei General Hospital, Seto, Japan
| | - Shogo Hayashi
- Department of Surgery, Tosei General Hospital, Seto, Japan
| | | | | | - Michita Shoka
- Department of Surgery, Tosei General Hospital, Seto, Japan
| | - Kohichi Sawaki
- Department of Surgery, Tosei General Hospital, Seto, Japan
| | - Eiji Onishi
- Department of Surgery, Tosei General Hospital, Seto, Japan
| | - Naomi Hayashi
- Department of Surgery, Tosei General Hospital, Seto, Japan
| | | | - Osamu Okochi
- Department of Surgery, Tosei General Hospital, Seto, Japan
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Gozalo A, Elkins W, Lambert L. Eosinophilic aortitis with thoracic aortic aneurysm and rupture in a captive-born owl monkey. J Med Primatol 2018; 47:423-426. [PMID: 30187922 PMCID: PMC11025315 DOI: 10.1111/jmp.12373] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 06/07/2018] [Accepted: 07/27/2018] [Indexed: 12/30/2022]
Abstract
Eosinophilic aortitis is a rare condition in animals and humans, and it has been occasionally reported associated with parasitic migration and with a poorly understood complex group of autoimmune vasculitides. Here, we describe a case of eosinophilic aortitis with thoracic aortic aneurysm and rupture in a captive-born owl monkey and discuss the differential diagnoses.
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Affiliation(s)
- A.S. Gozalo
- Comparative Medicine Branch and National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - W.R. Elkins
- Comparative Medicine Branch and National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - L.E. Lambert
- Laboratory of Malaria Immunology and Vaccinology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
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10
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Aortic Aneurysm as a Complication of Granulomatosis with Polyangiitis Successfully Treated with Prednisolone and Cyclophosphamide: A Case Report and Review of the Literature. Case Rep Rheumatol 2018; 2018:9682801. [PMID: 29971178 PMCID: PMC6008675 DOI: 10.1155/2018/9682801] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2017] [Revised: 04/21/2018] [Accepted: 05/15/2018] [Indexed: 12/23/2022] Open
Abstract
A 57-year-old Japanese man was admitted to the hospital with back pain and fever, multiple lung nodules, and abdominal aortic aneurysm (AAA). Laboratory tests performed at admission showed an increased proteinase 3 anti-neutrophil cytoplasmic antibody (PR3-ANCA) level. Video-associated thoracoscopic lung biopsy was performed; pathologic examination showed granulation tissue with necrosis and multinucleated giant cells. The diagnosis of granulomatosis with polyangiitis (GPA) was confirmed on the basis of the clinical presentation, laboratory findings, and lung biopsy. All symptoms were ameliorated, and the serum level of PR3-ANCA declined following treatment with prednisolone and cyclophosphamide. Although the association of GPA with AAA is rare, GPA may be included among the large vessel vasculitides that can give rise to aortic aneurysm.
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11
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Ozaki T, Maeshima K, Kiyonaga Y, Torigoe M, Imada C, Hamasaki H, Haranaka M, Ishii K, Shibata H. Large-vessel involvement in granulomatosis with polyangiitis successfully treated with rituximab: A case report and literature review. Mod Rheumatol 2015; 27:699-704. [PMID: 25736357 DOI: 10.3109/14397595.2015.1021950] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Granulomatosis with polyangiitis (GPA) is primary necrotizing vasculitis, which predominantly affects small to medium vessels. Herein, we describe a case of a 60-year-old female with GPA who developed inflammatory wall thickening localized in the aortic arch, upper abdominal aorta, and pulmonary artery. The wall thickening in the large vessels and other GPA lesions such as lung nodules and orbital mass had failed to respond to high-dose glucocorticoids combined with cyclophosphamide; however, all were successfully treated with rituximab. Our literature review identified 24 cases of large-vessel involvement associated with GPA. Luminal stenosis, occlusion, or wall thickening were observed in 8, periaortitis in 11, and aneurysms in 5 cases. The most commonly affected vessel was the abdominal aorta (12 cases), followed by the thoracic aorta (6 cases), subclavian artery (4 cases), and internal carotid artery (4 cases). Glucocorticoids were used in 23 cases, 20 of which received combination therapy with cyclophosphamide. Surgical or endovascular therapies were performed in 10 cases with aneurysmal dilatation. This is the first case showing the potential efficacy of rituximab for refractory large-vessel involvement associated with GPA.
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Affiliation(s)
- Takashi Ozaki
- a Department of Endocrinology , Metabolism, Rheumatology and Nephrology, Faculty of Medicine, Oita University , Yufu , Oita , Japan
| | - Keisuke Maeshima
- a Department of Endocrinology , Metabolism, Rheumatology and Nephrology, Faculty of Medicine, Oita University , Yufu , Oita , Japan
| | - Yasuhiro Kiyonaga
- a Department of Endocrinology , Metabolism, Rheumatology and Nephrology, Faculty of Medicine, Oita University , Yufu , Oita , Japan
| | - Masataka Torigoe
- a Department of Endocrinology , Metabolism, Rheumatology and Nephrology, Faculty of Medicine, Oita University , Yufu , Oita , Japan
| | - Chiharu Imada
- a Department of Endocrinology , Metabolism, Rheumatology and Nephrology, Faculty of Medicine, Oita University , Yufu , Oita , Japan
| | - Hajime Hamasaki
- a Department of Endocrinology , Metabolism, Rheumatology and Nephrology, Faculty of Medicine, Oita University , Yufu , Oita , Japan
| | - Miwa Haranaka
- a Department of Endocrinology , Metabolism, Rheumatology and Nephrology, Faculty of Medicine, Oita University , Yufu , Oita , Japan
| | - Koji Ishii
- a Department of Endocrinology , Metabolism, Rheumatology and Nephrology, Faculty of Medicine, Oita University , Yufu , Oita , Japan
| | - Hirotaka Shibata
- a Department of Endocrinology , Metabolism, Rheumatology and Nephrology, Faculty of Medicine, Oita University , Yufu , Oita , Japan
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