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Alkhaldi A, Alaraifi A, Alsalamah S, Nassar J. Atypical presentation of granulomatosis with polyangiitis: a case report and review of the literature. AME Case Rep 2024; 8:82. [PMID: 39091557 PMCID: PMC11292081 DOI: 10.21037/acr-24-47] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Accepted: 05/30/2024] [Indexed: 08/04/2024]
Abstract
Background Granulomatosis with polyangiitis (GPA) is a systemic autoimmune disease characterized by necrotizing granulomatous vasculitis of the small- and medium-sized vessels. Classical GPA affects the upper and lower airways and kidneys. It commonly affects the nose and paranasal sinuses, middle and inner ear, and subglottic region of the larynx. Therefore, otolaryngological involvement is common in GPA and can sometimes be the initial presentation. In rare cases, otologic signs and symptoms can be the initial manifestations of this disease, including recurrent otitis media, otitis media with effusion, and sensorineural hearing loss. Case Description In the present study, we describe an atypical case of GPA of a 22-year-old female. The patient presented with severe and complicated otitis media with hearing loss and polyneuropathy (facial nerve paralysis and trigeminal nerve impairment), in addition to nasopharyngeal and parotid infiltration, in the absence of other otolaryngologic and systemic manifestations of GPA. Conclusions The diagnosis of GPA can be challenging due to its wide range of clinical manifestations. Otologic signs and symptoms are rare in this disease and can sometimes be the initial manifestations. Early diagnosis and treatment are important to prevent serious and permanent complications of the disease. Otolaryngologists should have high index of suspicion to systemic diseases such as GPA.
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Affiliation(s)
- Abdullah Alkhaldi
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Abdulaziz Alaraifi
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Shmokh Alsalamah
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Jihad Nassar
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
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Enabi J, Sharif W, Mannem M, Rodriguez Vazquez JL, Mukkera S. Granulomatosis With Polyangiitis (GPA): Isolated Nasal Bridge Involvement. Cureus 2024; 16:e62911. [PMID: 39040769 PMCID: PMC11262417 DOI: 10.7759/cureus.62911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/22/2024] [Indexed: 07/24/2024] Open
Abstract
Granulomatosis with polyangiitis (GPA) is a rare autoimmune vasculitis primarily affecting small blood vessels and presenting with systemic manifestations, including those in the kidneys and respiratory tracts. Diagnosis involves clinical assessment and specific serological tests. This paper presents the case of a 68-year-old morbidly obese woman with chronic sinusitis, hypertension, and hyperlipidemia who developed a saddle nose deformity. Despite the absence of typical respiratory and renal symptoms, her laboratory results showed positive antineutrophil cytoplasmic antibodies (ANCA) and antinuclear antibodies (ANA), with a nasal septal biopsy confirming GPA. She was treated with methotrexate and folic acid. This case underscores the variability of GPA presentations and the critical importance of early diagnosis and treatment to prevent irreversible damage.
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Affiliation(s)
- Joud Enabi
- Internal Medicine, Texas Tech University Health Sciences Center, Odessa, USA
| | - Waqar Sharif
- Internal Medicine, Texas Tech University Health Sciences Center, Odessa, USA
| | - Maneesh Mannem
- Internal Medicine, Texas Tech University Health Sciences Center, Odessa, USA
| | | | - Srikanth Mukkera
- Rheumatology, Texas Tech University Health Sciences Center, Odessa, USA
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Kramer N, Manthei B, Speier L, Bigcas JLM, Manthei S. Granulomatosis With Polyangiitis as an Etiology of Silent Sinus Syndrome: A Case Report. Cureus 2024; 16:e61442. [PMID: 38947644 PMCID: PMC11214768 DOI: 10.7759/cureus.61442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2024] [Indexed: 07/02/2024] Open
Abstract
Silent sinus syndrome (SSS) is a rare condition characterized by the collapse of the maxillary sinus and the sinking of the eye socket (enophthalmos). Only around 100 cases of SSS have been reported so far. The underlying cause of this condition is the chronic obstruction of the osteomeatal complex, which leads to sinus contraction. In this case, we present a novel finding linking SSS with granulomatosis with polyangiitis (GPA). The patient described is a 39-year-old male who was diagnosed with SSS after a prolonged period of sinus pressure, headaches, epistaxis, and generalized congestion. Additionally, the patient reported a significant autoimmune history, including a previous occurrence of ANCA-mediated glomerulonephritis. Surgical intervention revealed the presence of significant granulation tissue, while histopathological examination identified areas of necrosis, vasculitis, and multinucleated giant cells consistent with GPA. This finding was further supported by the detection of positive blood c-ANCA. This case is particularly noteworthy as it is the first reported instance of GPA causing SSS. It serves as an excellent example to illustrate the underlying pathophysiology of SSS.
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Affiliation(s)
- Nicholas Kramer
- College of Osteopathic Medicine, Touro University Nevada, Henderson, USA
| | - Brandon Manthei
- College of Osteopathic Medicine, Touro University Nevada, Henderson, USA
| | - Luke Speier
- College of Osteopathic Medicine, Touro University Nevada, Henderson, USA
| | - Jo-Lawrence M Bigcas
- Department of Otolaryngology-Head and Neck Surgery, Kerkorian School of Medicine at the University of Nevada Las Vegas, Las Vegas, USA
| | - Scott Manthei
- Department of Otolaryngology, Nevada Ear and Sinus Institute, Las Vegas, USA
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Odom JQ, Mangan AR, Gibson AC, Larson M, Dornhoffer JL, Saadi RA. Diagnosis and management of facial nerve palsy secondary to granulomatosis with polyangiitis - A systematic review. Am J Otolaryngol 2024; 45:104132. [PMID: 38039912 DOI: 10.1016/j.amjoto.2023.104132] [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: 09/07/2023] [Accepted: 11/25/2023] [Indexed: 12/03/2023]
Abstract
OBJECTIVE Granulomatosis with polyangiitis is associated with otolaryngologic complaints in 70-95 % of cases, with the most common being serous otitis media. In rare cases, patients may experience facial nerve palsy in conjunction with otologic or nasal symptoms; and, often, initially present to an otolaryngologist. It is important for healthcare professionals to be able to recognize the nuisances of facial nerve palsy as a potential presentation of granulomatosis with polyangiitis. STUDY DESIGN Systematic review. METHODS Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Protocol, PubMed and MED-LINE Databases were queried for articles published from January 2007 to December 2022 describing facial nerve palsy in the context of Granulomatosis with polyangiitis, formerly known as Wegener's Granulomatosis. The keywords included "facial nerve palsy", "facial palsy", "granulomatosis with polyangiitis", "Wegener's granulomatosis", "ANCA positive" in the title/abstract. All full-text articles available in English were screened, including single case presentations. Abstracts, commentaries, and publications deemed outside the scope of our study aims were excluded from review. After removal of duplicate articles, a total of 85 articles were screened. After applying inclusion and exclusion criteria, 14 articles were included in the review. RESULTS There were a total of 28 reports of facial nerve palsy in the literature in patients who were eventually diagnosed with granulomatosis with polyangiitis. The patients' ages ranged from 14 to 68 years old. None of the patients had been previously diagnosed with GPA, and a majority of them presented initially with other otologic symptoms. Hearing loss was reported in 24 patients (86 %), otalgia was present in 11 patients (39 %), and otorrhea was present in 6 patients (21 %). Bilateral facial paralysis was reported in 10 patients in the literature (36 %). In total, 16 patients underwent surgery for facial paralysis: 6 tympanomastoidectomies, 4 mastoidectomies, 2 explorative tympanotomies. Surgery was generally considered ineffective in resolving facial weakness. All patients ended up receiving some combination of steroids and immunosuppressant, most commonly prednisolone and cyclophosphamide or rituximab, which was eventually transitioned to azathioprine for maintenance. Unlike auditory thresholds, which remained decreased in two patients, all patients recovered facial function following appropriate medical treatment of their vasculitis. CONCLUSIONS Facial nerve paralysis in patients with granulomatosis with polyangiitis is a rare but treatable phenomenon. In patients with intractable otitis media, unresolving facial palsy, or a combination of otologic issues, it is important to consider GPA as a possible source. The prognosis for facial function appears to be excellent in patients who undergo appropriate treatment for vasculitis, but further studies are needed for confirmation.
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Affiliation(s)
- John Q Odom
- University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Andrew R Mangan
- University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | | | - Michael Larson
- University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - John L Dornhoffer
- University of Arkansas for Medical Sciences, Little Rock, AR, USA; Arkansas Children's Hospital, Little Rock, AR, USA
| | - Robert A Saadi
- University of Arkansas for Medical Sciences, Little Rock, AR, USA; Arkansas Children's Hospital, Little Rock, AR, USA.
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Vainutienė V, Ivaška J, Dadonienė J, Beleškienė V, Ivaškienė T, Lesinskas E. Audiological Manifestations in Patients with Granulomatosis with Polyangiitis. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:267. [PMID: 38399554 PMCID: PMC10890050 DOI: 10.3390/medicina60020267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Revised: 01/30/2024] [Accepted: 02/01/2024] [Indexed: 02/25/2024]
Abstract
Background and Objectives: Granulomatosis with Polyangiitis (GPA) is a rare, autoimmune, multisystemic disease characterized by vasculitis and necrotizing granuloma that commonly affects the upper and lower respiratory tract and kidneys. Audiovestibular dysfunction in GPA diseases may have different clinical presentations. The aim of the present study was to evaluate hearing function in patients with GPA and to compare the results with a healthy control group. Materials and Methods: A total of 34 individuals participated in the study. The GPA group consisted of 14 participants, and the control group was composed of 20 healthy participants with no signs or symptoms of ear disease. The ages ranged from 18 to 65 years old, with a mean age of 43.8 years. The participants underwent a complete audiological evaluation using otoscopy, impedance audiometry, pure tone audiometry, speech audiometry-evaluation of speech thresholds, and speech recognition in quiet. Both ears were tested. All of the participants of the study were native Lithuanian speakers. Data were statistically analyzed using the Statistical Analysis System software SAS® Studio 3.8. A p value < 0.05 was regarded as statistically significant. Results: 92.85% of patients from the GPA group reported hearing-related symptoms: hearing loss, tinnitus, and fullness in the ears. The arithmetic means of all hearing thresholds at frequencies from 125 Hz to 8000 Hz were significantly higher in the GPA group. The results revealed statistically significant differences between the two groups in the Speech Detection Threshold, Speech Recognition Threshold, Speech Discomfort level, and Word Recognition Scores. Conclusions: The frequency of hearing loss, the average hearing thresholds, and speech thresholds were higher in GPA patients than in healthy individuals. The most common type of hearing loss was sensorineural. Audiological assessments should be considered during the routine evaluation of patients with GPA disease to prevent hearing-related disabilities.
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Affiliation(s)
- Vija Vainutienė
- State Research Institute Centre for Innovative Medicine, Santariškių str. 5, LT-08406 Vilnius, Lithuania; (J.D.); (T.I.)
| | - Justinas Ivaška
- Clinic of Ear, Nose, Throat and Eye Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, M.K. Čiurlionio str. 21, LT-03101 Vilnius, Lithuania; (J.I.); (V.B.); (E.L.)
| | - Jolanta Dadonienė
- State Research Institute Centre for Innovative Medicine, Santariškių str. 5, LT-08406 Vilnius, Lithuania; (J.D.); (T.I.)
- Department of Public Health, Faculty of Medicine, Vilnius University, M.K. Čiurlionio str. 21, LT-03101 Vilnius, Lithuania
| | - Vilma Beleškienė
- Clinic of Ear, Nose, Throat and Eye Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, M.K. Čiurlionio str. 21, LT-03101 Vilnius, Lithuania; (J.I.); (V.B.); (E.L.)
| | - Tatjana Ivaškienė
- State Research Institute Centre for Innovative Medicine, Santariškių str. 5, LT-08406 Vilnius, Lithuania; (J.D.); (T.I.)
| | - Eugenijus Lesinskas
- Clinic of Ear, Nose, Throat and Eye Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, M.K. Čiurlionio str. 21, LT-03101 Vilnius, Lithuania; (J.I.); (V.B.); (E.L.)
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Horino T. Early diagnosis of otitis media with anti-neutrophil cytoplasmic antibody-associated vasculitis using biopsy-proven pauci-immune necrotising crescentic glomerulonephritis. Nephrology (Carlton) 2024; 29:56-57. [PMID: 37853956 DOI: 10.1111/nep.14248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 10/04/2023] [Indexed: 10/20/2023]
Affiliation(s)
- Taro Horino
- Department of Endocrinology, Metabolism and Nephrology, Kochi Medical School, Nankoku, Japan
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Shu Jiun K, Kamel S, Arasu K, Zuhaidi KM, Mohan Singh AS. Primary Nasal Tuberculosis Masquerading as Granulomatosis With Polyangiitis: A Case Report of Diagnostic Dilemma. Cureus 2023; 15:e49649. [PMID: 38161936 PMCID: PMC10755803 DOI: 10.7759/cureus.49649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/29/2023] [Indexed: 01/03/2024] Open
Abstract
Primary nasal tuberculosis (TB) is a rare disease even in areas with high TB burden, possibly attributed to the protective mechanism of sinonasal mucosa. Its symptoms are subtle and can be mistaken for other granulomatous inflammatory conditions. We would like to report a case of a 70-year-old Indian lady who underwent a successful left endoscopic dacryocystorhinostomy three years ago and presented with recurrent left epiphora. During nasal endoscopy, multiple ulcerative masses with crusting were detected over the left nasal vestibule, anterior nasal septum, left inferior, and middle turbinate. Biopsy of the nasal mass revealed granulomatous inflammation without caseating necrosis. Initially, all TB-related tests were negative. As the patient had granulomatous nasal lesions with microscopic haematuria, granulomatosis with polyangiitis (GPA) was suspected. Regrettably, the patient did not respond to treatment. A repeated tissue culture at a later stage finally detected mycobacterium tuberculosis without the presence of pulmonary tuberculosis. Considering the current TB prevalence in the Southeast Asian region, it is crucial for otorhinolaryngologists to be aware of primary nasal TB when encountering unusual head and neck lesions, even in the absence of pulmonary TB.
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Affiliation(s)
- Khoo Shu Jiun
- Otorhinolaryngology - Head and Neck Surgery, Taiping Hospital, Taiping, MYS
| | - Syafiqah Kamel
- Otorhinolaryngology - Head and Neck Surgery, Taiping Hospital, Taiping, MYS
| | - Kanivannen Arasu
- Otorhinolaryngology - Head and Neck Surgery, Taiping Hospital, Taiping, MYS
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Alanazi F, Alenezi M, Alanazy S, Yahya B. Rhinoplasty for Sinonasal Deformities in Granulomatosis with Polyangiitis: A Systematic Review and Meta-Analysis. J Craniofac Surg 2023; 34:2347-2351. [PMID: 37665071 DOI: 10.1097/scs.0000000000009721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 07/09/2023] [Indexed: 09/05/2023] Open
Abstract
BACKGROUND Granulomatosis with polyangiitis (GPA) is a vasculitis that affects respiratory and kidney vessels. It primarily involves the nose and sinuses but can progress systemically. Granulomatosis with polyangiitis causes severe nasal deformities, impacting aesthetics and breathing. Literature focuses on rhinoplasty for saddle nose deformities in non-GPA patients, but its suitability for GPA patients remains uncertain. AIM Our study aims to assess the effectiveness and safety of rhinoplasty in GPA patients by analyzing the existing literature. METHODS Four databases were searched; 2 reviewers independently screened the retrieved references, then relevant data for our study were extracted. Categorical outcomes were analyzed using pooled proportions and 95% CI. Statistical heterogeneity was assessed using the I2 statistics χ 2 test with a P -value lower than 0.1 indicating heterogeneity. RESULTS In our systematic review and meta-analysis, we incorporated 16 studies encompassing 136 patients who underwent nasal reconstruction as part of their treatment for GPA. The collective findings indicate a favorable success rate for rhinoplasty, with a pooled ratio of 89% (95% CI: 84%, 95%). The rate of revision surgeries was relatively low, with a pooled rate of 19% (95% CI: 12%, 26%). Furthermore, rhinoplasty demonstrated comparatively lower rates of recurrence (pooled rate: 22%, 95% CI: 3%, 42%) and complications (pooled rate: 12%, 95% CI: 7%, 18%). CONCLUSION Rhinoplasty benefits GPA patients with saddle nose deformity and septal perforation with high success rates and low recurrence, revision, and complication outcomes. However, more research is needed for validation and refinement.
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Affiliation(s)
- Farhan Alanazi
- Department of Otolaryngology Head and Neck Surgery, Prince Sultan Military Medical City, Riyadh
- Department of Otolaryngology Head and Neck Surgery, Prince Mohammed Medical City, Jouf
| | - Mazyad Alenezi
- Department of Otolaryngology Head and Neck Surgery, Collage of Medicine, Qassim University, Buriyadh, Qassim
| | - Sultan Alanazy
- Department of Surgery, Ears Nose and Throat Unit, Unaizah College of Medicine and Medical Sciences, Qassim University, Unaizah
| | - Buthaina Yahya
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia
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Bannour I, Ben Brahim M, Arfa S, Amor SB, Ben Mabrouk A, Berrich O, Hammemi S. Case Report: Case report: An unusual presentation of granulomatosis with polyangiitis. F1000Res 2023; 12:430. [PMID: 37900198 PMCID: PMC10600508 DOI: 10.12688/f1000research.133102.4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/19/2023] [Indexed: 10/31/2023] Open
Abstract
Aim: We are reporting a case of an unusual presentation of granulomatosis with polyangiitis (GPA) with liver involvement. Case presentation: A 45-year-old male patient presented with erythematous plaques on the face and bilateral nasal obstruction. On physical examination, the patient had a ring-shaped squamous plaque on the face. The laboratory findings revealed an accelerated erythrocyte sedimentation rate at 100 mm/h, an elevated C-reactive protein at 66 mg/L, hyper gamma globulinemia 16 g/L and an elevated alkaline phosphatase (twice the upper normal limit). The craniofacial and thoracoabdominal computed tomography (CT) -scans showed ethmoid and maxillary sinusitis, low facial bone density, multiple mediastinal and hilar lymphadenopathy, diffuse small pulmonary nodules, and hepatomegaly. A cutaneous lesion biopsy, the nasal mucosa, and the liver showed a chronic inflammatory granulomatosis process with necrosis. Serum anti-neutrophil cytoplasmic antibody (ANCA) against PR3 was positive. The clinical, biological, radiological, and histological findings substantiated the diagnosis of GPA. The patient received systemic steroids combined with cyclophosphamide pulses on days 1, 14 and 28 and then he was lost to follow-up. Two-years later, he presented with a cardiac failure and skin ulcer in the right lower limb. A nasal endoscopic exam showed nasal septum cartilage perforation with resorption of the middle and inferior nasal concha. Two weeks later, he developed a diffuse alveolar hemorrhage and was therefore transferred to the intensive care unit but died of respiratory failure 3 days later. Conclusion: Clinicians should be aware of GPA atypical clinical manifestations.
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Affiliation(s)
- Ichrak Bannour
- Laboratory of Molecular Immuno-Oncology, Faculty of Medicine, Universite de Monastir, Monastir, Monastir, 5000, Tunisia
- Immunology Laboratory, Fattouma Bourguiba Universitary Hospital, Universite de Monastir, Monastir, Monastir, 5000, Tunisia
| | - Maroi Ben Brahim
- Biochemistry Laboratory, LR12ES05 LR-NAFS Nutrition-Functional Food and Vascular Health, Faculty of Medicine, Universite de Monastir, Monastir, Monastir, 5000, Tunisia
- Internal Medicine and Endocrinology Department, Tahar Sfar University Hospital, Universite de Monastir, Monastir, Monastir, 5111, Tunisia
| | - Sondes Arfa
- Internal Medicine and Endocrinology Department, Tahar Sfar University Hospital, Universite de Monastir, Monastir, Monastir, 5111, Tunisia
| | - Soumaya ben Amor
- Department of Gastrology, Tahar Sfar University Hospital, Mahdia, Tunisia
| | - Asma Ben Mabrouk
- Internal Medicine and Endocrinology Department, Tahar Sfar University Hospital, Universite de Monastir, Monastir, Monastir, 5111, Tunisia
| | - Olfa Berrich
- Biochemistry Laboratory, LR12ES05 LR-NAFS Nutrition-Functional Food and Vascular Health, Faculty of Medicine, Universite de Monastir, Monastir, Monastir, 5000, Tunisia
- Internal Medicine and Endocrinology Department, Tahar Sfar University Hospital, Universite de Monastir, Monastir, Monastir, 5111, Tunisia
| | - Sonia Hammemi
- Biochemistry Laboratory, LR12ES05 LR-NAFS Nutrition-Functional Food and Vascular Health, Faculty of Medicine, Universite de Monastir, Monastir, Monastir, 5000, Tunisia
- Internal Medicine and Endocrinology Department, Fattouma Bourguiba University Hospital, Universite de Monastir, Monastir, Monastir, 5000, Tunisia
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Červený K, Janoušková K, Vaněčková K, Zavázalová Š, Funda D, Astl J, Holy R. Olfactory Evaluation in Clinical Medical Practice. J Clin Med 2022; 11:jcm11226628. [PMID: 36431104 PMCID: PMC9698169 DOI: 10.3390/jcm11226628] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 10/27/2022] [Accepted: 11/04/2022] [Indexed: 11/10/2022] Open
Abstract
The subjective and demanding nature of olfactory testing means that it is often neglected in clinic despite loss of smell leading to significant limitations in everyday life. The list of diseases associated with loss of olfaction far exceeds the field of otorhinolaryngology and can also be seen in neurodegenerative disorders. Knowledge of possible clinical testing is essential to determine a proper differential diagnosis for the loss of olfactory sense. Causes of olfactory impairment can be divided into either failure in transferring odour to the organ of perception or damage to the olfactory pathway structure itself. Examination should therefore include methods evaluating cross-sectional area and patency of the nasal cavity as well as subjective or objective assessment of olfactory function. In this report we summarize several articles, studies, and our own experiences to provide a comprehensive review of their current clinical usage including their benefits, limitations, and possible outcomes. We also discuss the mechanism of olfaction step by step to provide a full understanding of the possible errors depending on the localization in the pathway and the methods designed for their detection. We discuss the correlation of the microbiome in nasal polyposis and chronic rhinitis with olfactory impairment using objective olfactometry. The topic of objective olfactometry and the examination of olfactory event-related potentials (OERP) is commented upon in detail.
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Affiliation(s)
- Květoslav Červený
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Motol, First Faculty of Medicine, Charles University, 15006 Prague, Czech Republic
- Institute of Anatomy, First Faculty of Medicine, Charles University, 12800 Prague, Czech Republic
| | - Karla Janoušková
- Department of Otorhinolaryngology and Maxillofacial Surgery, Military University Hospital, 16902 Prague, Czech Republic
- Third Faculty of Medicine, Charles University, 10000 Prague, Czech Republic
| | - Kristýna Vaněčková
- Department of Otorhinolaryngology and Maxillofacial Surgery, Military University Hospital, 16902 Prague, Czech Republic
- Third Faculty of Medicine, Charles University, 10000 Prague, Czech Republic
| | - Šárka Zavázalová
- Department of Otorhinolaryngology and Maxillofacial Surgery, Military University Hospital, 16902 Prague, Czech Republic
- Third Faculty of Medicine, Charles University, 10000 Prague, Czech Republic
| | - David Funda
- Laboratory of Cellular and Molecular Immunology, Institute of Microbiology of the CAS, v. v. i., 14220 Prague, Czech Republic
| | - Jaromír Astl
- Department of Otorhinolaryngology and Maxillofacial Surgery, Military University Hospital, 16902 Prague, Czech Republic
- Third Faculty of Medicine, Charles University, 10000 Prague, Czech Republic
| | - Richard Holy
- Department of Otorhinolaryngology and Maxillofacial Surgery, Military University Hospital, 16902 Prague, Czech Republic
- Third Faculty of Medicine, Charles University, 10000 Prague, Czech Republic
- Correspondence:
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Granulomatosis with polyangiitis diagnosed during the treatment of otitis media with prednisolone in a patient with anti-neutrophil cytoplasmic antibody-associated vasculitis: A case report. Respir Med Case Rep 2022; 40:101771. [DOI: 10.1016/j.rmcr.2022.101771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 11/06/2022] [Indexed: 11/11/2022] Open
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Barańska M, Makowska J, Wągrowska-Danilewicz M, Pietruszewska W. Supraglottic Localization of IgG4-Related Disease—Rare and Challenging Equity. J Pers Med 2022; 12:jpm12081223. [PMID: 36013172 PMCID: PMC9409927 DOI: 10.3390/jpm12081223] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 07/12/2022] [Accepted: 07/22/2022] [Indexed: 11/17/2022] Open
Abstract
Supraglottic stenosis is a rare symptom, particularly in fibroinflammatory multifocal diseases, such as IgG4-related disease (IgG4-RD). There is still an inconsistency in the diagnosis of less-common locations of IgG4-RD, which causes a delay in the diagnosis and treatment. Our paper aims to analyze different aspects of IgG4-RD presenting as supraglottic stenosis, including the possible overlap with ANCA-associated vasculitis. We compare the usefulness of the recently revised ACR/EULAR and Comprehensive criteria and discuss treatment options. The review was performed according to PRISMA guidelines using the MEDLINE Pubmed and Scopus databases. The analysis includes nine papers describing supraglottic laryngeal stenosis in 13 patients. Furthermore, we present a case of a woman with ongoing supraglottic stenosis presenting with cough, temporary dyspnea and stridor as the symptoms of localized IgG4-RD. At the time of writing, the patient remains in remission while receiving treatment with cyclophosphamide and methylprednisolone. The symptoms of supraglottic localization of IgG4-RD may be severe; however, at that point, clinicians should suspect autoimmune etiology and attempt to modulate the autoimmune response instead of performing dilatation surgery—the effects of which may not result in extended intervals between interventions. The ACR/EULAR criteria show great specificity; however, when IgG4-RD is presumed, the specific treatment should be implemented.
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Affiliation(s)
- Magda Barańska
- Department of Otolaryngology, Head and Neck Oncology, Medical University of Lodz, 90-419 Lodz, Poland;
- Correspondence:
| | - Joanna Makowska
- Department of Rheumatology, Medical University of Lodz, 90-419 Lodz, Poland;
| | | | - Wioletta Pietruszewska
- Department of Otolaryngology, Head and Neck Oncology, Medical University of Lodz, 90-419 Lodz, Poland;
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Stavrakas M, Smith R, Akil M, Kuet KP, Morley F, Ray J. Added value of Joint ENT-Rheumatology clinic in the management of ANCA-associated vasculitis: One year's experience. Am J Otolaryngol 2022; 43:103485. [PMID: 35567837 DOI: 10.1016/j.amjoto.2022.103485] [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: 04/19/2022] [Accepted: 05/01/2022] [Indexed: 11/01/2022]
Abstract
PURPOSE ANCA-associated vasculitides (AAV) represent a group of diagnoses, including granulomatosis with polyangiitis (GPA), eosinophilic granulomatosis with polyangiitis (EGPA) and microscopic polyangiitis (MPA). Most commonly, they present initially with ENT-associated symptomatology, and therefore they often pose a diagnostic challenge. We aim to present our one-year experience in the joint management of AAV in a multi-disciplinary setting. METHODS We performed a retrospective analysis based on the records of 39 patients who were seen in the joint clinic, during a period of one year. RESULTS After clinical assessment, 13 patients had changes made to their ENT treatment, 2 had some changes in their immunosuppression, while 11 had changes in both ENT and Rheumatology treatment. Six patients did not require any alterations to their therapeutic scheme. On average three separate appointments were reduced to a single appointment in the joint clinic where definitive treatment decisions were made. This led to significant cost reductions. CONCLUSIONS Cost-effectiveness, patient satisfaction, rapid multi-disciplinary evaluation, avoidance of unnecessary immunosuppression, patient education and medical training are only a few of the many advantages of this proposed joint service.
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Marchioni A, Andrisani D, Tonelli R, Andreani A, Cappiello GF, Ori M, Gozzi F, Bruzzi G, Nani C, Feminò R, Manicardi L, Baroncini S, Mattioli F, Fermi M, Fantini R, Tabbì L, Castaniere I, Presutti L, Clini E. Stenting versus balloon dilatation in patients with tracheal benign stenosis: The
STROBE
trial. Laryngoscope Investig Otolaryngol 2022; 7:395-403. [PMID: 35434321 PMCID: PMC9008152 DOI: 10.1002/lio2.734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 08/31/2021] [Accepted: 12/28/2021] [Indexed: 11/12/2022] Open
Affiliation(s)
- Alessandro Marchioni
- Respiratory Diseases Unit, Department of Surgical and Medical Sciences University Hospital of Modena Modena Italy
| | - Dario Andrisani
- Respiratory Diseases Unit, Department of Surgical and Medical Sciences University Hospital of Modena Modena Italy
- PhD Course Clinical and Experimental Medicine (CEM) University of Modena & Reggio Emilia Modena Italy
| | - Roberto Tonelli
- Respiratory Diseases Unit, Department of Surgical and Medical Sciences University Hospital of Modena Modena Italy
- PhD Course Clinical and Experimental Medicine (CEM) University of Modena & Reggio Emilia Modena Italy
| | - Alessandro Andreani
- Respiratory Diseases Unit, Department of Surgical and Medical Sciences University Hospital of Modena Modena Italy
| | - Gaia Francesca Cappiello
- Respiratory Diseases Unit, Department of Surgical and Medical Sciences University Hospital of Modena Modena Italy
| | - Margherita Ori
- Respiratory Unit and Cystic Fibrosis Adult Center Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Milan Italy
| | - Filippo Gozzi
- Respiratory Diseases Unit, Department of Surgical and Medical Sciences University Hospital of Modena Modena Italy
- PhD Course Clinical and Experimental Medicine (CEM) University of Modena & Reggio Emilia Modena Italy
| | - Giulia Bruzzi
- Respiratory Diseases Unit, Department of Surgical and Medical Sciences University Hospital of Modena Modena Italy
| | - Chiara Nani
- Respiratory Diseases Unit, Department of Surgical and Medical Sciences University Hospital of Modena Modena Italy
| | - Raimondo Feminò
- Anesthesiology Unit University Hospital of Modena Modena Italy
| | - Linda Manicardi
- Respiratory Diseases Unit, Department of Surgical and Medical Sciences University Hospital of Modena Modena Italy
| | - Serena Baroncini
- Respiratory Diseases Unit, Department of Surgical and Medical Sciences University Hospital of Modena Modena Italy
| | | | - Matteo Fermi
- Otolaryngology Unit University Hospital of Modena Modena Italy
| | - Riccardo Fantini
- Respiratory Diseases Unit, Department of Surgical and Medical Sciences University Hospital of Modena Modena Italy
| | - Luca Tabbì
- Respiratory Diseases Unit, Department of Surgical and Medical Sciences University Hospital of Modena Modena Italy
| | - Ivana Castaniere
- Respiratory Diseases Unit, Department of Surgical and Medical Sciences University Hospital of Modena Modena Italy
- PhD Course Clinical and Experimental Medicine (CEM) University of Modena & Reggio Emilia Modena Italy
| | - Livio Presutti
- Anesthesiology Unit University Hospital of Modena Modena Italy
| | - Enrico Clini
- Respiratory Diseases Unit, Department of Surgical and Medical Sciences University Hospital of Modena Modena Italy
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Garefis K, Marini K, Skliris JP, Tarazis K, Nikolaidis V, Poutoglidis A, Tsetsos N, Tsikopoulos A, Markou K. Granulomatosis with Polyangiitis: Otorhinolaryngological Manifestations and Meningeal Involvement. EAR, NOSE & THROAT JOURNAL 2022:1455613221078180. [PMID: 35168386 DOI: 10.1177/01455613221078180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Konstantinos Garefis
- 2nd Academic ORL, Head and Neck Surgery Department, Aristotle University of Thessaloniki, 37794Papageorgiou Hospital, Thessaloniki, Greece
| | - Katerina Marini
- 2nd Academic ORL, Head and Neck Surgery Department, Aristotle University of Thessaloniki, 37794Papageorgiou Hospital, Thessaloniki, Greece
| | - James Philip Skliris
- Department of Pathology, 37798"G. Papanikolaou" General Hospital, Thessaloniki, Greece
| | - Konstantinos Tarazis
- 2nd Academic ORL, Head and Neck Surgery Department, Aristotle University of Thessaloniki, 37794Papageorgiou Hospital, Thessaloniki, Greece
| | - Vasilios Nikolaidis
- 2nd Academic ORL, Head and Neck Surgery Department, Aristotle University of Thessaloniki, 37794Papageorgiou Hospital, Thessaloniki, Greece
| | - Alexandros Poutoglidis
- Department of Otorhinolaryngology-Head and Neck Surgery, 37798"G. Papanikolaou" General Hospital, Thessaloniki, Greece
| | - Nikolaos Tsetsos
- Department of Otorhinolaryngology-Head and Neck Surgery, 37798"G. Papanikolaou" General Hospital, Thessaloniki, Greece
| | - Alexios Tsikopoulos
- 1st Academic ORL, Head and Neck Surgery Department, 37798Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Konstantinos Markou
- 2nd Academic ORL, Head and Neck Surgery Department, Aristotle University of Thessaloniki, 37794Papageorgiou Hospital, Thessaloniki, Greece
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16
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Eide JG, Dua AB, Alexiev BA, Matsuoka AJ. Granulomatosis with polyangiitis presenting as otomastoiditis with nasopharyngeal and parotid lesions. OTOLARYNGOLOGY CASE REPORTS 2021. [DOI: 10.1016/j.xocr.2021.100363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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17
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Guzman-Soto MI, Kimura Y, Romero-Sanchez G, Cienfuegos-Alvear JA, Candanedo-Gonzalez F, Kimura-Sandoval Y, Sanchez-Nava DA, Alonso-Ramon I, Hinojosa-Azaola A. From Head to Toe: Granulomatosis with Polyangiitis. Radiographics 2021; 41:1973-1991. [PMID: 34652975 DOI: 10.1148/rg.2021210132] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Granulomatosis with polyangiitis (GPA) is an antineutrophil cytoplasmic antibody-associated vasculitis. It is an uncommon multisystem disease involving predominantly small vessels and is characterized by granulomatous inflammation, pauci-immune necrotizing glomerulonephritis, and vasculitis. GPA can involve virtually any organ. Clinical manifestations are heterogeneous and can be classified as granulomatous (eg, ear, nose, and throat disease; lung nodules or masses; retro-orbital tumors; pachymeningitis) or vasculitic (eg, glomerulonephritis, alveolar hemorrhage, mononeuritis multiplex, scleritis). The diagnosis of GPA relies on a combination of clinical findings, imaging study results, laboratory test results, serologic markers, and histopathologic results. Radiology has a crucial role in the diagnosis and follow-up of patients with GPA. CT and MRI are the primary imaging modalities used to evaluate GPA manifestations, allowing the differentiation of GPA from other diseases that could simulate GPA. The authors review the main clinical, histopathologic, and imaging features of GPA to address the differential diagnosis in the affected organs and provide a panoramic picture of the protean manifestations of this infrequent disease. The heterogeneous manifestations of GPA pose a significant challenge in the diagnosis of this rare condition. By recognizing the common and unusual imaging findings, radiologists play an important role in the diagnosis and follow-up of patients with GPA and aid clinicians in the differentiation of disease activity versus disease-induced damage, which ultimately affects therapeutic decisions. Online supplemental material is available for this article. ©RSNA, 2021.
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Affiliation(s)
- Mahatma I Guzman-Soto
- From the Departments of Radiology (M.I.G.S., Y.K., G.R.S., J.A.C.A., Y.K.S., D.A.S.N., I.A.R.), Pathology (F.C.G.), and Immunology and Rheumatology (A.H.A.), Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga No. 15, Col. Sección XVI, Tlalpan, Mexico City, Mexico 14080
| | - Yukiyoshi Kimura
- From the Departments of Radiology (M.I.G.S., Y.K., G.R.S., J.A.C.A., Y.K.S., D.A.S.N., I.A.R.), Pathology (F.C.G.), and Immunology and Rheumatology (A.H.A.), Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga No. 15, Col. Sección XVI, Tlalpan, Mexico City, Mexico 14080
| | - Griselda Romero-Sanchez
- From the Departments of Radiology (M.I.G.S., Y.K., G.R.S., J.A.C.A., Y.K.S., D.A.S.N., I.A.R.), Pathology (F.C.G.), and Immunology and Rheumatology (A.H.A.), Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga No. 15, Col. Sección XVI, Tlalpan, Mexico City, Mexico 14080
| | - Jose Antonio Cienfuegos-Alvear
- From the Departments of Radiology (M.I.G.S., Y.K., G.R.S., J.A.C.A., Y.K.S., D.A.S.N., I.A.R.), Pathology (F.C.G.), and Immunology and Rheumatology (A.H.A.), Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga No. 15, Col. Sección XVI, Tlalpan, Mexico City, Mexico 14080
| | - Fernando Candanedo-Gonzalez
- From the Departments of Radiology (M.I.G.S., Y.K., G.R.S., J.A.C.A., Y.K.S., D.A.S.N., I.A.R.), Pathology (F.C.G.), and Immunology and Rheumatology (A.H.A.), Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga No. 15, Col. Sección XVI, Tlalpan, Mexico City, Mexico 14080
| | - Yumi Kimura-Sandoval
- From the Departments of Radiology (M.I.G.S., Y.K., G.R.S., J.A.C.A., Y.K.S., D.A.S.N., I.A.R.), Pathology (F.C.G.), and Immunology and Rheumatology (A.H.A.), Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga No. 15, Col. Sección XVI, Tlalpan, Mexico City, Mexico 14080
| | - Dulce A Sanchez-Nava
- From the Departments of Radiology (M.I.G.S., Y.K., G.R.S., J.A.C.A., Y.K.S., D.A.S.N., I.A.R.), Pathology (F.C.G.), and Immunology and Rheumatology (A.H.A.), Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga No. 15, Col. Sección XVI, Tlalpan, Mexico City, Mexico 14080
| | - Ingrid Alonso-Ramon
- From the Departments of Radiology (M.I.G.S., Y.K., G.R.S., J.A.C.A., Y.K.S., D.A.S.N., I.A.R.), Pathology (F.C.G.), and Immunology and Rheumatology (A.H.A.), Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga No. 15, Col. Sección XVI, Tlalpan, Mexico City, Mexico 14080
| | - Andrea Hinojosa-Azaola
- From the Departments of Radiology (M.I.G.S., Y.K., G.R.S., J.A.C.A., Y.K.S., D.A.S.N., I.A.R.), Pathology (F.C.G.), and Immunology and Rheumatology (A.H.A.), Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga No. 15, Col. Sección XVI, Tlalpan, Mexico City, Mexico 14080
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18
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Tabei A, Sakairi T, Ohishi Y, Watanabe M, Nakasatomi M, Hamatani H, Ikeuchi H, Kaneko Y, Hiromura K. Otitis media with ANCA-associated vasculitis: A retrospective study of 30 patients. Mod Rheumatol 2021; 32:923-929. [PMID: 34915561 DOI: 10.1093/mr/roab078] [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: 06/29/2021] [Revised: 08/19/2021] [Accepted: 08/25/2021] [Indexed: 11/12/2022]
Abstract
OBJECTIVES Otitis media with antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (OMAAV) is a new category of otitis media in which cases of otitis media due to ANCA-associated vasculitis (AAV) are classified, regardless of ANCA variant or ANCA serotype. We aimed to describe the clinical features and course of patients with OMAAV and identify factors associated with hearing outcomes. METHODS We retrospectively analysed 30 patients with OMAAV, classified based on the criteria proposed by the Japan Otological Society in 2016. RESULTS Single-positive myeloperoxidase-ANCA, single-positive proteinase 3-ANCA, double-positive ANCA, and double-negative ANCA were identified in 47%, 33%, 7%, and 13% of the patients, respectively. All patients subjected to audiometry showed hearing impairments, and 85% were affected bilaterally. Mixed- and sensorineural-type hearing impairments were identified in 80% and 20% of impaired ears, respectively. Hypertrophic pachymeningitis (HPM) was identified in 37% of the patients. Immunosuppressive therapy was administered to 93% of patients, and the median air conduction hearing levels at pre- and post-treatment were 66.1 dB and 43.4 dB, respectively, indicating significant hearing improvements. HPM and a long interval between disease onset and treatment initiation were significantly correlated with poor hearing prognosis. CONCLUSIONS OMAAV develops under any type of ANCA-serology and typically causes mixed or sensorineural bilateral hearing loss. The early initiation of immunosuppressive therapy and the absence of HPM were associated with good hearing outcomes.
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Affiliation(s)
| | - Toru Sakairi
- Department of Nephrology and Rheumatology, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Yuko Ohishi
- Department of Nephrology and Rheumatology, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Mitsuharu Watanabe
- Department of Nephrology and Rheumatology, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Masao Nakasatomi
- Department of Nephrology and Rheumatology, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Hiroko Hamatani
- Department of Nephrology and Rheumatology, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Hidekazu Ikeuchi
- Department of Nephrology and Rheumatology, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Yoriaki Kaneko
- Department of Nephrology and Rheumatology, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Keiju Hiromura
- Department of Nephrology and Rheumatology, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
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19
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Djerić D, Perić A, Pavlović B, Folić M, Bontić A, Baralić M, Pavlović J, Radović M. Otitis media with effusion as an initial manifestation of granulomatosis with polyangiitis. SAGE Open Med Case Rep 2021; 9:2050313X211036006. [PMID: 34377487 PMCID: PMC8327233 DOI: 10.1177/2050313x211036006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 07/09/2021] [Indexed: 11/25/2022] Open
Abstract
Granulomatosis with polyangiitis is a systemic vasculitis of unknown etiology, characterized by necrotizing granulomas. It is an autoimmune disease affecting small- and medium-sized vessels of upper and lower respiratory tract, kidneys, and other organs. We described a case of a patient with otitis media with effusion as the first manifestations of granulomatosis with polyangiitis. A 54-year-old female presented as an urgent case with history of a severe otalgia, hearing loss, vertigo, and fever. The patient was treated with diagnosis of otitis media with effusion and acute rhinosinusitis, but without significant success. She developed an acute kidney dysfunction as a sign of glomerulonephritis with rapidly progressive renal failure. Diagnosis of granulomatosis with polyangiitis was confirmed after the histopathological analysis of kidney tissue, not by analysis of middle ear and paranasal sinus mucosa specimens. The patient was treated according to generally accepted protocol, and over time, there was an almost complete recovery.
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Affiliation(s)
- Dragoslava Djerić
- School of Medicine, University in Belgrade, Belgrade, Serbia
- Clinic for Otorhinolaryngology and Maxillofacial Surgery, Clinical Center of Serbia, Belgrade, Serbia
| | - Aleksandar Perić
- Department of Otorhinolaryngology, Military Medical Academy Faculty of Medicine, University of Defence, Belgrade, Serbia
- Aleksandar Perić, Department of Otorhinolaryngology, Military Medical Academy Faculty of Medicine, University of Defence, Crnotravska 17, 11000 Belgrade, Serbia.
| | - Bojan Pavlović
- School of Medicine, University in Belgrade, Belgrade, Serbia
- Clinic for Otorhinolaryngology and Maxillofacial Surgery, Clinical Center of Serbia, Belgrade, Serbia
| | - Miljan Folić
- School of Medicine, University in Belgrade, Belgrade, Serbia
- Clinic for Otorhinolaryngology and Maxillofacial Surgery, Clinical Center of Serbia, Belgrade, Serbia
| | - Ana Bontić
- Clinic for Nephrology, Clinical Center of Serbia, Belgrade, Serbia
| | - Marko Baralić
- Clinic for Nephrology, Clinical Center of Serbia, Belgrade, Serbia
| | - Jelena Pavlović
- Clinic for Nephrology, Clinical Center of Serbia, Belgrade, Serbia
| | - Milan Radović
- School of Medicine, University in Belgrade, Belgrade, Serbia
- Clinic for Nephrology, Clinical Center of Serbia, Belgrade, Serbia
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20
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Hackenberg S, Kraus F, Scherzad A. Rare Diseases of Larynx, Trachea and Thyroid. Laryngorhinootologie 2021; 100:S1-S36. [PMID: 34352904 PMCID: PMC8363221 DOI: 10.1055/a-1337-5703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
This review article covers data on rare diseases of the larynx, the trachea and the thyroid. In particular, congenital malformations, rare manifestations of inflammatory laryngeal disorders, benign and malignant epithelial as well as non-epithelial tumors, laryngeal and tracheal manifestations of general diseases and, finally, thyroid disorders are discussed. The individual chapters contain an overview of the data situation in the literature, the clinical appearance of each disorder, important key points for diagnosis and therapy and a statement on the prognosis of the disease. Finally, the authors indicate on study registers and self-help groups.
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Affiliation(s)
- Stephan Hackenberg
- Klinik und Poliklinik für Hals-, Nasen- und Ohrenkrankheiten,
plastische und ästhetische Operationen, Universitätsklinikum
Würzburg
| | - Fabian Kraus
- Klinik und Poliklinik für Hals-, Nasen- und Ohrenkrankheiten,
plastische und ästhetische Operationen, Universitätsklinikum
Würzburg
| | - Agmal Scherzad
- Klinik und Poliklinik für Hals-, Nasen- und Ohrenkrankheiten,
plastische und ästhetische Operationen, Universitätsklinikum
Würzburg
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21
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Eslambolchi A, Aghaghazvini L, Gholamrezanezhad A, Kavosi H, Radmard AR. Coronavirus disease 2019 (COVID-19) in patients with systemic autoimmune diseases or vasculitis: radiologic presentation. J Thromb Thrombolysis 2020; 51:339-348. [PMID: 32981005 PMCID: PMC7519703 DOI: 10.1007/s11239-020-02289-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/19/2020] [Indexed: 02/07/2023]
Abstract
Coronavirus disease 2019 (COVID-19) has transformed into a worldwide challenge, since its outbreak in December 2019. Generally, patients with underlying medical conditions are at a higher risk of complications and fatality of pneumonias. Whether patients with systemic autoimmune diseases or vasculitides, are at increased risk for serious complications associated with COVID-19, is not established yet. Computed tomography (CT) has been employed as a diagnostic tool in the evaluation of patients with clinical suspicion of severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2) infection with a reported sensitivity of higher than reverse transcription polymerase chain reaction (RT-PCR) test. Multifocal bilateral ground-glass opacities (GGOs) with peripheral and posterior distribution and subsequent superimposition of consolidations are considered the main imaging features of the disease in chest CT. However, chest CT images of underlying rheumatologic or autoimmune diseases or vasculitides, such as systemic sclerosis, systemic lupus erythematosus, rheumatoid arthritis, Behçet disease, and granulomatosis with polyangiitis, especially those with extensive lung involvement can overshadow or obliterate features of COVID-19. In addition, CT findings of such diseases may resemble manifestations of COVID-19 (such as ground glass opacities with or without superimposed consolidation), making the diagnosis of viral infections, more challenging on imaging. Comparing the imaging findings with prior studies (if available) for any interval change is the most helpful approach. Otherwise, the diagnosis of COVID-19 in such patients must be cautiously made according to the clinical context and laboratory results, considering a very high clinical index of suspicion on imaging.
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Affiliation(s)
| | - Leila Aghaghazvini
- Department of Radiology, Shariati Hospital, Tehran University of Medical Sciences (TUMS), Jalal-e-Al-e-Ahmad Hwy, Tehran, Iran.
| | - Ali Gholamrezanezhad
- Department of Radiology, Keck School of Medicine, University of Southern California (USC), Los Angeles, CA, USA
| | - Hoda Kavosi
- Rheumatology Research Center, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Amir Reza Radmard
- Department of Radiology, Shariati Hospital, Tehran University of Medical Sciences (TUMS), Jalal-e-Al-e-Ahmad Hwy, Tehran, Iran
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22
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Learned KO, Vu TH, Choi JM, Gule-Monroe MK, Pytynia KB, Ginsberg LE. Purulent chondritis of thyroid cartilage. BJR Case Rep 2020; 6:20200013. [PMID: 32922843 PMCID: PMC7465748 DOI: 10.1259/bjrcr.20200013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 04/29/2020] [Accepted: 05/01/2020] [Indexed: 11/24/2022] Open
Abstract
We report a case of a 77-year-old female with purulent chondritis of the thyroid cartilage who was initially referred for laryngeal neoplasm. Purulent chondritis of the laryngeal cartilage is a rare entity with three reports in the literature. The unique CT imaging features of expansile laryngeal cartilage with peripheral rim enhancement and central fluid-attenuation correlate to the abscess formation between the inner and outer perichondria. The correct imaging assessment prompts surgical management and avoid misdiagnosis.
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Affiliation(s)
- Kim O Learned
- Diagnostic Radiology, Neuroradiology (KOL, THV, MKG, LEG), and Head and Neck Surgery (KBP), University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Thinh H Vu
- Diagnostic Radiology, Neuroradiology (KOL, THV, MKG, LEG), and Head and Neck Surgery (KBP), University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jeanie M Choi
- Diagnostic and Interventional Imaging, Neuroradiology, University of Texas Health Science Center, Houston, TX (JMC), USA
| | - Maria K Gule-Monroe
- Diagnostic Radiology, Neuroradiology (KOL, THV, MKG, LEG), and Head and Neck Surgery (KBP), University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Kristen B Pytynia
- Head & Neck Surgery, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Lawrence E Ginsberg
- Diagnostic Radiology, Neuroradiology (KOL, THV, MKG, LEG), and Head and Neck Surgery (KBP), University of Texas MD Anderson Cancer Center, Houston, TX, USA
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23
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Akiyama M, Kaneko Y, Takeuchi T. Characteristics and prognosis of ANCA-positive retroperitoneal fibrosis: A systematic literature review. Autoimmun Rev 2020; 19:102642. [PMID: 32801045 DOI: 10.1016/j.autrev.2020.102642] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Accepted: 04/03/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Anti-neutrophil cytoplasmic autoantibody (ANCA)-positive retroperitoneal fibrosis (RPF) is extremely rare. This study aimed to clarify the clinical characteristics and prognosis of patients with ANCA-positive RPF. METHODS We conducted a systematic literature review of articles reporting on ANCA-positive RPF from the database inception dates until March 8, 2020. RESULTS We identified 19 patients with ANCA-positive RPF with a mean age of 62 years; a male dominance (68.4%) was noted. Most patients presented with systemic symptoms and/or lower back or abdominal pain. Proteinase 3 (PR3) -ANCA positivity was predominant compared with myeloperoxidase (MPO)-ANCA (63.2% vs. 36.8%, respectively), and all patients showed elevated serum C-reactive protein levels. Of note, 26.7% of patients had isolated RPF without any other ANCA-associated systemic organ involvement. Regarding typical manifestations of ANCA- associated vasculitis, ear, nose, and throat involvement occurred in 26.3%, lung involvement in 36.8%, and kidney involvement (rapidly progressive glomerulonephritis) in 31.6% of patients. Necrosis and granulomatous inflammation, vasculitis, and multinucleated giant cells were pathologically observed in tissue sections of RPF, whereas tertiary lymphoid organ formation was not identified. Glucocorticoids with or without other immunosuppressive treatments were effective in most patients, but 4 patients experienced disease relapse during the clinical course. All relapsed patients were positive for PR3-ANCA. CONCLUSION Clinical features of ANCA-positive RPF are associated with systemic inflammatory components such as fever and elevated serum C-reactive protein levels. ANCA-. positive RPF presents as an "isolated" involved organ in one-third of patients. Immunosuppressive treatments are effective, but the disease can recur, particularly in PR3-ANCA-positive patients.
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Affiliation(s)
- Mitsuhiro Akiyama
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Japan
| | - Yuko Kaneko
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Japan.
| | - Tsutomu Takeuchi
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Japan
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Localized Granulomatous with Polyangiitis (GPA): Varied Clinical Presentations and Update on Treatment. Curr Allergy Asthma Rep 2020; 20:56. [PMID: 32648055 DOI: 10.1007/s11882-020-00953-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE OF REVIEW Granulomatosis with polyangiitis is a primary systemic vasculitis commonly described with the typical triad of upper airway, lung, and kidney involvement. Upper and lower airway involvement is characteristic in patients with granulomatosis with polyangiitis and can sometimes represent the initial or in some instances the sole manifestation. The objective of this review is to summarize the various clinical manifestations of localized disease in GPA and their treatment. RECENT FINDINGS Sinonasal disease is seen in up to 90% of patients. Otologic and ocular involvement is also commonly seen. Laryngeal and tracheal disease although less common is associated with significant morbidity and can be therapeutically challenging. Clinicians need to be aware of these localized GPA manifestations as they may be presenting disease features in the absence of other systemic findings. Treatment of localized GPA involves both immunosuppressive and surgical interventions for specific manifestations. Collaboration between specialists including rheumatologists, otolaryngologists, and ophthalmologists is often crucial to ensure optimal outcomes for patients. This is a narrative review that provides a comprehensive overview of localized granulomatosis with polyangiitis and current treatment options.
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25
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Nasal reconstructive surgery for vasculitis affecting the nose: our two-centre international experience. Eur Arch Otorhinolaryngol 2020; 277:3059-3066. [PMID: 32623509 DOI: 10.1007/s00405-020-06180-8] [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: 05/09/2020] [Accepted: 06/28/2020] [Indexed: 01/28/2023]
Abstract
PURPOSE To recommend an international multidisciplinary medical and surgical algorithm of treatment in nasal vasculitis, which will create a more streamlined approach. METHODS A two-centre, international retrospective analysis of granulomatosis with polyangiitis (GPA) and levamisole-associated vasculitis (LAV) cases presenting between 2005 and 2019 was carried out. Demographic data, and surgical and medical treatment were recorded. Patients' signs and symptoms were analysed, and recommended treatment strategies outlined with key surgical procedures described. RESULTS Forty-one GPA patients and 11 LAV patients were included in the study with a mean age of 38.6 and 38.8 years, respectively. A stepwise surgical management approach with reconstructive options is described and includes: (1) examination under general anaesthesia, biopsy, and insertion of silastic nasal splints; (2) septal perforation repair (with caution); (3) mild-to-moderate saddle nose reconstruction with costal cartilage; (4) severe saddle nose reconstruction with osseocartilaginous rib grafts; (5) soft-tissue reconstruction techniques. CONCLUSIONS The management of nasal vasculitis is a particular challenge in facial plastic surgery. It requires a close collaborative approach with a physician skilled in the medical management of vasculitis. Surgery must be planned judiciously, with realistic patient expectations and only after a sustained period of remission. For more severe saddle deformities, the modified osseocartilaginous Andrews technique gives excellent long-term results.
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26
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Pendolino AL, Unadkat S, Zhang H, Pendolino M, Bianchi G, Randhawa PS, Andrews PJ. The role of surgery in antineutrophil cytoplasmic antibody-associated vasculitides affecting the nose and sinuses: A systematic review. SAGE Open Med 2020; 8:2050312120936731. [PMID: 32676189 PMCID: PMC7340348 DOI: 10.1177/2050312120936731] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Accepted: 05/29/2020] [Indexed: 01/28/2023] Open
Abstract
Background: The ear, nose and throat region has been reported to be one of the commonest sites involved in antineutrophil cytoplasmic antibody (ANCA)–associated vasculitis diseases and often precedes the diagnosis of ANCA–associated vasculitis by many months. Although treatment for ANCA–associated vasculitis primarily requires systemic immunosuppressive therapy, there are specific indications for sinonasal surgery during the course of the disease process. The three major roles for surgery in sinonasal vasculitis are to aid diagnosis through biopsy, enable symptom relief and nasal reconstructive surgery consideration when in remission. Purpose: The aim of this systematic review is to provide an overview of the surgical procedures which can be performed in patients with ANCA–associated vasculitis presenting with sinonasal involvement. Materials and methods: A systematic literature search was performed for scientific articles on MEDLINE (PubMed Advanced MEDLINE Search) and EMBASE. The search included all articles up to April 2020. Conclusion: Surgical intervention during the active phase of ANCA–associated vasculitis disease can improve the patient’s symptoms and enable histological diagnosis. The surgical decision to manage the nose requires a multidisciplinary approach involving the vasculitis specialist and the ear, nose and throat surgeon. Nasal reconstruction can be performed to restore form and function but only when the disease is in remission so as to maximise success and minimise complications.
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Affiliation(s)
- Alfonso Luca Pendolino
- Department of ENT, Royal National ENT & Eastman Dental Hospitals, London, UK.,Ear Institute, University College London (UCL), London, UK
| | - Samit Unadkat
- Department of ENT, Royal National ENT & Eastman Dental Hospitals, London, UK
| | - Henry Zhang
- Department of ENT, Royal National ENT & Eastman Dental Hospitals, London, UK
| | - Monica Pendolino
- Division of Rheumatology, Department of Locomotor System, ASL 3, Genoa, Italy
| | - Gerolamo Bianchi
- Division of Rheumatology, Department of Locomotor System, ASL 3, Genoa, Italy
| | - Premjit S Randhawa
- Department of ENT, Royal National ENT & Eastman Dental Hospitals, London, UK
| | - Peter J Andrews
- Department of ENT, Royal National ENT & Eastman Dental Hospitals, London, UK.,Ear Institute, University College London (UCL), London, UK
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Havuz E, GÜdÜl Havuz S. Rare Presentation of Severely Limited Granulomatosis With Polyangiitis Manifesting With Orbital Wall Destruction: Literature Review and Case Report. Arch Rheumatol 2020; 35:292-299. [PMID: 32851382 DOI: 10.46497/archrheumatol.2020.7503] [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: 03/17/2019] [Accepted: 05/30/2019] [Indexed: 11/03/2022] Open
Abstract
Necrosis resulting from mechanical local factors can be seen in patients with granulomatosis with polyangiitis (GPA) even in remission. GPA can cause serious morbidity even when limited. An ocular prosthesis that increases inflammation and damages local circulation should be used very carefully in such patients. In this article, we report a 68-year-old male patient who was diagnosed with localized GPA 11 years ago and referred to our clinic with the complaint of displacement of an ocular prosthesis inside the nose and epistaxis. Four years ago, the left eye was enucleated because of pain and vision loss. Two months after the enucleation, the patient began to use an ocular prosthesis. Orbital medial wall destruction developed while the patient was receiving maintenance therapy that consisted of cyclophosphamide (150 mg/day) plus prednisolone (32 mg). When the ocular prosthesis was displaced in the nasal cavity, the prosthesis was first removed and the patient was clinically stabilized. Later, orbital wall reconstruction was performed at another center.
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Affiliation(s)
- Erol Havuz
- Department of Ophthalmology, University of Health Sciences, SUAM Samsun Hospital, Samsun, Turkey
| | - Seda GÜdÜl Havuz
- Department of Microbiology, Public Health Institution of Turkey, Samsun, Turkey
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28
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Mattei P, De Bonnecaze G, Chabrillac E. Necrotizing sinusitis. Eur Ann Otorhinolaryngol Head Neck Dis 2020; 137:105-106. [PMID: 31982361 DOI: 10.1016/j.anorl.2020.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- P Mattei
- Department of ENT-Head and Neck Surgery, Toulouse University Hospital, Hôpital Larrey, 24, chemin de Pouvourville, 31400 Toulouse, France
| | - G De Bonnecaze
- Department of ENT-Head and Neck Surgery, Toulouse University Hospital, Hôpital Larrey, 24, chemin de Pouvourville, 31400 Toulouse, France
| | - E Chabrillac
- Department of ENT-Head and Neck Surgery, Toulouse University Hospital, Hôpital Larrey, 24, chemin de Pouvourville, 31400 Toulouse, France.
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29
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Abdelghany MF, Khalaf MGA. Submandibular salivary gland involvement in granulomatosis with polyangiitis. THE EGYPTIAN JOURNAL OF BRONCHOLOGY 2019. [DOI: 10.4103/ejb.ejb_15_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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30
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Granulomatosis With Polyangiitis and Continuous Positive Airway Pressure-The Challenge of Interface Between Nose and Mask. J Clin Rheumatol 2019; 24:102-103. [PMID: 29200024 DOI: 10.1097/rhu.0000000000000632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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31
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Wojciechowska J, KręCicki T. Clinical characteristics of patients with granulomatosis with polyangiitis and microscopic polyangiitis in ENT practice: a comparative analysis. ACTA ACUST UNITED AC 2019; 38:517-527. [PMID: 30623897 PMCID: PMC6325653 DOI: 10.14639/0392-100x-1776] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Accepted: 09/24/2017] [Indexed: 01/19/2023]
Abstract
ENT manifestations are commonly observed in patients with small vessel vasculitis (SVV). The main aim of this study was to analyse and present the clinicopathological characteristics of individuals with SVV emphasising otorhinolaryngological symptoms. This study evaluated 64 patients, 41 with granulomatosis with polyangiitis (GPA) and 23 with microscopic polyangiitis (MPA). Herein, we compare the clinicopathologic features of GPA and MPA. The average age at diagnosis was 50.2 and 56.2 years, for GPA and MPA, respectively. 57 patients (89%) were antineutrophil cytoplasmic antibody (ANCA) positive, 34 (59.6%) for anti-proteinase 3 (PR3)-ANCA and 21 (36.8%) for myeloperoxidase (MPO)-ANCA. 7 patients (10.9%) were ANCA negative. The most commonly affected organs were lungs (76.56%), ear, nose, throat (ENT) (75%) and kidneys (73.44%). ENT disorders mainly appeared as chronic rhinosinusitis and epistaxis and preceded SVV diagnosis by an average 14.4 months. In the majority of patients, ENT disorders were the first symptoms of SVV and preceded its systemic transformation. Pulmonary, ENT and nervous manifestations were more common in GPA, whereas the prevalence of renal, gastrointestinal, cutaneous, cardiovascular and ocular disorders was higher in MPA. The results of our study emphasise the high prevalence of ENT symptoms in patients with SVV, especially in those with GPA. We highlight the significant role of the otorhinolaryngologist in early SVV diagnosis and management. Any patient with persistent ENT symptoms or ENT dysfunctions not responding to standard otorhinolaryngological treatment should be precisely and rapidly evaluated for the presence of systemic dysfunctions (especially renal and pulmonary). Realising the differences and similarities between GPA and MPA is crucial in undelayed SVV diagnosis and proper treatment.
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Affiliation(s)
- J Wojciechowska
- Department and Clinic of Otolaryngology, Head and Neck Surgery, Wrocław Medical University Hospital, Borowska, Poland
| | - T KręCicki
- Department and Clinic of Otolaryngology, Head and Neck Surgery, Wrocław Medical University Hospital, Borowska, Poland
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Szczeklik K, Włudarczyk A, Wawrzycka-Adamczyk K, Górka J, Fuks-Kulska M, Darczuk D, Pytko-Polończyk J, Szczeklik W. Oral manifestations of granulomatosis with polyangiitis - Clinical and radiological assessment. J Dent Sci 2019; 14:54-60. [PMID: 30988880 PMCID: PMC6445982 DOI: 10.1016/j.jds.2018.10.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 09/04/2018] [Indexed: 12/19/2022] Open
Abstract
Background/purpose Granulomatosis with polyangiitis (GPA) is a type of primary systemic vasculitis associated with the presence of anti-neutrophil cytoplasmic antibodies (ANCA). GPA mainly affects medium and small vessels and may manifest in different organs, most commonly upper respiratory tract. Oral lesions occur in 6–13% of GPA patients and might be the first symptom observed by the patient. This study presents the evaluation of orofacial manifestations of patients with GPA. Materials and methods Prospective study was conducted between June 2014 and November 2017 in Department of Allergy and Immunology at University Hospital in Krakow. Patients diagnosed with GPA, after medical assessment, were examined including precise dental inspection, bacterial and fungal flora of oral cavity evaluation and Cone Beam Computed Tomography (CBCT) imaging. Results Nine patients were enrolled in the study. Characteristic for GPA strawberry gingivitis was observed in one patient. Bone destruction and inflammatory lesions in paranasal sinuses was confirmed by CBCT in 55.6% of patients. Fungal infection was revealed in 66.7% of patients. Conclusion These findings oblige dentists to consult patient with laryngologist or internal medicine physician to establish further diagnostic approach, because early diagnosis of GPA is crucial for implementing appropriate treatment and preventing chronic organ damage.
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Affiliation(s)
- Katarzyna Szczeklik
- Department of Integrated Dentistry, Institute of Dentistry, Jagiellonian University Medical College, Krakow, Poland
| | - Anna Włudarczyk
- 2nd Department of Medicine, Jagiellonian University Medical College, Krakow, Poland
| | | | - Jacek Górka
- 2nd Department of Medicine, Jagiellonian University Medical College, Krakow, Poland
| | | | - Dagmara Darczuk
- Department of Periodontology and Clinical Oral Pathology Institute of Dentistry, Jagiellonian University Medical College, Krakow, Poland
| | - Jolanta Pytko-Polończyk
- Department of Integrated Dentistry, Institute of Dentistry, Jagiellonian University Medical College, Krakow, Poland
| | - Wojciech Szczeklik
- 2nd Department of Medicine, Jagiellonian University Medical College, Krakow, Poland
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Nasal Septal Perforation in Propylthiouracil-Induced Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis. Case Rep Rheumatol 2018; 2018:8192021. [PMID: 29765786 PMCID: PMC5885392 DOI: 10.1155/2018/8192021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Revised: 12/13/2017] [Accepted: 01/08/2018] [Indexed: 11/23/2022] Open
Abstract
Here, we present the case of a 29-year-old woman with nasal septal perforation and positive myeloperoxidase- (MPO-) anti-neutrophil cytoplasmic antibody (ANCA). She had been diagnosed with Graves' disease and had been treated with propylthiouracil (PTU) for 14 months. A biopsy of the nasal septum revealed an infiltration of inflammatory cells, with no evidence of malignancy or granulomatous change. Because of the use of PTU, destructive nasal lesion, and positive MPO-ANCA, she was diagnosed with drug-induced ANCA-associated vasculitis (AAV) and was treated with prednisolone and methotrexate after the cessation of PTU. Although PTU is known to be the medicine that induces drug-induced AAV, the manifestation of nasal septal perforation in drug-induced AAV is poorly identified. This is the rare case of drug-induced AAV which manifested only nasal septal perforation.
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34
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Li J, Li C, Li J. Thoracic manifestation of Wegener's granulomatosis: Computed tomography findings and analysis of misdiagnosis. Exp Ther Med 2018; 16:413-419. [PMID: 29896268 DOI: 10.3892/etm.2018.6154] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Accepted: 01/18/2018] [Indexed: 12/11/2022] Open
Abstract
The aim of the present study was to investigate the computed tomography (CT) manifestations of Wegener granulomatosis (WG) in the chest and potential reasons for misdiagnosis. Conventional CT scans and clinical data of 45 patients with WG were retrospectively analyzed. Patients typically presented with multiple system involvement, primarily in the upper and lower respiratory tract. The incidence of thoracic involvement was 75.56% (34/45). Radiographic features were varied between cases in the present study, with the most common features being numerous cavitary nodules and masses in the lungs. Cavitations were usually irregular, with uneven wall thickness, partial centrality, fuzzy inner edges and piecemeal necrosis. These results indicate that WG typically has multiple system involvement, with the chest being most prominent. Multiple variable-sized cavitary nodules with irregular edges and piecemeal necrosis were the most notable features revealed using CT scanning; however, in order to give a definitive diagnosis, biopsies should be performed.
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Affiliation(s)
- Jiakai Li
- Department of Radiology, The Hainan Branch of The Chinese PLA General Hospital, Sanya, Hainan 572013, P.R. China.,Department of Radiology, The Chinese PLA General Hospital, Beijing 100853, P.R. China
| | - Chuangui Li
- Department of Radiology, The First Affiliated Hospital, Northern Hebei College, Zhangjiakou, Hebei 075000, P.R. China
| | - Jiaojiao Li
- Department of Radiology, The General Hospital, Tianjin Medical University, Tianjin, Hebei 300052, P.R. China
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35
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Granulomatosis with Polyangiitis Localized in the Greater Omentum. Case Rep Surg 2018; 2018:6145903. [PMID: 29682388 PMCID: PMC5851328 DOI: 10.1155/2018/6145903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 02/08/2018] [Indexed: 11/17/2022] Open
Abstract
Granulomatosis with polyangiitis (GPA) is known as anti-neutrophil cytoplasmic antibody- (ANCA-) associated small vessel vasculitis and typically manifests as pulmonary-renal syndrome, but the disease is not limited to pulmonary or renal systems. The inflammation can involve whole body organs. In addition, the ANCA titer does not always become positive. Here, we describe the case of a 91-year-old man who presented with umbilical pain and fever of unknown origin. Only the increased computed tomography value of the greater omentum suggested intra-abdominal inflammation; however, serological examinations, including the ANCA level, could not reveal the focus or cause of symptoms. Finally, the histopathological examination of specimens surgically excised from the greater omentum demonstrated GPA limited to the greater omentum. This report reminds physicians to consider GPA in the differential diagnosis of acute abdominal pain or fever of unknown origin.
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36
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Ear, nose and throat involvement in granulomatosis with polyangiitis: how it presents and how it determines disease severity and long-term outcomes. Clin Rheumatol 2018; 37:1075-1083. [DOI: 10.1007/s10067-018-4019-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 01/27/2018] [Accepted: 01/31/2018] [Indexed: 10/18/2022]
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37
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King C, Harper L, Little M. The complications of vasculitis and its treatment. Best Pract Res Clin Rheumatol 2018; 32:125-136. [DOI: 10.1016/j.berh.2018.07.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 06/12/2018] [Accepted: 07/06/2018] [Indexed: 10/28/2022]
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38
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Subglottic Stenosis in Granulomatosis With Polyangiitis: The Role of Laryngotracheal Resection. Ann Thorac Surg 2018; 105:249-253. [DOI: 10.1016/j.athoracsur.2017.07.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Revised: 06/11/2017] [Accepted: 07/17/2017] [Indexed: 11/20/2022]
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39
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Cizenski JD, Michel P, Watson IT, Frieder J, Wilder EG, Wright JM, Menter MA. Spectrum of orocutaneous disease associations: Immune-mediated conditions. J Am Acad Dermatol 2017; 77:795-806. [PMID: 29029901 DOI: 10.1016/j.jaad.2017.02.019] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 02/01/2017] [Accepted: 02/03/2017] [Indexed: 02/07/2023]
Abstract
There are a number of diseases that manifest both on the skin and the oral mucosa, and therefore the importance for dermatologists in clinical practice to be aware of these associations is paramount. In the following continuing medical education series, we outline orocutaneous disease associations with both immunologic and inflammatory etiologies.
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Affiliation(s)
- Jeffrey D Cizenski
- Division of Dermatology, Baylor University Medical Center, Dallas, Texas
| | - Pablo Michel
- Division of Dermatology, Baylor University Medical Center, Dallas, Texas
| | - Ian T Watson
- Texas A&M Health Science Center College of Medicine, Bryan, Texas
| | - Jillian Frieder
- Division of Dermatology, Baylor University Medical Center, Dallas, Texas
| | - Elizabeth G Wilder
- Division of Dermatology, Baylor University Medical Center, Dallas, Texas
| | - John M Wright
- Department of Diagnostic Sciences, Texas A&M College of Dentistry, Dallas, Texas
| | - M Alan Menter
- Division of Dermatology, Baylor University Medical Center, Dallas, Texas.
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40
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Bowers L, Brennan M. Oral Complications of Multiorgan Disorders. Atlas Oral Maxillofac Surg Clin North Am 2017; 25:187-195. [PMID: 28778307 DOI: 10.1016/j.cxom.2017.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Leah Bowers
- Oral and Maxillofacial Surgery, UCSF School of Dentistry, 533 Parnassus Avenue, PO Box 0404, UB-10, San Francisco, CA 94143, USA.
| | - Michael Brennan
- Department of Oral Medicine, Carolinas Medical Center, Carolinas HealthCare System, 1000 Blythe Boulevard, Charlotte, NC, 28203, USA
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41
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von Itzstein MS, Abeykoon JP, Summerfield DD, Whitaker JA. Severe destructive nasopharyngeal granulomatosis with polyangiitis with superimposed skull base Pseudomonas aeruginosa osteomyelitis. BMJ Case Rep 2017; 2017:bcr-2017-220135. [PMID: 28724596 PMCID: PMC5534968 DOI: 10.1136/bcr-2017-220135] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Skull base osteomyelitis in the setting of granulomatosis with polyangiitis (GPA) is rare and entails significant diagnostic challenges. We present a case of a 65-year-old Caucasian man with a history of rheumatoid arthritis, off immunosuppression for 18 months, who presented with 2 years of chronic headaches, severe fatigue, saddle nose deformity and 20-kilogram unintentional weight loss. Maxillofacial CT revealed an extensive destructive sinonasal and erosive skull base process. Laboratory evaluation showed equivocal elevation of antiproteinase 3 antibodies with negative antineutrophil cytoplasmic antibody panel. Biopsy of the skull base/clivus revealed necrotising granulomatous inflammation with focal vasculitis consistent with GPA, and multiple bone cultures were positive for Pseudomonas aeruginosa. This patient was diagnosed concurrently with GPA and P. aeruginosa skull base osteomyelitis. He was started on a 6-week course of cefepime intravenously and oral prednisone, with the plan to initiate rituximab infusion 2 weeks after initiation of antibiotic therapy.
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Affiliation(s)
| | - Jithma P Abeykoon
- Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Daniel D Summerfield
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
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Cichon N, Lampe K, Bremmer F, Becker T, Mätz-Rensing K. Unique case of granulomatous arteritis in a grey mouse lemur (Microcebus murinus) - first case description. Primate Biol 2017; 4:71-75. [PMID: 32110694 PMCID: PMC7041525 DOI: 10.5194/pb-4-71-2017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 03/09/2017] [Indexed: 11/11/2022] Open
Abstract
Overall, diseases of the vascular system are rarely observed entities among
nonhuman primates that are commonly associated with systemic infections,
septicemia or bacteremia. Rhesus monkeys infected with simian
immunodeficiency virus (SIV) may develop a chronic occlusive arteriopathy of
unknown etiology in late stages of the disease. This SIV associated
arteriopathy is the only well-known specific vascular entity described in
nonhuman primates. We herein report a unique case of granulomatous
arteritis in a grey mouse lemur affecting multiple organs, which is not
comparable to other disease entities formerly described in nonhuman
primates. The features of the entity most closely resemble disseminated
visceral giant cell arteritis in humans. A concise description of the
disease is given, and the differential diagnoses are discussed. An idiopathic
pathogenesis is suspected.
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Affiliation(s)
- Nicole Cichon
- German Primate Center, Kellnerweg 4, 37077 Göttingen, Germany
| | - Karen Lampe
- German Primate Center, Kellnerweg 4, 37077 Göttingen, Germany
| | - Felix Bremmer
- Georg-August-Universität, Universitätsmedizin Göttingen, Robert Kochstr. 40, 37075 Göttingen, Germany
| | - Tamara Becker
- German Primate Center, Kellnerweg 4, 37077 Göttingen, Germany
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43
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de Queiroz Pimentel C, Lanzarin LD, de Oliveira Santana FA, Rodrigues Pereira RM, Levy-Neto M. Laryngeal Primary Amyloidosis: Differential Diagnosis of Localized Granulomatosis with Polyangiitis. Report of Two Cases. ACTA ACUST UNITED AC 2017. [DOI: 10.17352/raoa.000004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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