1
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Xu P, Zhang Y, Guo J, Li H, Konrath S, Zhou P, Cai L, Rao H, Chen H, Lin J, Cui Z, Ji B, Wang J, Li N, Liu DP, Renné T, Wang M. A single-domain antibody targeting factor XII inhibits both thrombosis and inflammation. Nat Commun 2024; 15:7898. [PMID: 39266545 PMCID: PMC11393108 DOI: 10.1038/s41467-024-51745-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 08/16/2024] [Indexed: 09/14/2024] Open
Abstract
Factor XII (FXII) is the zymogen of the plasma protease FXIIa that activates the intrinsic coagulation pathway and the kallikrein kinin-system. The role of FXII in inflammation has been obscure. Here, we report a single-domain antibody (nanobody, Nb) fused to the Fc region of a human immunoglobulin (Nb-Fc) that recognizes FXII in a conformation-dependent manner and interferes with FXIIa formation. Nb-Fc treatment inhibited arterial thrombosis in male mice without affecting hemostasis. In a mouse model of extracorporeal membrane oxygenation (ECMO), FXII inhibition or knockout reduced thrombus deposition on oxygenator membranes and systemic microvascular thrombi. ECMO increased circulating levels of D-dimer, alkaline phosphatase, creatinine and TNF-α and triggered microvascular neutrophil adherence, platelet aggregation and their interaction, which were substantially attenuated by FXII blockade. Both Nb-Fc treatment and FXII knockout markedly ameliorated immune complex-induced local vasculitis and anti-neutrophil cytoplasmic antibody-induced systemic vasculitis, consistent with selectively suppressed neutrophil migration. In human blood microfluidic analysis, Nb-Fc treatment prevented collagen-induced fibrin deposition and neutrophil adhesion/activation. Thus, FXII is an important mediator of inflammatory responses in vasculitis and ECMO, and Nb-Fc provides a promising approach to alleviate thrombo-inflammatory disorders.
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Affiliation(s)
- Pengfei Xu
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yingjie Zhang
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Junyan Guo
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- College of Life Science, Zhejiang Normal University, Jinhua, Zhejiang, China
| | - Huihui Li
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Sandra Konrath
- Institute of Clinical Chemistry and Laboratory Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Peng Zhou
- Synthetic and Functional Biomolecules Center, Beijing National Laboratory for Molecular Sciences, College of Chemistry and Molecular Engineering, Peking University, Beijing, China
| | - Liming Cai
- Department of Cardiopulmonary Bypass, State Key Laboratory of Cardiovascular Medicine, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Haojie Rao
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hong Chen
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jian Lin
- Synthetic and Functional Biomolecules Center, Beijing National Laboratory for Molecular Sciences, College of Chemistry and Molecular Engineering, Peking University, Beijing, China
| | - Zhao Cui
- Renal Division, Peking University First Hospital, Beijing, China
| | - Bingyang Ji
- Department of Cardiopulmonary Bypass, State Key Laboratory of Cardiovascular Medicine, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jianwei Wang
- MOH Key Laboratory of Systems Biology of Pathogens, Institute of Pathogen Biology, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Nailin Li
- Department of Medicine-Solna, Cardiovascular Medicine Unit, Karolinska Institute, Stockholm, Sweden
| | - De-Pei Liu
- Key Laboratory of Common Mechanism Research for Major Diseases, Department of Biochemistry and Molecular Biology, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Thomas Renné
- Institute of Clinical Chemistry and Laboratory Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
- Center for Thrombosis and Hemostasis (CTH), Johannes Gutenberg University Medical Center, Mainz, Germany
- Irish Centre for Vascular Biology, School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Miao Wang
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
- Clinical Pharmacology Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
- National Health Commission Cardiovascular Disease Regenerative Medicine Research Key Laboratory, Central China Subcenter of National Center for Cardiovascular Diseases, Henan Cardiovascular Disease Center, Fuwai Central-China Cardiovascular Hospital, Central China Fuwai Hospital of Zhengzhou University, Zhengzhou, China.
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2
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Yamamoto T, Chen KR. A Complex Vasculitis: Thrombophlebitis, Subcutaneous Granulomatous Arteritis, and Eosinophilic Granulomatosis With Polyangiitis Presenting Clinically as Livedo Racemosa With Nodular Erythema. Am J Dermatopathol 2024; 46:634-636. [PMID: 39008490 DOI: 10.1097/dad.0000000000002763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/17/2024]
Affiliation(s)
- Toshiyuki Yamamoto
- Department of Dermatology, Fukushima Medical University, Fukushima, Japan
| | - Ko-Ron Chen
- Department of Dermatology, Meguro Chen Dermatology Clinic, Tokyo, Japan
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3
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Mitroi RM, Roșu MM, Clenciu D, Pădureanu V, Mitrea A, Grigore MA, Mazilu ER, Rădulescu D, Vladu IM. Vasculitis and infectious risk in a patient with type 2 diabetes mellitus: A case report. Exp Ther Med 2024; 27:234. [PMID: 38628659 PMCID: PMC11019656 DOI: 10.3892/etm.2024.12522] [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: 05/09/2023] [Accepted: 01/16/2024] [Indexed: 04/19/2024] Open
Abstract
The connection between vasculitis and infection is complex. The present study described a typical situation for a patient with unbalanced type 2 diabetes and chronic complications, in which a lack of adherence to the protection and care measures ultimately led to the appearance of some of the worst consequences of the condition, namely, ulceration, gangrene and amputation. In the context of an unstable condition with significant metabolic imbalance there was an impaired response to infections in the present patient, and the amputation resulted in wound persistence and ulcer development, followed by superinfection with methicillin-resistant Staphylococcus aureus according to the antibiogram performed. In this case, an episode of vasculitis was triggered without evidence of bacteraemia. The present case report highlighted the importance of proper hygiene and good metabolic control in patients with diabetes that suffer from amputations and conditions that expose them to certain complications, including vasculitis.
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Affiliation(s)
- Roxana Mădălina Mitroi
- Department of Diabetes, Nutrition and Metabolic Diseases, County Clinical Emergency Hospital of Craiova, 200642 Craiova, Romania
| | - Maria Magdalena Roșu
- Department of Diabetes, Nutrition and Metabolic Diseases, County Clinical Emergency Hospital of Craiova, 200642 Craiova, Romania
- Department of Diabetes, Nutrition and Metabolic Diseases, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Diana Clenciu
- Department of Diabetes, Nutrition and Metabolic Diseases, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
- Department of Diabetes, Nutrition and Metabolic Diseases, Clinical Municipal Hospital ‘Philanthropy’ of Craiova, 200143 Craiova, Romania
| | - Vlad Pădureanu
- Department of Internal Medicine, Faculty of Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Adina Mitrea
- Department of Diabetes, Nutrition and Metabolic Diseases, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
- Department of Diabetes, Nutrition and Metabolic Diseases, Clinical Municipal Hospital ‘Philanthropy’ of Craiova, 200143 Craiova, Romania
| | - Maria Andreea Grigore
- Department of Diabetes, Nutrition and Metabolic Diseases, County Clinical Emergency Hospital of Craiova, 200642 Craiova, Romania
| | - Emilia Roxana Mazilu
- Department of Diabetes, Nutrition and Metabolic Diseases, County Clinical Emergency Hospital of Craiova, 200642 Craiova, Romania
| | - Dumitru Rădulescu
- Department of General Surgery, Faculty of Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Ionela Mihaela Vladu
- Department of Diabetes, Nutrition and Metabolic Diseases, County Clinical Emergency Hospital of Craiova, 200642 Craiova, Romania
- Department of Diabetes, Nutrition and Metabolic Diseases, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
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4
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Xing Y, Zhuang C, Yu Q, Liu C, Xu M, Zhao L, Kong X. Cutaneous leukocytoklastic vasculitis in a patient with ankylosing spondylitis: A case report. Heliyon 2024; 10:e28134. [PMID: 38524579 PMCID: PMC10958421 DOI: 10.1016/j.heliyon.2024.e28134] [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: 07/03/2023] [Revised: 02/22/2024] [Accepted: 03/12/2024] [Indexed: 03/26/2024] Open
Abstract
Extra-articular manifestations (EAMs) in ankylosing spondylitis (AS) are common and most extra-articular manifestations such as acute iritis and inflammatory bowel disease are positively correlated with disease activity of AS. Vasculitis is an extra-articular manifestation of AS. However cutaneous leukocytoclastic vasculitis (CLV) is uncommon in AS patients. In this article, we report a case of a 66-year-old female patient who has had AS for long time. Although the patient's articular manifestations were stable, the aortic aneurysm and CLV continued to occur sequentially. This article reminds clinicians that even AS patients with stable articular manifestations should be followed up regularly. All extra-articular manifestations of AS patients should be taken seriously and treated as soon as possible under the guidance of rheumatoid immunologists.
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Affiliation(s)
- Yida Xing
- Department of Rheumatology, The Second Affiliated Hospital of Dalian Medical University, China
| | - Chengjun Zhuang
- Department of Intensive Care Unit, The Second Affiliated Hospital of Dalian Medical University, China
| | - Qian Yu
- Wound Stoma Clinic, The Second Affiliated Hospital of Dalian Medical University, China
| | - Changyan Liu
- Department of Rheumatology, The Second Affiliated Hospital of Dalian Medical University, China
| | - Mingxi Xu
- Department of Rheumatology, The Second Affiliated Hospital of Dalian Medical University, China
| | - Lin Zhao
- Department of Rheumatology, The Second Affiliated Hospital of Dalian Medical University, China
| | - Xiaodan Kong
- Department of Rheumatology, The Second Affiliated Hospital of Dalian Medical University, China
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5
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Ancona S, Bianchin S, Zampatti N, Nosratian V, Bigatti C, Ferro J, Trambaiolo Antonelli C, Viglizzo G, Gandullia P, Malerba F, Crocco M. Cutaneous Disorders Masking Celiac Disease: Case Report and Mini Review with Proposal for a Practical Clinical Approach. Nutrients 2023; 16:83. [PMID: 38201912 PMCID: PMC10780572 DOI: 10.3390/nu16010083] [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: 12/03/2023] [Revised: 12/16/2023] [Accepted: 12/21/2023] [Indexed: 01/12/2024] Open
Abstract
Celiac disease (CD) is an immune-mediated systemic gluten-related disorder characterized by a wide spectrum of intestinal and extra-intestinal manifestations, including damage to cutaneous and connective tissue. We report a rare case of chronic severe dermatitis involving connective tissue and cutaneous vascular vessels as the main clinical presentation of undiagnosed seronegative gluten disorder. A gluten-free diet dramatically improved the intestinal and cutaneous clinical damage in the patient. Pitfalls and the steps of differential diagnosis are described. We also review the literature regarding studies of CD and connective tissue diseases to extend the knowledge of these rare associations. We propose a practical diagnostic approach in suspected CD in autoimmune cutaneous disorders.
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Affiliation(s)
- Silvana Ancona
- Pediatric Gastroenterology and Endoscopy Unit, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy (P.G.); (F.M.)
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genova, 16132 Genoa, Italy
| | - Silvia Bianchin
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genova, 16132 Genoa, Italy
| | - Noemi Zampatti
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genova, 16132 Genoa, Italy
| | | | - Carolina Bigatti
- UO Nephrology Dialysis and Transplant, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
| | - Jacopo Ferro
- Pathology Unit, U.O.C. Anatomia Patologica, IRCCS Istituto Giannina Gaslini, 16147 Genova, Italy; (J.F.); (C.T.A.)
| | - Chiara Trambaiolo Antonelli
- Pathology Unit, U.O.C. Anatomia Patologica, IRCCS Istituto Giannina Gaslini, 16147 Genova, Italy; (J.F.); (C.T.A.)
| | | | - Paolo Gandullia
- Pediatric Gastroenterology and Endoscopy Unit, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy (P.G.); (F.M.)
| | - Federica Malerba
- Pediatric Gastroenterology and Endoscopy Unit, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy (P.G.); (F.M.)
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genova, 16132 Genoa, Italy
| | - Marco Crocco
- Pediatric Gastroenterology and Endoscopy Unit, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy (P.G.); (F.M.)
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6
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Błaż A, Zalewski J, Masiak A, Kujawa MJ, Gosz M, Buda N. Rat bite fever mimicking ANCA-associated vasculitis. Rheumatol Int 2023; 43:1957-1964. [PMID: 37450033 PMCID: PMC10435600 DOI: 10.1007/s00296-023-05369-4] [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: 02/16/2023] [Accepted: 06/05/2023] [Indexed: 07/18/2023]
Abstract
Rat bite fever (RBF) is a rare infectious zoonotic disease caused by two bacterial species: the Gram-negative rod Streptobacillus moniliformis and the Gram-negative coiled rod Spirillum minus. The association between RBF and skin vasculitis and arthritis has been observed. The aim of this paper was to present a case of rat-bite fever with symptoms of skin vasculitis and arthritis, associated with high titers of ANCA antibodies and anti-endothelial cell antibodies suggestive of primary vasculitis. The patient was successfully treated with antibiotics and non-steroidal anti-inflammatory drugs, leading to significant improvement. Based on the presented case, we discuss the differential diagnosis of the signs and the role of infection in the induction of ANCA antibodies. We reviewed the English language literature for cases of RBF presenting with symptoms of vasculitis and/or antibody presence. A literature review was performed in PubMed and Google using the keywords "rat bite fever" AND "vasculitis", "systemic vasculitis", "ANCA", "antiendothelial antibodies". No cases of rat-bite fever with the presence of ANCA antibodies or AECA antibodies in its course have been described thus far. Rat bite fever is a rare disease with nonspecific symptoms. In its course, general weakness, intermittent fever, leukocytoclastic vasculitis, and arthritis are reported. To our knowledge, this is the first reported case of ANCA positivity associated with RBF.
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Affiliation(s)
- Aleksandra Błaż
- Department of Internal Medicine, Connective Tissue Diseases & Geriatrics, Medical University of Gdańsk and University Clinical Centre in Gdańsk, ul. Dębinki 7, 80-952, Gdańsk, Poland.
| | - Jan Zalewski
- Department of Internal Medicine, Connective Tissue Diseases & Geriatrics, Medical University of Gdańsk and University Clinical Centre in Gdańsk, ul. Dębinki 7, 80-952, Gdańsk, Poland
| | - Anna Masiak
- Department of Internal Medicine, Connective Tissue Diseases & Geriatrics, Medical University of Gdańsk and University Clinical Centre in Gdańsk, ul. Dębinki 7, 80-952, Gdańsk, Poland.
| | - Mariusz J Kujawa
- Division of Radiology, University Clinical Centre in Gdańsk, Gdańsk, Poland
| | - Monika Gosz
- Department of Internal Medicine, Connective Tissue Diseases & Geriatrics, Medical University of Gdańsk and University Clinical Centre in Gdańsk, ul. Dębinki 7, 80-952, Gdańsk, Poland
| | - Natalia Buda
- Department of Internal Medicine, Connective Tissue Diseases & Geriatrics, Medical University of Gdańsk and University Clinical Centre in Gdańsk, ul. Dębinki 7, 80-952, Gdańsk, Poland
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Vats V, Makineni P, Hemaida S, Haider A, Subramani S, Kaur N, Butt AN, Scott-Emuakpor R, Zahir M, Mathew M, Iqbal J. Gluten Intolerance and Its Association With Skin Disorders: A Narrative Review. Cureus 2023; 15:e44549. [PMID: 37790051 PMCID: PMC10544948 DOI: 10.7759/cureus.44549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2023] [Indexed: 10/05/2023] Open
Abstract
Gluten sensitivity is defined as a chronic intolerance to gluten ingestion in genetically predisposed individuals. The etiology is thought to be immune-mediated and has a variable dermatologic presentation. Celiac disease (CD) is one of the most common forms of gluten intolerance and encompasses a wide range of extra-intestinal pathology, including cutaneous, endocrine, nervous, and hematologic systems. Psoriasis, another long-term inflammatory skin condition, has been linked to significant symptomatic improvement with a gluten-free diet (GFD). Palmoplantar pustulosis (PP), a variant of psoriasis, and aphthous stomatitis, which causes recurrent oral ulcers, have also exhibited beneficial results after the dietary elimination of gluten. In addition to this, dermatitis herpetiformis (DH), another immune-mediated skin disorder, is genetically similar to CD and has, therefore, shown tremendous improvement with a GFD. Another highly prevalent long-term skin condition called atopic dermatitis (AD), however, has revealed inconsistent results with gluten elimination and would require further research in the future to yield concrete results. Hereditary angioedema (HA) has shown an association with gluten intolerance in some patients who had symptomatic benefits with a GFD. Similarly, vitiligo and linear IgA bullous dermatosis have also shown some clinical evidence of reversal with a GFD. On the contrary, rosacea enhances the risk of developing CD. This narrative review emphasizes the potential impact of gluten intolerance on different cutaneous conditions and the potential therapeutic effect of a GFD on various symptomatic manifestations. There is a need for additional clinical and observational trials to further expand on the underlying pathophysiology and provide conclusive and comprehensive recommendations for possible dietary interventions.
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Affiliation(s)
- Vaibhav Vats
- Internal Medicine, Smt. Kashibai Navale Medical College and General Hospital, Mumbai, IND
| | - Pallavi Makineni
- Medicine, All India Institute of Medical Sciences, Bhubaneswar, Bhubaneswar, IND
| | | | - Anum Haider
- Internal Medicine, Bahria University Medical & Dental College, Karachi, PAK
| | | | - Navjot Kaur
- Medicine, Government Medical College, Amritsar, Amritsar, IND
| | - Amna Naveed Butt
- Medicine/Internal Medicine, Allama Iqbal Medical College, Lahore, PAK
| | | | - Mohammad Zahir
- Medicine, Ayub Medical College, Abottabad, Abottabad, PAK
| | - Midhun Mathew
- Internal Medicine, Pennsylvania Hospital, Philadelphia, USA
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Kavya RM, Adya KA, Inamadar AC. Utility of Dermoscopy in Cutaneous Small Vessel Vasculitis: Preliminary Observations from a Study of 30 Cases. Indian Dermatol Online J 2023; 14:506-509. [PMID: 37521212 PMCID: PMC10373834 DOI: 10.4103/idoj.idoj_648_22] [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: 12/01/2022] [Revised: 01/04/2023] [Accepted: 01/07/2023] [Indexed: 08/01/2023] Open
Abstract
Background Dermoscopy is a non-invasive diagnostic technique that provides an added advantage to the routine clinical diagnostic exercise. Role of dermoscopy in cutaneous small vessel vasculitis has not been explored well. Objective This study was intended to delineate the dermoscopic features of cutaneous small vessel vasculitis and to correlate them with histopathological findings of the disease. Materials and Methods This was a cross-sectional study involving 30 patients with cutaneous small vessel vasculitis confirmed by histopathology and direct immunofluorescence. In each patient, dermoscopic features of early/evolving and established lesions were recorded. Dermoscopic-histopathological correlation was assessed for established lesions. Results On dermoscopy, the early/evolving lesions showed a dull red background in all the 30 (100%) patients, red globules in 8 (26.7%), and red dots in 4 (13.30%) patients. The established lesions showed red background in 28 (93.3%) patients, white and yellow structureless areas in 19 (63.33%) patients each, red globules in 18 (60%), and red dots in 16 (53.3%) patients. A statistically significant association between red globules and red blood cell extravasation was noted (P-0.01). White and yellow structureless areas also showed a statistically significant association between sparse (P-0.023) and dense (P-0.007) perivascular infiltrates, respectively. Conclusion Dermoscopy of cutaneous small vessel vasculitis exhibits fairly reliable and reproducible features correlating well with histopathological aspects of the disease. Hence, inclusion of dermoscopy in the clinical diagnostic protocol for cutaneous small vessel vasculitis is beneficial in complementing the clinical diagnosis and in differentiating from other inflammatory purpuras.
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Affiliation(s)
- RM Kavya
- Departments of Dermatology, Venereology and Leprosy, Shri B M Patil Medical College, Hospital and Research Center, BLDE (Deemed to be University), Vijayapur, Karnataka, India
| | - Keshavmurthy A. Adya
- Departments of Dermatology, Venereology and Leprosy, Shri B M Patil Medical College, Hospital and Research Center, BLDE (Deemed to be University), Vijayapur, Karnataka, India
| | - Arun C. Inamadar
- Departments of Dermatology, Venereology and Leprosy, Shri B M Patil Medical College, Hospital and Research Center, BLDE (Deemed to be University), Vijayapur, Karnataka, India
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9
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Khanal UP, Ghimire P, Shahi T, Dhakal TR, Jha S. Secondary cardiac amyloidosis in a patient with mixed connective tissue disease: A case report. Clin Case Rep 2023; 11:e07669. [PMID: 37426686 PMCID: PMC10323719 DOI: 10.1002/ccr3.7669] [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: 05/03/2023] [Revised: 06/06/2023] [Accepted: 06/19/2023] [Indexed: 07/11/2023] Open
Abstract
We report the case of a 62-year-old man who presented with shortness of breath, cough, bilateral lower limbs' swelling, and blackish discoloration of multiple fingertips over the past 2 months. Anti-Ribonucleoprotein antibodies were found to be present, and gadolinium-based cardiac MRI showed non-vascular subendocardial enhancement with diffuse symmetrical thickening of the left ventricular wall. A diagnosis of Mixed connective tissue disease with secondary cardiac amyloidosis was thus made, and the patient was successfully managed with intravenous cyclophosphamide, corticosteroids, and other supportive measures. Although extremely rare, this case shows that secondary cardiac amyloidosis should be considered while managing patients with MCTD.
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Affiliation(s)
| | - Prinska Ghimire
- Institute of Medicine, Tribhuwan University Teaching HospitalKathmanduNepal
| | - Tejash Shahi
- Institute of Medicine, Tribhuwan University Teaching HospitalKathmanduNepal
| | - Tulsi Ram Dhakal
- Institute of Medicine, Tribhuwan University Teaching HospitalKathmanduNepal
| | - Saket Jha
- Institute of Medicine, Tribhuwan University Teaching HospitalKathmanduNepal
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10
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Sood AK, Francis O, Schworer SA, Johnson SM, Smith BD, Googe PB, Wu EY. ANCA vasculitis expands the spectrum of autoimmune manifestations of activated PI3 kinase δ syndrome. Front Pediatr 2023; 11:1179788. [PMID: 37274825 PMCID: PMC10235767 DOI: 10.3389/fped.2023.1179788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Accepted: 05/03/2023] [Indexed: 06/07/2023] Open
Abstract
Activated phosphoinositide 3-kinase δ syndrome (APDS) is a combined immunodeficiency with a broad clinical phenotype, including not only an increased propensity for sinopulmonary and herpesviruses infections but also immune dysregulation, such as benign lymphoproliferation, autoimmunity, and malignancy. Autoimmune complications are increasingly recognized as initial presenting features of immune dysregulation in inborn errors of immunity (IEIs), including APDS, so awareness of the spectrum of autoimmune features inherit within these disorders is critical. We present here a patient vignette to highlight cutaneous antineutrophil cytoplasmic antibody (ANCA) vasculitis as an underrecognized autoimmune manifestation of APDS. The genetic defects underlying APDS result in increased PI3Kδ signaling with aberrant downstream signaling pathways and loss of B- and/or T-cell immunologic tolerance mechanisms, which promote the development of autoimmunity. An understanding of the molecular pathways and mechanisms that lead to immune dysregulation in APDS has allowed for significant advancements in the development of precision-medicine therapeutics, such as leniolisib, to reduce the morbidity and mortality for these patients. Overall, this case and review highlight the need to maintain a high index of suspicion for IEIs, such as APDS, in those presenting with autoimmunity in combination with a dysregulated immune phenotype for prompt diagnosis and targeted intervention.
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Affiliation(s)
- Amika K. Sood
- Division of Rheumatology, Allergy, and Immunology, Department of Internal Medicine, The University of North Carolina, Chapel Hill, NC, United States
| | - Olivia Francis
- Division of Allergy/Immunology, Department of Pediatrics, The University of North Carolina, Chapel Hill, NC, United States
| | - Stephen A. Schworer
- Division of Rheumatology, Allergy, and Immunology, Department of Internal Medicine, The University of North Carolina, Chapel Hill, NC, United States
- Division of Allergy/Immunology, Department of Pediatrics, The University of North Carolina, Chapel Hill, NC, United States
| | - Steven M. Johnson
- Department of Pathology and Laboratory Medicine, The University of North Carolina, Chapel Hill, NC, United States
| | - Benjamin D. Smith
- Division of Pediatric Radiology, Department of Radiology, The University of North Carolina, Chapel Hill, NC, United States
| | - Paul B. Googe
- Dermatopathology, Department of Dermatology, The University of North Carolina, Chapel Hill, NC, United States
| | - Eveline Y. Wu
- Division of Allergy/Immunology, Department of Pediatrics, The University of North Carolina, Chapel Hill, NC, United States
- Division of Rheumatology, Department of Pediatrics, The University of North Carolina, Chapel Hill, NC, United States
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11
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Dissemond J. [Wounds caused by vasculitis-Current classification, diagnostics and treatment]. Z Gerontol Geriatr 2023:10.1007/s00391-023-02166-3. [PMID: 36894767 DOI: 10.1007/s00391-023-02166-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 01/26/2023] [Indexed: 03/11/2023]
Abstract
Wounds of the skin can have very different causes. Especially in clinically atypical or non-healing wounds, the very heterogeneous group of vasculitides is of particularly important differential diagnostic significance. Nowadays, the classification of vasculitis is based on the affected vessels according to the Chapel Hill consensus conference. Thus, potentially any part of the vascular system can be affected. It becomes clear that there is often a risk of systemic diseases with high interdisciplinary relevance.Clinically, the usually very painful wounds in cutaneous vasculitis develop from necrosis and are typically surrounded by an erythematous-livid rim in the florid phase. In addition to clinical inspection, the histopathological examination of biopsies is of particular importance in the usually extensive diagnostic work-up.Therapeutically, adequate wound treatment should always be performed with a focus on pain prevention and infection prophylaxis. In the case of edema, compression therapy also supports wound healing. In addition, it is often necessary to initiate systemic treatment with immunosuppressive or immunomodulating drugs. Whenever possible, causally relevant factors and comorbidities should be diagnosed early and avoided or treated. Otherwise, there is a risk of severe or even fatal disease progression.
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Affiliation(s)
- Joachim Dissemond
- Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Essen, Hufelandstr. 55, 45122, Essen, Deutschland.
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12
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Stenger S, Grasshoff H, Hundt JE, Lange T. Potential effects of shift work on skin autoimmune diseases. Front Immunol 2023; 13:1000951. [PMID: 36865523 PMCID: PMC9972893 DOI: 10.3389/fimmu.2022.1000951] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 11/29/2022] [Indexed: 02/16/2023] Open
Abstract
Shift work is associated with systemic chronic inflammation, impaired host and tumor defense and dysregulated immune responses to harmless antigens such as allergens or auto-antigens. Thus, shift workers are at higher risk to develop a systemic autoimmune disease and circadian disruption with sleep impairment seem to be the key underlying mechanisms. Presumably, disturbances of the sleep-wake cycle also drive skin-specific autoimmune diseases, but epidemiological and experimental evidence so far is scarce. This review summarizes the effects of shift work, circadian misalignment, poor sleep, and the effect of potential hormonal mediators such as stress mediators or melatonin on skin barrier functions and on innate and adaptive skin immunity. Human studies as well as animal models were considered. We will also address advantages and potential pitfalls in animal models of shift work, and possible confounders that could drive skin autoimmune diseases in shift workers such as adverse lifestyle habits and psychosocial influences. Finally, we will outline feasible countermeasures that may reduce the risk of systemic and skin autoimmunity in shift workers, as well as treatment options and highlight outstanding questions that should be addressed in future studies.
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Affiliation(s)
- Sarah Stenger
- Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany
| | - Hanna Grasshoff
- Department of Rheumatology and Clinical Immunology, University of Lübeck, Lübeck, Germany
| | - Jennifer Elisabeth Hundt
- Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany
- Center for Research on Inflammation of the Skin, University of Lübeck, Lübeck, Germany
| | - Tanja Lange
- Department of Rheumatology and Clinical Immunology, University of Lübeck, Lübeck, Germany
- Center for Research on Inflammation of the Skin, University of Lübeck, Lübeck, Germany
- Center of Brain, Behavior and Metabolism (CBBM), University of Lübeck, Lübeck, Germany
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13
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Haider A, Gurjar H, Ghazanfar H, Singh H, Siddiqa A. A Reversible Cause of Cutaneous Rash in a Patient With Alcohol Consumption. Cureus 2023; 15:e35011. [PMID: 36938293 PMCID: PMC10021349 DOI: 10.7759/cureus.35011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2023] [Indexed: 02/17/2023] Open
Abstract
The most common cutaneous manifestations of alcoholism include urticarial reaction, flushing, porphyria cutanea tarda, psoriasis, rosacea, seborrheic dermatitis, and pruritus. Here, we present a case of a young male with a history of alcohol abuse who presented with non-blanching, petechial, and perifollicular macular rash secondary to vitamin C deficiency in view of poor oral intake. The rash improved significantly with vitamin C supplementation. Although rare in developed countries, clinicians should keep vitamin C deficiency as a differential diagnosis for skin rash in alcohol consumers.
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Affiliation(s)
- Asim Haider
- Internal Medicine, BronxCare Health System, New York, USA
| | - Hitesh Gurjar
- Internal Medicine, BronxCare Health System, New York, USA
| | | | | | - Ayesha Siddiqa
- Infectious Diseases, NewYork-Presbyterian Queens Hospital, New York, USA
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14
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Wilk M, Zelger BG, Zelger B. Vasculitides and occluding vasculopathies, challenges in recognizing histopathological patterns, and their solutions. Front Med (Lausanne) 2023; 9:994450. [PMID: 36816722 PMCID: PMC9929945 DOI: 10.3389/fmed.2022.994450] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 12/12/2022] [Indexed: 02/04/2023] Open
Abstract
In this review, we propose a classification of vasculitides and occluding vasculopathies using the clinicopathological correlation as the basic process. We use an algorithmic approach with pattern analysis, which allows reliable reporting of microscopic findings. We first differentiate between small and medium vessel vasculitis. Second, we differentiate the subtypes of small- and medium-sized vessels. Finally, we differentiate vasculitides according to the predominant cell type into leukocytoclastic and/or granulomatous vasculitis. Regarding leukocytoclastic vasculitis as a central reaction pattern of cutaneous small/medium vessel vasculitides, its relation or variations may be arranged in a wheel-like order. With respect to occluding vasculopathies, the first two steps are identical to the algorithm of vasculitides, and we finally differentiate according to the time point of the coagulation/reorganization process and the involved inflammatory cells/stromal features. By visualizing the criteria in the style of bar codes, clinical and histological overlaps and differences may become more transparent.
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Affiliation(s)
- Michael Wilk
- Private Dermatohistological Laboratory, Nuremberg, Germany,*Correspondence: Michael Wilk,
| | - Bettina G. Zelger
- Institute of Pathology, Medical University Innsbruck, Innsbruck, Austria
| | - Bernhard Zelger
- Private Dermatohistopathological Laboratory Zelger, Innsbruck, Austria
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15
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Cutaneous vasculitis associated with molecular tergeted therapies: systematic review of the literature. Clin Rheumatol 2023; 42:339-357. [PMID: 36369405 DOI: 10.1007/s10067-022-06406-6] [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: 06/19/2022] [Revised: 10/04/2022] [Accepted: 10/05/2022] [Indexed: 11/13/2022]
Abstract
Cutaneo us vasculitis (CV) has a broad spectrum of etiologies, and drugs are one of the main culprits. With the increasing use of targeted therapies in medicine, especially in rheumatology and oncology, the number of CV cases reported due to these drugs has increased. Therefore, the recognition and treatment of CV associated with targeted agents have become more and more important. In the literature, anti-TNFs (n = 73, 59.5%), secukinumab (n = 7, 6%), rituximab (n = 5, 4%), tocilizumab (n = 1, 0.8%), ustekinumab (n = 8, 6.5%), abatacept (n = 3, 2.4%), Janus kinase inhibitors (n = 3, 2.4%), alemtuzumab (n = 3, 2.4%), and immune checkpoint inhibitors (n = 20, 16%) have been reported as responsible agents. However, our knowledge of the pathogenetic mechanisms is fairly limited, and the standardized management is yet to be established. Furthermore, though it is uncommon, this complication may pose a safety issue. In this manuscript, we reviewed the literature on CV with or without systemic involvement related to targeted agents. We also proposed the pathogenetic mechanisms of these adverse events. Thus, we aimed to make it easier for clinicians to manage similar cases by reviewing the diagnosis and treatment processes.
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16
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Dermatological manifestations of hematologic neoplasms. Part II: nonspecific skin lesions/paraneoplastic diseases. An Bras Dermatol 2023; 98:141-158. [PMID: 36682966 PMCID: PMC9984718 DOI: 10.1016/j.abd.2022.08.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 06/22/2022] [Accepted: 08/09/2022] [Indexed: 01/21/2023] Open
Abstract
Cutaneous manifestations occur in the course of hematologic malignancies and precede, accompany or occur late in relation to the diagnosis. They result from paraneoplastic phenomena, tumor infiltrations, immunosuppression resulting from the hematologic disease itself or its treatment. The dermatologist must be aware of these conditions that may be helpful both in the diagnosis of the underlying disease and in reducing patient morbidity. This review (part II) addresses the paraneoplastic dermatological changes associated with systemic hematologic malignancies.
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17
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DeHoratius DM. Cutaneous small vessel vasculitis. Postgrad Med 2022; 135:44-51. [PMID: 36524408 DOI: 10.1080/00325481.2022.2159207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
This review discusses the clinical manifestations of cutaneous small vessel vasculitis. The etiologies and work up will be explored as well as the treatment considerations. This entity is multifactorial and usually involves multiple specialties. The presentation can range from self-limited to life threatening, multi-organ failure. It is essential to be able to diagnose vasculitis and proceed with the appropriate laboratory studies and work-up. Finally, investigation of associated etiologies such as infection and drugs will guide additional diagnostic studies.
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Affiliation(s)
- Danielle M. DeHoratius
- Bryn Mawr Hospital – Dermatology, 825 Old Lancaster Road Suite 450 Bryn Mawr Pennsylvania, Pennsylvania, United States
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18
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Ajao A, Cosgrove A, Eworuke E, Mohamoud M, Zhang R, Shapira O, Kolonoski J, Connolly JG. A cohort study to assess risk of cutaneous small vessel vasculitis among users of different oral anticoagulants. Pharmacoepidemiol Drug Saf 2022; 31:1164-1173. [PMID: 35909259 PMCID: PMC9872093 DOI: 10.1002/pds.5514] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 07/19/2022] [Accepted: 07/25/2022] [Indexed: 01/27/2023]
Abstract
PURPOSE Cutaneous small vessel vasculitis (CSVV) was identified as a safety signal among patients treated with direct oral anticoagulants (DOAC). This study aimed to determine if CSVV risk differed among patients with atrial fibrillation (Afib) who newly initiated warfarin or a DOAC. METHODS We identified enrollees aged ≥21 years diagnosed with Afib who newly initiated rivaroxaban, dabigatran, apixaban, and warfarin in the Sentinel Distributed Database from October 19, 2010 to February 29, 2020. We selected and followed patients who did not have evidence of the following in the 183 days prior to initiating treatment: CSVV diagnosis, dispensing of other study drugs, select autoimmune diseases or autoimmune medications, cancer diagnoses or chemotherapeutic treatment, kidney dialysis or transplant, alternative anticoagulation indications, or an institutional (nursing home, hospice, hospital) stay on the treatment initiation date (index date) until CSVV outcome or pre-specified censoring. We conducted 1:1 propensity score matching in six comparisons. RESULTS CSVV incidence rates for DOACs and warfarin ranged from 3.3 to 5.6 per 10 000-person years in our matched Afib population. The adjusted CSVV hazard ratio (HR) and 95% confidence interval (CI) was 0.94 (0.64, 1.39) for rivaroxaban versus warfarin; 1.17 (0.67, 2.06) for dabigatran vs. warfarin; 0.85 (0.62, 1.16) for apixaban vs. warfarin; 0.86 (0.49, 1.50) for rivaroxaban vs. dabigatran; 0.99 (0.68, 1.45) for rivaroxaban versus apixaban; and 1.70 (0.90, 3.21) for dabigatran versus apixaban. CONCLUSION We did not find significant evidence of differential CSVV risk in pair-wise comparisons of DOACs and warfarin.
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Affiliation(s)
- Adebola Ajao
- Division of Epidemiology, Office of Pharmacovigilance and Epidemiology, Office of Surveillance and Epidemiology, Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, Maryland, USA
| | - Austin Cosgrove
- Harvard Medical School Department of Population Medicine, Harvard Pilgrim Healthcare Institute, Boston, Massachusetts, USA
| | - Efe Eworuke
- Division of Epidemiology, Office of Pharmacovigilance and Epidemiology, Office of Surveillance and Epidemiology, Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, Maryland, USA
| | - Mohamed Mohamoud
- Division of Pharmacovigilance, Office of Pharmacovigilance and Epidemiology, Office of Surveillance and Epidemiology, Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, Maryland, USA
| | - Rongmei Zhang
- Division of Biometrics VII, Office of Biostatistics, Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, Maryland, USA
| | - Oren Shapira
- Harvard Medical School Department of Population Medicine, Harvard Pilgrim Healthcare Institute, Boston, Massachusetts, USA
| | - Joy Kolonoski
- Harvard Medical School Department of Population Medicine, Harvard Pilgrim Healthcare Institute, Boston, Massachusetts, USA
| | - John G Connolly
- Harvard Medical School Department of Population Medicine, Harvard Pilgrim Healthcare Institute, Boston, Massachusetts, USA
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19
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Seitz L, Seitz P, Pop R, Lötscher F. Spectrum of Large and Medium Vessel Vasculitis in Adults: Primary Vasculitides, Arthritides, Connective Tissue, and Fibroinflammatory Diseases. Curr Rheumatol Rep 2022; 24:352-370. [PMID: 36166150 PMCID: PMC9513304 DOI: 10.1007/s11926-022-01086-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2022] [Indexed: 11/24/2022]
Abstract
PURPOSE OF REVIEW To provide a comprehensive overview of the spectrum of large and medium vessel vasculitis in adults with primary vasculitides, arthritides, connective tissue, and fibroinflammatory diseases as well as vasculitis mimics, for an efficient differential diagnosis and initial diagnostic approach. RECENT FINDINGS Imaging has had a tremendous impact on the diagnosis of medium to large vessel vasculitis, now often replacing histopathologic confirmation and identifying new disease manifestations (e.g., intracranial disease in giant cell arteritis; vascular manifestations of IgG4-related disease). Novel diseases or syndromes involving blood vessels have been described (e.g., VEXAS-Syndrome with polychondritis). The use of the terms "medium" or "large" vessel varies considerably between medical specialties. The differential diagnosis of large and medium vessel vasculitis is becoming increasingly complex as new entities or disease manifestations of known inflammatory rheumatic diseases are regularly identified. A more precise and widely recognized definition of the vessel sizes would make future research more comparable.
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Affiliation(s)
- Luca Seitz
- Department of Rheumatology and Immunology, Inselspital, University Hospital, University of Bern, Freiburgstrasse, CH-3010, Bern, Switzerland.
- Immunodeficiency Laboratory, Department of Biomedicine, University Hospital and University of Basel, Basel, Switzerland.
| | - Pascal Seitz
- Department of Rheumatology and Immunology, Inselspital, University Hospital, University of Bern, Freiburgstrasse, CH-3010, Bern, Switzerland
| | - Roxana Pop
- Department of Infectious Diseases and Hospital Hygiene, University Hospital, University of Zurich, Zurich, Switzerland
| | - Fabian Lötscher
- Department of Rheumatology and Immunology, Inselspital, University Hospital, University of Bern, Freiburgstrasse, CH-3010, Bern, Switzerland
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20
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Leukocytoclastic Vasculitis following the First Dose of the Elasomeran COVID-19 Vaccination. Case Rep Dermatol Med 2022; 2022:1469410. [PMID: 35968197 PMCID: PMC9371881 DOI: 10.1155/2022/1469410] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 02/17/2022] [Accepted: 07/13/2022] [Indexed: 11/25/2022] Open
Abstract
Our case highlights leukocytoclastic vasculitis as a potential side effect of the elasomeran COVID-19 vaccine. As the elasomeran vaccine becomes more widely available to the public, cutaneous reactions should be noted and looked for as potential side effects of the vaccine. Our patient had a history of immune thrombocytopenic purpura, making this a potential predisposing condition to the development of vasculitis following elasomeran administration. The case of vasculitis in our patient, although diffuse in distribution, was self-resolving. Our patient was counseled of the potential risk of worsening reaction to the second dose of the vaccine and instructed to proceed at their own risk. He elected to receive the second vaccination dose without any further reaction or side effects. Primary teaching points from this case include the potential of developing leukocytoclastic vasculitis following the elasomeran vaccination. Patients who develop LCV following the first dose should be counseled of the risks associated with receiving the second dose, including progression to systemic organ involvement.
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21
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What to Know About Biopsy Sampling and Pathology in Vasculitis? Curr Rheumatol Rep 2022; 24:279-291. [PMID: 35895226 DOI: 10.1007/s11926-022-01082-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/24/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE OF REVIEW To summarize the histologic findings of vasculitis, and to give some practical considerations on biopsy samples. RECENT FINDINGS The larger use of imaging and the discoveries of serological markers in the diagnosis of vasculitis have increased the clinical recognition of these entities. Nevertheless, biopsy remains the gold standard for diagnosis in most cases. So far, biopsies are also useful to obtain information about prognosis and to guide a more specific treatment. In recent years, less invasive diagnostic approaches have become available, lowering the risks related to the procedure and permitting a definite diagnosis in most cases. Histological examination permits a definite diagnosis of vasculitis. However, the findings may be nonspecific if not evaluated in the proper clinical setting. The interaction between clinicians and pathologists is crucial to obtain a definite diagnosis.
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22
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Gnesotto L, Mioso G, Alaibac M. Use of granulocyte and monocyte adsorption apheresis in dermatology (Review). Exp Ther Med 2022; 24:536. [PMID: 35837066 PMCID: PMC9257973 DOI: 10.3892/etm.2022.11463] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 05/24/2022] [Indexed: 12/04/2022] Open
Abstract
Adsorptive granulocyte and monocyte apheresis (GMA) is an extracorporeal treatment that selectively removes activated myeloid lineage leukocytes from peripheral blood. This technique consists of a column with cellulose acetate beads as absorptive leukocytapheresis carriers, and was initially used to treat ulcerative colitis. A literature search was conducted to extract recently published studies about the clinical efficacy of GMA in patients with different skin disorders, reporting information on demographics, clinical symptoms, treatment and clinical course. Dermatological diseases, in which GMA has been performed, include generalized pustular psoriasis, pyoderma gangrenosum, palmoplantar pustular psoriasis, Behcet's disease, Sweet's syndrome, adult-onset Still's disease, impetigo herpetiformis, reactive arthritis, acne and hidradenitis suppurativa syndrome, cutaneous allergic vasculitis and systemic lupus erythematosus. In most patients, GMA was started after the failure of conventional therapeutic options and it was helpful in the majority of cases. Based on the information summarized, GMA could be considered a valid non-pharmacological treatment option for patients with several dermatological conditions, which are difficult to treat with other pharmacological preparations.
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Affiliation(s)
- Laura Gnesotto
- Dermatology Unit, Department of Medicine, University of Padova, I‑35128 Padova, Italy
| | - Guido Mioso
- Dermatology Unit, Department of Medicine, University of Padova, I‑35128 Padova, Italy
| | - Mauro Alaibac
- Dermatology Unit, Department of Medicine, University of Padova, I‑35128 Padova, Italy
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23
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Almasoudi AA, Bablghaith ES, Alaauldeen SI, M Falemban A, Sherbeeni AA, Bulkhi AA. Ceftriaxone-induced leukocytoclastic vasculitis: a case report and literature review of antibiotic-induced leukocytoclastic vasculitis. J Int Med Res 2022; 50:3000605221097768. [PMID: 35587703 PMCID: PMC9127858 DOI: 10.1177/03000605221097768] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Leukocytoclastic vasculitis (hypersensitivity vasculitis) is defined as small blood vessel inflammation with skin or other systemic manifestations due to infections, drugs, or neoplastic disease. This clinical case report highlights an association between ceftriaxone and leukocytoclastic vasculitis in a 49-year-old female patient with a history of penicillin allergy, on mirtazapine for anxiety disorder. Articles concerning antibiotic-induced leukocytoclastic vasculitis are also reviewed. The patient reported a symptom of upper respiratory tract infection and fever 5 days previously for which she received ceftriaxone for 2 days before presenting to the emergency department with a pruritic skin rash in the upper and lower extremities and swollen lips for 1 day. The rash was erythematous, maculopapular, itchy, and non-tender, with no mucus membrane involvement. Laboratory investigations revealed leukocytosis (white blood cells, 22.3 × 109/L) that was mainly eosinophilic (18.4%). The patient was administered prednisolone and antihistamine after stopping ceftriaxone empirically. A skin biopsy confirmed the diagnosis of leukocytoclastic vasculitis. Significant clinical improvement was observed after treatment initiation. Upon follow-up, the skin rash was resolved entirely with no scars; however, there was skin-peeling over the lower extremities. Recognition of antibiotic-induced leukocytoclastic vasculitis is crucial as many classes of antibiotics can contribute to this condition. Continuation of the offending drug may lead to life-threatening complications.
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Affiliation(s)
- Aseel A Almasoudi
- Department of Internal Medicine, King Abdullah Medical City, Makkah, Kingdom of Saudi Arabia
| | - Eman S Bablghaith
- Department of Internal Medicine, King Abdullah Medical City, Makkah, Kingdom of Saudi Arabia
| | - Samaher I Alaauldeen
- Department of Internal Medicine, King Abdullah Medical City, Makkah, Kingdom of Saudi Arabia
| | - Ayman M Falemban
- Department of Internal Medicine, King Abdullah Medical City, Makkah, Kingdom of Saudi Arabia
| | - Ahlam A Sherbeeni
- Department of Internal Medicine, King Abdullah Medical City, Makkah, Kingdom of Saudi Arabia
| | - Adeeb A Bulkhi
- Department of Internal Medicine, King Abdullah Medical City, Makkah, Kingdom of Saudi Arabia.,Department of Internal Medicine, College of Medicine, Umm Al-Qura University, Makkah, Kingdom of Saudi Arabia
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24
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Sarkar N, Palit A, Sethy M, Behera B, Dash S, Sahu DP. A Cross-Sectional Study to Correlate Serum Complement C3 and C4 Levels With Clinical and Pathological Severity in Cutaneous Small-Vessel Vasculitis. Cureus 2022; 14:e24845. [PMID: 35693365 PMCID: PMC9175591 DOI: 10.7759/cureus.24845] [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] [Accepted: 05/08/2022] [Indexed: 12/03/2022] Open
Abstract
Introduction The role of serum C3 and C4 levels as a marker of disease activity in cutaneous small-vessel vasculitis (CSVV) has been sparsely studied, especially in India. The primary objective was to determine the correlation between clinico-histopathological severity and serum C3 and C4 levels in CSVV. The secondary objective was to determine the association between direct immunofluorescence (DIF) findings and serum C3 and C4 levels and clinico-histopathological findings. Method This prospective cross-sectional study included all the clinically diagnosed cases of CSVV that satisfied the pathological criteria for CSVV. A clinical disease activity grade and a histopathological severity grade were calculated in all patients (N=50). Results Serum C3 and C4 levels (n=44) were diminished in 4.5% of cases. There was no significant correlation between the serum C3 and C4 levels and the clinical and histopathological severity. DIF was positive in 60.0% of cases (n=45), and IgA was the predominant immune deposit (46.7%). No significant association was detected between the DIF findings and the serum C3 and C4 levels, histopathological severity, and clinical disease activity grade. Positive DIF findings were significantly associated with palpable purpura and cutaneous necrosis. A significant association was detected between gastrointestinal involvement and IgA positivity. Conclusion In CSVV, serum C3 and C4 may not be used as markers of disease severity, and a positive DIF finding may indicate an underlying gastrointestinal involvement.
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25
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Abukhatwah MW, Kamal NM, Altowairqi MK, Alzahrani WA, Alsuwat SA, Soliman A. IgA Vasculitis Without Typical Skin Rash Concomitated With c-ANCA Positivity. CLINICAL MEDICINE INSIGHTS-CASE REPORTS 2022; 15:11795476221077790. [PMID: 35237087 PMCID: PMC8883303 DOI: 10.1177/11795476221077790] [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: 02/15/2021] [Accepted: 01/08/2022] [Indexed: 11/17/2022]
Abstract
We describe a case of IgA vasculitis without typical skin rash concomitated with c-ANCA positivity in a 6-year-old boy who presented with persistent severe generalized colicky abdominal pain, recurrent episodes of vomiting, non-pitting edema of both hands and feet, both knees and ankles arthritis with no associated skin rash following a history of an upper respiratory tract infection 2 weeks before presentation. Initially, he had normal laboratory findings apart from sub-nephrotic range proteinuria and microscopic hematuria in his urine analysis. Two weeks later, he started to have hypertension, gross hematuria, nephrotic range proteinuria, marked elevation of serum urea and creatinine associated with positive serum C-ANCA. Renal biopsy revealed heavy IgA mesangial deposition with marked crescent formation involving more than 89% of the glomeruli (grade V). Aggressive therapeutic measures were initiated including IV pulsed steroid therapy and IV pulsed cyclophosphamide for 5 cycles followed by oral steroid and mycophenolate with close monitoring of the patient who showed marked improvement. Up to our knowledge, this is the first reported case of IgA-vasculitis-associated nephritis with bowel angina symptoms, arthritis, and edema but without typical skin rashes.
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Affiliation(s)
| | - Naglaa M Kamal
- Pediatrics & Pediatric Hepatology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | | | | | - Shaher A Alsuwat
- Pediatrics, Alhada Armed Forces Hospital, Taif, Kingdom of Saudi Arabia
| | - Ahmed Soliman
- Pediatrics, Alhada Armed Forces Hospital, Taif, Kingdom of Saudi Arabia
- Pediatrics, Faculty of Medicine, Benha University, Benha, Egypt
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26
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Dastoli S, Nisticò SP, Morrone P, Patruno C, Leo A, Citraro R, Gallelli L, Russo E, De Sarro G, Bennardo L. Colchicine in Managing Skin Conditions: A Systematic Review. Pharmaceutics 2022; 14:pharmaceutics14020294. [PMID: 35214027 PMCID: PMC8878049 DOI: 10.3390/pharmaceutics14020294] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 01/24/2022] [Accepted: 01/25/2022] [Indexed: 12/13/2022] Open
Abstract
(1) Background: Colchicine is a natural alkaloid with anti-inflammatory properties used to treat various disorders, including some skin diseases. This paper aims to incorporate all the available studies proposing colchicine as a treatment alternative in the management of cutaneous conditions. (2) Methods: In this systematic review, the available articles present in various databases (PubMed, Scopus-Embase, and Web of Science), proposing colchicine as a treatment for cutaneous pathological conditions, have been selected. Exclusion criteria included a non-English language and non-human studies. (3) Results: Ninety-six studies were included. Most of them were case reports and case series studies describing colchicine as single therapy, or in combination with other drugs. Hidradenitis suppurativa, pyoderma gangrenosum, erythema nodosum, erythema induratum, storage diseases, perforating dermatosis, bullous diseases, psoriasis, vasculitis, acne, urticaria, stomatitis, actinic keratosis, and pustular dermatosis were the main diseases discussed in literature. Although the therapeutic outcomes were variable, most of the studies reported, on average, good clinical results (4) Conclusions: Colchicine could be, as a single therapy or in combination with other drugs, a possible treatment to manage several skin diseases.
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Affiliation(s)
- Stefano Dastoli
- Department of Health Sciences, Magna Graecia University, 88100 Catanzaro, Italy; (S.D.); (S.P.N.); (C.P.); (A.L.); (R.C.); (L.G.); (E.R.); (G.D.S.)
| | - Steven Paul Nisticò
- Department of Health Sciences, Magna Graecia University, 88100 Catanzaro, Italy; (S.D.); (S.P.N.); (C.P.); (A.L.); (R.C.); (L.G.); (E.R.); (G.D.S.)
| | | | - Cataldo Patruno
- Department of Health Sciences, Magna Graecia University, 88100 Catanzaro, Italy; (S.D.); (S.P.N.); (C.P.); (A.L.); (R.C.); (L.G.); (E.R.); (G.D.S.)
| | - Antonio Leo
- Department of Health Sciences, Magna Graecia University, 88100 Catanzaro, Italy; (S.D.); (S.P.N.); (C.P.); (A.L.); (R.C.); (L.G.); (E.R.); (G.D.S.)
| | - Rita Citraro
- Department of Health Sciences, Magna Graecia University, 88100 Catanzaro, Italy; (S.D.); (S.P.N.); (C.P.); (A.L.); (R.C.); (L.G.); (E.R.); (G.D.S.)
| | - Luca Gallelli
- Department of Health Sciences, Magna Graecia University, 88100 Catanzaro, Italy; (S.D.); (S.P.N.); (C.P.); (A.L.); (R.C.); (L.G.); (E.R.); (G.D.S.)
| | - Emilio Russo
- Department of Health Sciences, Magna Graecia University, 88100 Catanzaro, Italy; (S.D.); (S.P.N.); (C.P.); (A.L.); (R.C.); (L.G.); (E.R.); (G.D.S.)
| | - Giovambattista De Sarro
- Department of Health Sciences, Magna Graecia University, 88100 Catanzaro, Italy; (S.D.); (S.P.N.); (C.P.); (A.L.); (R.C.); (L.G.); (E.R.); (G.D.S.)
| | - Luigi Bennardo
- Department of Health Sciences, Magna Graecia University, 88100 Catanzaro, Italy; (S.D.); (S.P.N.); (C.P.); (A.L.); (R.C.); (L.G.); (E.R.); (G.D.S.)
- Azienda Ospedaliera di Cosenza, 87100 Cosenza, Italy;
- Correspondence: ; Tel.: +39-09-613627195
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27
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Ireifej B, Weingarten M, Dhamrah U, Weingarten M, Hadi S. Leukocytoclastic Vasculitic Rash Following Second Dose of Moderna COVID-19 Vaccine. J Investig Med High Impact Case Rep 2022; 10:23247096211066283. [PMID: 35293793 PMCID: PMC8943294 DOI: 10.1177/23247096211066283] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
The immunization against coronavirus disease (COVID-19) via vaccination serves as a significant milestone in the fight against the pandemic. Rapid introduction of various COVID-19 vaccines to stem the spread of virus has researchers scrambling to document the adverse effects left in its wake. Thus far, there have been singular examples of cutaneous vasculitis associated with COVID-19. A history of vasculitis leaves little error to miss its inclusion in diagnostic differentials. It also invokes the physiologic possibility that afflicted patients possess a more susceptible landscape for recurrence that was then triggered by the vaccine when compared with those who lack similar history. In our case report, we build on those findings with one of the first documented examples of vaccination-induced vasculitic rash in a previously asymptomatic patient.
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Affiliation(s)
- Branden Ireifej
- Icahn School of Medicine at Mount Sinai-Elmhurst Hospital Center, New York, NY, USA
| | - Mark Weingarten
- Icahn School of Medicine at Mount Sinai-Elmhurst Hospital Center, New York, NY, USA
| | - Umaima Dhamrah
- Icahn School of Medicine at Mount Sinai-Elmhurst Hospital Center, New York, NY, USA
| | | | - Suhail Hadi
- Icahn School of Medicine at Mount Sinai-Elmhurst Hospital Center, New York, NY, USA
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28
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Nelson JH, Foo C, Hammock L, Lucero O. Herpes Zoster Presenting As Cutaneous Vasculitis in the Upper Extremity. Cureus 2021; 13:e20391. [PMID: 35036221 PMCID: PMC8754063 DOI: 10.7759/cureus.20391] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2021] [Indexed: 12/04/2022] Open
Abstract
The varicella-zoster virus (VZV), a member of the Herpesviridae family (HHV-3), is the pathogen responsible for causing herpes zoster, the skin eruption known as shingles. This report describes a rare presentation of herpes zoster involving cutaneous vasculitis in the unilateral upper extremity in an immunocompetent patient. Histologic evaluation confirmed a diagnosis of leukocytoclastic vasculitis and yielded a positive VZV immunoperoxidase stain. An approach to histologic evaluation of this case is discussed.
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Affiliation(s)
- Jacob H Nelson
- Dermatology, Western University of Health Sciences, Lebanon, USA
| | - Chong Foo
- Dermatology, Peace Health, Eugene, USA
| | | | - Olivia Lucero
- Dermatology, Oregon Health & Science University, Portland, USA
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29
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Turgutkaya A, Yavaşoğlu İ. [Ruxolitinib induced leukocytoclastic vasculitis]. Med Clin (Barc) 2021; 157:501. [PMID: 33386115 DOI: 10.1016/j.medcli.2020.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 10/30/2020] [Accepted: 11/06/2020] [Indexed: 10/22/2022]
Affiliation(s)
- Atakan Turgutkaya
- Division of Hematology, Adnan Menderes University Medical Faculty, Aytepe Location, Efeler 09010, Aydın, Turkey.
| | - İrfan Yavaşoğlu
- Division of Hematology, Adnan Menderes University Medical Faculty, Aytepe Location, Efeler 09010, Aydın, Turkey
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30
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Miyabe C, Dong Y, Ikeda T, Takahashi K, Miyabe Y, Kawakami T. Immune checkpoint molecule expression is altered in the skin and peripheral blood in vasculitis. Sci Rep 2021; 11:20019. [PMID: 34625602 PMCID: PMC8501116 DOI: 10.1038/s41598-021-99558-5] [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: 05/17/2021] [Accepted: 09/28/2021] [Indexed: 11/10/2022] Open
Abstract
Dysfunction of immunoinhibitory signals and persistent T cell activation reportedly play important roles in the development of vasculitis. The skin is one of the most accessible organs, and it is suitable for the characterization of immune cell signatures. However, the inhibitory checkpoint molecules in the skin and their relevance to vasculitis have not been studied. Here, we investigated the profile of immune checkpoint molecules in the skin and peripheral blood of patients with vasculitis and healthy donors. We found that some of the inhibitory checkpoint molecules, including programmed cell death 1 receptor (PD-1), were elevated in T-cells in the blood of patients with systemic and cutaneous vasculitis. In addition, programmed death-ligand 1 (PD-L1) expression was elevated in the skin of patients with cutaneous vasculitis. Histologically, PD-L1 was highly expressed in the vessels in the skin along with CD4+ and CD8+ T-cell infiltration in patients with cutaneous vasculitis. Notably, plasma soluble PD-L1 levels were increased, and these correlated with C-reactive protein in patients with systemic vasculitis. Our findings suggest that inhibitory checkpoint molecules might be differentially modulated in the skin and peripheral blood of patients with vasculitis, and that the alteration of the PD-L1/PD-1 axis may be associated with the regulation of T-cell activation in vasculitis.
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Affiliation(s)
- Chie Miyabe
- Division of Dermatology, Tohoku Medical and Pharmaceutical University, Sendai, Japan. .,Department of Dermatology, Tokyo Women's Medical University, Tokyo, Japan.
| | - Yupeng Dong
- Division of Dermatology, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Takaharu Ikeda
- Division of Dermatology, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Kazuo Takahashi
- Division of Dermatology, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Yoshishige Miyabe
- Department of Cell Biology, Institute for Advanced Medical Sciences, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Tamihiro Kawakami
- Division of Dermatology, Tohoku Medical and Pharmaceutical University, Sendai, Japan
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Sharifinejad N, Mahdaviani SA, Jamee M, Daneshmandi Z, Moniri A, Marjani M, Tabarsi P, Farnia P, Rekabi M, Fallahi M, Hashemimoghaddam SA, Mohkam M, Bustamante J, Casanova JL, Mansouri D, Velayati AA. Leukocytoclastic vasculitis in patients with IL12B or IL12RB1 deficiency: case report and review of the literature. Pediatr Rheumatol Online J 2021; 19:121. [PMID: 34389021 PMCID: PMC8361607 DOI: 10.1186/s12969-021-00623-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 06/24/2021] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Mendelian susceptibility to mycobacterial disease (MSMD) is an inborn error of immunity, resulting in susceptibility to weakly virulent mycobacteria and other intramacrophagic pathogens. Rheumatologic manifestations and vasculitis are considered rare manifestations in MSMD patients. CASE PRESENTATION In this study, we reported a 20-year-old female who was presented with recurrent lymphadenitis following bacillus Calmette-Guérin (BCG) vaccination and a history of recurrent disseminated rash diagnosed as leukocytoclastic vasculitis (LCV). A slight reduction in lymphocyte subsets including CD4+, CD19+, and CD 16 + 56 T-cell count, as well as an elevation in immunoglobulins level (IgG, IgA, IgM, IgE), were observed in the patient. Whole exome sequencing revealed a homozygous Indel-frameshift mutation, c.527_528delCT (p. S176Cfs*12), at the exon 5 of the IL12B gene. She experienced symptom resolution after treatment with anti-mycobacterial agents and subcutaneous IFN-γ. We conducted a manual literature search for MSMD patients reported with vasculitis in PubMed, Web of Science, and Scopus databases. A total of 18 MSMD patients were found to be affected by a variety of vasculitis phenotypes mainly including LCV and Henoch-Schönlein purpura (HSP) with often skin involvement. Patients were all involved with vasculitis at the median age of 6.8 (2.6-7.7) years, nearly 6.1 years after the initial presentations. Sixteen patients (88.9%) had IL12RB1 defects and concurrent Salmonella infection was reported in 15 (88.2%) patients. CONCLUSION The lack of IL-12 and IL-23 signaling/activity/function and salmonella infection may be triggering factors for the development of leukocytoclastic vasculitis. IL12B or IL12RB1 deficiency and salmonellosis should be considered in MSMD patients with vasculitis.
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Affiliation(s)
- Niusha Sharifinejad
- grid.411705.60000 0001 0166 0922Non-Communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran
| | - Seyed Alireza Mahdaviani
- Pediatric Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Mahnaz Jamee
- grid.411600.2Pediatric Nephrology Research Center, Research Institute for Children’s Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran ,grid.411600.2Pediatric Infections Research Center, Research Institute for Children’s Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Zahra Daneshmandi
- grid.411600.2Pediatric Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Afshin Moniri
- grid.411600.2Clinical Tuberculosis and Epidemiology Research Centre, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Majid Marjani
- grid.411600.2Clinical Tuberculosis and Epidemiology Research Centre, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Payam Tabarsi
- grid.411600.2Clinical Tuberculosis and Epidemiology Research Centre, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Parisa Farnia
- grid.411600.2Mycobacteriology Research Centre (MRC), National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mahsa Rekabi
- grid.411600.2Pediatric Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mazdak Fallahi
- grid.411600.2Pediatric Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyedeh Atefeh Hashemimoghaddam
- grid.411600.2Pediatric Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Masoumeh Mohkam
- grid.411600.2Pediatric Nephrology Research Center, Research Institute for Children’s Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Jacinta Bustamante
- grid.412134.10000 0004 0593 9113Laboratory of Human Genetics of Infectious Diseases, Necker Branch, INSERM UMR 1163, Necker Hospital for Sick Children, University of Paris, Imagine Institute, 75015 Paris, EU France ,grid.134907.80000 0001 2166 1519St. Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, The Rockefeller University, New York, NY USA ,grid.412134.10000 0004 0593 9113Center for the Study of Primary Immunodeficiencies, Necker Hospital for Sick Children, AP-HP, Paris, EU France
| | - Jean-Laurent Casanova
- grid.412134.10000 0004 0593 9113Laboratory of Human Genetics of Infectious Diseases, Necker Branch, INSERM UMR 1163, Necker Hospital for Sick Children, University of Paris, Imagine Institute, 75015 Paris, EU France ,grid.134907.80000 0001 2166 1519St. Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, The Rockefeller University, New York, NY USA ,grid.413575.10000 0001 2167 1581Howard Hughes Medical Institute, New York, NY USA
| | - Davood Mansouri
- grid.411600.2Pediatric Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ali Akbar Velayati
- grid.411600.2Pediatric Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
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32
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Kus KJB, LaChance AH, Vleugels RA. Recognition and Management of Cutaneous Connective Tissue Diseases. Med Clin North Am 2021; 105:757-782. [PMID: 34059249 DOI: 10.1016/j.mcna.2021.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Connective tissue diseases (CTDs) encompass a broad spectrum of clinical presentations that involve multidisciplinary management. Cutaneous findings are common in CTD and careful examination of these features aids in appropriate diagnosis and subsequent evaluation. Thorough work-up of CTD is crucial to properly identify disease subtypes and systemic involvement. Management plans can be developed based on diagnosis and systemic manifestations of disease. Disease management often requires treatment with pharmacotherapies with potential for toxicities, further underscoring the importance of diagnostic accuracy in this patient population. Evolving research strives to better elucidate the pathogenic mechanisms of CTDs allowing for more targeted treatment modalities.
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MESH Headings
- Adult
- Comorbidity
- Connective Tissue Diseases/complications
- Connective Tissue Diseases/diagnosis
- Connective Tissue Diseases/drug therapy
- Connective Tissue Diseases/pathology
- Dermatomyositis/diagnosis
- Dermatomyositis/etiology
- Dermatomyositis/pathology
- Diagnosis, Differential
- Drug Therapy/methods
- Drug Therapy/statistics & numerical data
- Drug-Related Side Effects and Adverse Reactions
- Early Diagnosis
- Female
- Humans
- Interdisciplinary Communication
- Lupus Erythematosus, Cutaneous/diagnosis
- Lupus Erythematosus, Cutaneous/etiology
- Lupus Erythematosus, Cutaneous/pathology
- Lupus Erythematosus, Discoid/diagnosis
- Lupus Erythematosus, Discoid/etiology
- Lupus Erythematosus, Discoid/pathology
- Lupus Erythematosus, Systemic/diagnosis
- Lupus Erythematosus, Systemic/etiology
- Lupus Erythematosus, Systemic/pathology
- Male
- Patient Care Management/methods
- Scleroderma, Systemic/diagnosis
- Scleroderma, Systemic/etiology
- Scleroderma, Systemic/pathology
- Vasculitis/diagnosis
- Vasculitis/etiology
- Vasculitis/pathology
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Affiliation(s)
- Kylee J B Kus
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, 221 Longwood Avenue, Boston, MA 02115, USA; Oakland University William Beaumont School of Medicine, 586 Pioneer Drive, Rochester, MI 48309-4482, USA
| | - Avery H LaChance
- Connective Tissue Disease Clinic, Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, 221 Longwood Avenue, Boston, MA 02115, USA.
| | - Ruth Ann Vleugels
- Autoimmune Skin Disease Program, Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, 221 Longwood Avenue, Boston, MA 02115, USA.
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33
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Martins-Martinho J, Dourado E, Khmelinskii N, Espinosa P, Ponte C. Localized Forms of Vasculitis. Curr Rheumatol Rep 2021; 23:49. [PMID: 34196889 PMCID: PMC8247627 DOI: 10.1007/s11926-021-01012-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2021] [Indexed: 12/26/2022]
Abstract
Purpose of Review To provide an updated review on epidemiology, clinical manifestations, diagnostic assessment, treatment, and prognosis of localized vasculitis, following the 2012 Revised International Chapel Hill Consensus Conference Nomenclature on single-organ vasculitis. Recent Findings Localized, single-organ vasculitides encompass a group of rare conditions in which there is no evidence of concomitant systemic vasculitis. Most data on this topic derives from case reports and small case series. Although some aspects of these diseases, such as clinical manifestations and histologic findings, have already been extensively investigated, there is still a lack of robust data concerning the pathogenesis, epidemiology, and treatment. Summary Localized vasculitides may have a wide range of clinical features depending on the organ affected. The inflammatory process may have a multifocal/diffuse or unifocal distribution. Diagnosis is usually based on histopathology findings and exclusion of systemic vasculitis, which may frequently pose a challenge. Further research on treatment is warranted.
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Affiliation(s)
- Joana Martins-Martinho
- Rheumatology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, 1649-035, Lisbon, Portugal. .,Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal.
| | - Eduardo Dourado
- Rheumatology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, 1649-035, Lisbon, Portugal.,Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Nikita Khmelinskii
- Rheumatology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, 1649-035, Lisbon, Portugal.,Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Pablo Espinosa
- Dermatology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, 1649-035, Lisbon, Portugal
| | - Cristina Ponte
- Rheumatology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, 1649-035, Lisbon, Portugal.,Dermatology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, 1649-035, Lisbon, Portugal
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34
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Pavia G, Gargiulo L, Facheris P, Valenti M, Brusa S, Manara S, Narcisi A, Costanzo A, Borroni RG. Bullous vasculitis associated with streptococcus pyogenes sepsis. Ital J Dermatol Venerol 2021; 156:623-625. [PMID: 34044506 DOI: 10.23736/s2784-8671.21.06917-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Giulia Pavia
- Dermatology Unit, Humanitas Clinical and Research Center IRCCS, Rozzano, Milan, Italy - .,Dermatology Unit, Humanitas University, Department of Biomedical Sciences, Pieve Emanuele, Milan, Italy -
| | - Luigi Gargiulo
- Dermatology Unit, Humanitas Clinical and Research Center IRCCS, Rozzano, Milan, Italy.,Dermatology Unit, Humanitas University, Department of Biomedical Sciences, Pieve Emanuele, Milan, Italy
| | - Paola Facheris
- Dermatology Unit, Humanitas Clinical and Research Center IRCCS, Rozzano, Milan, Italy.,Dermatology Unit, Humanitas University, Department of Biomedical Sciences, Pieve Emanuele, Milan, Italy
| | - Mario Valenti
- Dermatology Unit, Humanitas Clinical and Research Center IRCCS, Rozzano, Milan, Italy.,Dermatology Unit, Humanitas University, Department of Biomedical Sciences, Pieve Emanuele, Milan, Italy
| | - Stefania Brusa
- Anesthesia and Critical Care Unit, Humanitas Clinical and Research Center IRCCS, Rozzano, Milan, Italy
| | - Sofia Manara
- Pathology, Humanitas Clinical and Research Center IRCCS, Rozzano, Milan, Italy
| | - Alessandra Narcisi
- Dermatology Unit, Humanitas Clinical and Research Center IRCCS, Rozzano, Milan, Italy
| | - Antonio Costanzo
- Dermatology Unit, Humanitas Clinical and Research Center IRCCS, Rozzano, Milan, Italy.,Dermatology Unit, Humanitas University, Department of Biomedical Sciences, Pieve Emanuele, Milan, Italy
| | - Riccardo G Borroni
- Dermatology Unit, Humanitas Clinical and Research Center IRCCS, Rozzano, Milan, Italy.,Dermatology Unit, Humanitas University, Department of Biomedical Sciences, Pieve Emanuele, Milan, Italy
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35
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Alpalhão M, Maia-Silva J, Filipe P. Severe Acute Respiratory Syndrome Coronavirus 2 Vaccines and Cutaneous Adverse Reactions: A Review. Dermatitis 2021; 32:133-139. [PMID: 33851937 DOI: 10.1097/der.0000000000000755] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
We are entering a new stage of the severe acute respiratory syndrome coronavirus 2 pandemic with the initiation of large-scale vaccination programs globally. In these circumstances, even rare adverse effects of vaccines may be encountered more often, if millions of people are to be vaccinated in a short period. Vaccination has the potential for causing cutaneous adverse effects. Thus, it is paramount that dermatologists worldwide are acquainted with the possible skin reaction patterns to the coming vaccines. Herein, we conduct a review to discuss the most frequent cutaneous adverse effects of vaccines and their management, with a particular focus on the expected adverse reactions for the coming severe acute respiratory syndrome coronavirus 2 vaccines, such as local reactions, as well as immediate- and delayed-type hypersensitivity reactions, including erythema multiforme, Stevens-Johnson syndrome, toxic epidermal necrosis, serum sickness-like reactions, and vasculitides. We also discuss the yet unanswered questions on vaccines for which we may soon be asked to provide an expert opinion.
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36
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Ko M, Yen C, Hsu Y, Chen C, Yen H. Small bowel ischemia as an unusual complication of Henoch‐Schönlein purpura in an adult: A case report. ADVANCES IN DIGESTIVE MEDICINE 2020. [DOI: 10.1002/aid2.13174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Meng‐Yu Ko
- Department of Internal Medicine Changhua Christian Hospital Changhua Taiwan
| | - Chi‐En Yen
- Department of Internal Medicine Changhua Christian Hospital Changhua Taiwan
| | - Yu‐Chun Hsu
- Department of Internal Medicine Changhua Christian Hospital Changhua Taiwan
- Division of Gastroenterology and Hepatology Changhua Christian Hospital Changhua Taiwan
| | - Chih‐Jung Chen
- Department of Pathology Changhua Christian Hospital Changhua Taiwan
- Department of Pathology and Laboratory Medicine Taichung Veterans General Hospital Taichung Taiwan
| | - Hsu‐Heng Yen
- Department of Internal Medicine Changhua Christian Hospital Changhua Taiwan
- Division of Gastroenterology and Hepatology Changhua Christian Hospital Changhua Taiwan
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37
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James WE. Overlap Syndromes in Sarcoidosis: Clinical Features and Outcomes. Semin Respir Crit Care Med 2020; 41:607-617. [PMID: 32777847 DOI: 10.1055/s-0040-1713008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Sarcoidosis is a multisystem inflammatory disease characterized by noncaseating granulomatous inflammation. While pulmonary sarcoidosis is most common, extrapulmonary involvement occurs in 50 to 74% of patients and can be the presenting abnormality in some patients. The diagnosis of sarcoidosis is based on a compatible clinical presentation in combination with granulomas on histology and exclusion of other causes. However, the absence of a diagnostic biomarker for sarcoidosis, in addition to the overlap of granulomatous inflammation and nonspecific clinical findings with other diseases, often results in a delayed diagnosis. Sarcoidosis overlap syndromes are typically described when sarcoidosis is diagnosed in the presence of another disease (concurrently or sequentially) with shared clinical and histologic features, or when sarcoidosis presents with clinical features typically observed in, but not diagnostic of, other diseases. Awareness of overlap syndromes is important for clinicians to avoid diagnostic errors and evaluate for concomitant diagnoses that may impact the management and outcome of sarcoidosis. This article is intended to provide an overview of these presentations and the most commonly associated diseases, with attention to their prevalence, clinical features, and reciprocal impacts on disease outcomes.
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Affiliation(s)
- W Ennis James
- Division of Pulmonary and Critical Care Medicine, Susan Pearlstine Sarcoidosis Center of Excellence, Medical University of South Carolina, Charleston, South Carolina
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Abstract
Eosinophilic dermatoses encompass a broad spectrum of diseases of different etiologies hallmarked by eosinophilic infiltration of the skin and/or mucous membranes, with or without associated blood eosinophilia. The wide range of dermatological manifestations of this spectrum, including nodules and plaques, pustules, blisters, ulcers, and urticarial lesions, is reflected in a non-univocal classification system. We identified six groups of eosinophilic dermatoses based on the predominant anatomic level of involvement: (1) epidermal; (2) of the dermal-epidermal junction; (3) dermal; (4) of the hypodermis and muscle fascia; (5) of the pilosebaceous unit; and (6) vascular/perivascular. We review clinicopathologic features and management of diseases belonging to each group, particularly: (1) pemphigus herpetiformis and atopic dermatitis as prototypes of the epidermal group; (2) bullous pemphigoid as prototypic eosinophilic dermatosis of the dermal-epidermal junction; (3) eosinophilic cellulitis (Wells syndrome), hypereosinophilic syndromes, Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) syndrome, eosinophilic dermatosis of hematologic malignancy and chronic spontaneous urticaria as paradigmatic dermal eosinophilic dermatoses; (4) eosinophilic fasciitis as an eosinophilic dermatosis with predominant involvement of the hypodermis and muscle fascia; (5) eosinophilic pustular folliculitis as a model of the pilosebaceous unit involvement; and (6) granuloma faciale, angiolymphoid hyperplasia with eosinophilia, and eosinophilic granulomatosis with polyangiitis, belonging to the vascular/perivascular group.
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Yamamoto T, Chen KR. Cutaneous arteriolitis: A novel cutaneous small vessel vasculitis disorder clinicopathologically different from cutaneous polyarteritis nodosa and cutaneous venulitis. J Cutan Pathol 2020; 47:854-859. [PMID: 32338386 PMCID: PMC7497012 DOI: 10.1111/cup.13726] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 04/14/2020] [Accepted: 04/20/2020] [Indexed: 12/16/2022]
Abstract
Cutaneous vasculitis can be classified into two types based on the affected vessel size: small vessel vasculitis predominantly affecting dermal venules, and muscular vessel vasculitis as found in cutaneous arteritis predominantly affecting arteries located at the dermal-subcutaneous junction. We describe two cases with a novel small vessel vasculitis disorder, which exclusively affected arterioles in the mid-dermis, and show clinical and pathological difference distinct from cutaneous polyarteritis nodosa and cutaneous venulitis. Both patients were male, and presented with painful infiltrative plaques, involving the palms, soles, and thighs without extracutaneous involvement except for fever and arthralgia. Histopathological examination revealed vasculitis in the mid-dermis characterized by a predominant infiltration of neutrophils with vessel wall fibrinoid necrosis and leukocytoclasia identical to the features of leukocytoclastic vasculitis, except that the affected vessels were arterioles rather than venules. Serological examinations showed normal levels of serum complements, immune complexes, and antineutrophil cytoplasmic antibodies, and vasculitis disorders associated with systemic diseases were excluded in both patients. The patients showed a good response to short-term treatment with prednisolone up to 30 mg. This novel cutaneous arteriolitis clinicopathologically different from both cutaneous venulitis and cutaneous arteritis appears to be a skin-limited disorder.
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Affiliation(s)
- Toshiyuki Yamamoto
- Department of Dermatology, Fukushima Medical University, Fukushima, Japan
| | - Ko-Ron Chen
- Meguro Chen Dermatology Clinic, Tokyo, Japan
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40
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Micheletti RG, Pagnoux C. Management of cutaneous vasculitis. Presse Med 2020; 49:104033. [PMID: 32645416 DOI: 10.1016/j.lpm.2020.104033] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Accepted: 07/02/2020] [Indexed: 02/07/2023] Open
Abstract
Cutaneous vasculitis encompasses cutaneous components of systemic vasculitides, skin-limited variants of systemic vasculitides, such as IgA vasculitis or cutaneous polyarteritis nodosa, and single-organ cutaneous vasculitis, as individualized in 2012 in the Chapel Hill Consensus Conference Nomenclature. In this article, we focus on the management of skin-limited and single-organ vasculitides, often referred to, in clinical practice, as isolated "cutaneous leukocyctoclastic vasculitis", terms which may correspond to histological findings or descriptions, but are imprecise and not specific. Since most cases of isolated cutaneous vasculitis are self-limited and resolve spontaneously over 3 to 4 weeks, most patients require no systemic treatment. For those with severe, intractable, or chronic and recurring vasculitis, systemic therapy can be indicated and should be tailored to the severity of the disease. High-quality literature is lacking to guide management. Oral glucocorticoids may be required for a short period of time for painful, ulcerative, or otherwise severe disease in order to speed resolution. Among drugs which are reasonable longer-term options are colchicine, dapsone, azathioprine or hydroxychloroquine. Additional studies, including an ongoing multicenter randomized trial, are needed to determine the most effective therapies for skin-limited vasculitis.
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Affiliation(s)
- Robert G Micheletti
- Departments of Dermatology and Medicine, University of Pennsylvania, 3400 Civic Center Blvd, 7 South, Room 724, Philadelphia, PA 19104, United States
| | - Christian Pagnoux
- Vasculitis Clinic, Division of Rheumatology, Mount Sinai Hospital, University of Toronto, 60 Murray Street, Ste 2-220, Toronto, Ontario, M5T 3L9, Canada.
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41
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Morita TCAB, Criado PR, Criado RFJ, Trés GFS, Sotto MN. Update on vasculitis: overview and relevant dermatological aspects for the clinical and histopathological diagnosis - Part II. An Bras Dermatol 2020; 95:493-507. [PMID: 32527591 PMCID: PMC7335877 DOI: 10.1016/j.abd.2020.04.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Accepted: 04/28/2020] [Indexed: 12/26/2022] Open
Abstract
Vasculitis is a group of several clinical conditions in which the main histopathological finding is fibrinoid necrosis in the walls of blood vessels. This article assesses the main dermatological aspects relevant to the clinical and laboratory diagnosis of small- and medium-vessel cutaneous and systemic vasculitis syndromes. The most important aspects of treatment are also discussed.
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Affiliation(s)
| | | | | | - Gabriela Franco S Trés
- Department of Dermatology, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Mirian Nacagami Sotto
- Department of Dermatology, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
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42
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Basu P, Russell-Goldman E, Nazarian RM, Das S. Alcohol-Associated Immunoglobulin A Vasculitis: A Case Report and Review of the Literature. Dermatopathology (Basel) 2020; 6:288-293. [PMID: 32596212 PMCID: PMC7315200 DOI: 10.1159/000507307] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 03/17/2020] [Indexed: 11/23/2022] Open
Abstract
Immunoglobulin A (IgA)-mediated leukocytoclastic vasculitis is a cutaneous small-vessel vasculitis characterized by skin findings of palpable purpura. It may occur secondary to infections, neoplasms, drugs, and systemic conditions, although it is most commonly idiopathic. A known, but rare, trigger for IgA vasculitis is alcohol consumption. We present a case of a man with IgA vasculitis associated with alcohol use and review the literature on alcohol-associated vasculitis. Although rarely reported, alcohol-associated IgA vasculitis is an important entity to consider for appropriate diagnosis and management of such patients.
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Affiliation(s)
- Pallavi Basu
- School of Medicine, University of California San Diego, La Jolla, California, USA
| | | | - Rosalynn M Nazarian
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Shinjita Das
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts, USA
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43
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Gehlhausen JR, Wetter DA, Nelson C, Ramachandran S, McNiff JM, Ko CJ. A detailed analysis of the distribution, morphology, and histopathology of complex purpura in hospitalized patients: A case series of 68 patients. J Am Acad Dermatol 2020; 84:1188-1196. [PMID: 32376433 DOI: 10.1016/j.jaad.2020.04.149] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 04/24/2020] [Accepted: 04/28/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Purpura in inpatients commonly leads to dermatologic consultation. The differential diagnosis is broad and algorithms are intricate. OBJECTIVE We evaluated inpatient consultations for complex purpura to document the most common diagnoses and to validate the true diagnostic utility of histopathology, clinical morphology, and distribution. METHODS We reviewed a case series of 68 inpatients during a 4-year period with a dermatologic consultation for purpura and biopsy findings of vasculitis or microvascular occlusion. RESULTS Key features of complex purpura are nonbranching (round) versus branching (retiform) morphology, dependent versus acral or generalized distribution, and leukocytoclastic vasculitis versus microvascular occlusion (with emphasis on depth of involvement). Dependent nonbranching purpura with only superficial vessels involved by leukocytoclastic vasculitis was most often due to IgA vasculitis or cutaneous single-organ small-vessel vasculitis. In contrast, deeper involvement by leukocytoclastic vasculitis was suggestive of systemic disease (eg, antineutrophil cytoplasmic antibody-associated vasculitis). Branching purpura was concerning, with greater than 90% sensitivity and specificity for microvascular occlusion and associated high mortality (≈50%). The majority of patients who died had acral branching lesions. LIMITATIONS Small sample size, inpatients at a tertiary care center, and retrospective nature are some limitations. CONCLUSION Nonbranching dependent purpura corresponded to leukocytoclastic vasculitis, with the most common diagnoses being IgA vasculitis or skin-limited small-vessel vasculitis; patients with deep involvement often had systemic diseases. In this series, branching purpura was due to microvascular occlusion rather than medium-vessel vasculitis, and had associated high mortality.
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Affiliation(s)
- Jeff R Gehlhausen
- Yale School of Medicine Department of Dermatology, New Haven, Connecticut
| | - David A Wetter
- Mayo Clinic Department of Dermatology, Rochester, Minnesota
| | - Caroline Nelson
- Yale School of Medicine Department of Dermatology, New Haven, Connecticut
| | | | - Jennifer M McNiff
- Yale School of Medicine Department of Dermatology, New Haven, Connecticut; Department of Pathology, New Haven, Connecticut
| | - Christine J Ko
- Yale School of Medicine Department of Dermatology, New Haven, Connecticut; Department of Pathology, New Haven, Connecticut.
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44
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Sobrin L, Stone JH, Huang AJ, Niles JL, Nazarian RM. Case 14-2020: A 37-Year-Old Man with Joint Pain and Eye Redness. N Engl J Med 2020; 382:1750-1758. [PMID: 32348648 DOI: 10.1056/nejmcpc1909623] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Lucia Sobrin
- From the Department of Ophthalmology, Massachusetts Eye and Ear (L.S.), the Departments of Medicine (J.H.S.), Radiology (A.J.H.), and Pathology (J.L.N., R.M.N.), Massachusetts General Hospital, and the Departments of Ophthalmology (L.S.), Medicine (J.H.S.), Radiology (A.J.H.), and Pathology (J.L.N., R.M.N.), Harvard Medical School - all in Boston
| | - John H Stone
- From the Department of Ophthalmology, Massachusetts Eye and Ear (L.S.), the Departments of Medicine (J.H.S.), Radiology (A.J.H.), and Pathology (J.L.N., R.M.N.), Massachusetts General Hospital, and the Departments of Ophthalmology (L.S.), Medicine (J.H.S.), Radiology (A.J.H.), and Pathology (J.L.N., R.M.N.), Harvard Medical School - all in Boston
| | - Ambrose J Huang
- From the Department of Ophthalmology, Massachusetts Eye and Ear (L.S.), the Departments of Medicine (J.H.S.), Radiology (A.J.H.), and Pathology (J.L.N., R.M.N.), Massachusetts General Hospital, and the Departments of Ophthalmology (L.S.), Medicine (J.H.S.), Radiology (A.J.H.), and Pathology (J.L.N., R.M.N.), Harvard Medical School - all in Boston
| | - John L Niles
- From the Department of Ophthalmology, Massachusetts Eye and Ear (L.S.), the Departments of Medicine (J.H.S.), Radiology (A.J.H.), and Pathology (J.L.N., R.M.N.), Massachusetts General Hospital, and the Departments of Ophthalmology (L.S.), Medicine (J.H.S.), Radiology (A.J.H.), and Pathology (J.L.N., R.M.N.), Harvard Medical School - all in Boston
| | - Rosalynn M Nazarian
- From the Department of Ophthalmology, Massachusetts Eye and Ear (L.S.), the Departments of Medicine (J.H.S.), Radiology (A.J.H.), and Pathology (J.L.N., R.M.N.), Massachusetts General Hospital, and the Departments of Ophthalmology (L.S.), Medicine (J.H.S.), Radiology (A.J.H.), and Pathology (J.L.N., R.M.N.), Harvard Medical School - all in Boston
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45
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Micheletti RG, Pagnoux C, Tamura RN, Grayson PC, McAlear CA, Borchin R, Krischer JP, Merkel PA. Protocol for a randomized multicenter study for isolated skin vasculitis (ARAMIS) comparing the efficacy of three drugs: azathioprine, colchicine, and dapsone. Trials 2020; 21:362. [PMID: 32345372 PMCID: PMC7189702 DOI: 10.1186/s13063-020-04285-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 03/26/2020] [Indexed: 11/17/2022] Open
Abstract
Background Skin-limited forms of vasculitis, while lacking systemic manifestations, can persist or recur indefinitely, cause pain, itch, or ulceration, and be complicated by infection or scarring. High-quality evidence on how to treat these conditions is lacking. The aim of this comparative effectiveness study is to determine the optimal management of patients with chronic skin-limited vasculitis. Methods ARAMIS is a multicenter, sequential, multiple assignment randomized trial with an enrichment design (SMARTER) aimed at comparing the efficacy of three drugs—azathioprine, colchicine, and dapsone—commonly used to treat various forms of isolated skin vasculitis. ARAMIS will enroll patients with isolated cutaneous small or medium vessel vasculitis, including cutaneous small vessel vasculitis, immunoglobulin A (IgA) vasculitis (skin-limited Henoch-Schönlein purpura), and cutaneous polyarteritis nodosa. Patients not responding to the initial assigned therapy will be re-randomized to one of the remaining two study drugs (Stage 2). Those with intolerance or contraindication to a study drug can be randomized directly into Stage 2. Target enrollment is 90 participants, recruited from international centers affiliated with the Vasculitis Clinical Research Consortium. The number of patients enrolled directly into Stage 2 of the study will be capped at 10% of the total recruitment target. The primary study endpoint is the proportion of participants from the pooled study stages with a response to therapy at month 6, according to the study definition. Discussion ARAMIS will help identify effective agents for skin-limited forms of vasculitis, an understudied group of diseases. The SMARTER design may serve as an example for future trials in rare diseases. Trial registration ClinicalTrials.gov: NCT02939573. Registered on 18 October 2016.
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Affiliation(s)
- Robert G Micheletti
- Departments of Dermatology and Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Christian Pagnoux
- Vasculitis Clinic, Department of Rheumatology, Mount Sinai Hospital, University of Toronto, 60 Murray Street, Toronto, ON, M5T3L9, Canada.
| | - Roy N Tamura
- Health Informatics Institute, University of South Florida, Tampa, FL, USA
| | - Peter C Grayson
- The National Institute of Arthritis and Musculoskeletal and Skin Diseases, Bethesda, MD, USA
| | - Carol A McAlear
- Divison of Rheumatology and Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Renee Borchin
- Department of Biostatistics, University of South Florida, Tampa, FL, USA
| | - Jeffrey P Krischer
- Health Informatics Institute, University of South Florida, Tampa, FL, USA
| | - Peter A Merkel
- Divison of Rheumatology and Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, PA, USA
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46
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Retiform purpura: A diagnostic approach. J Am Acad Dermatol 2020; 82:783-796. [DOI: 10.1016/j.jaad.2019.07.112] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 07/15/2019] [Accepted: 07/28/2019] [Indexed: 12/28/2022]
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47
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Georgesen C, Fox LP, Harp J. Retiform purpura: Workup and therapeutic considerations in select conditions. J Am Acad Dermatol 2020; 82:799-816. [DOI: 10.1016/j.jaad.2019.07.113] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 07/15/2019] [Accepted: 07/28/2019] [Indexed: 02/07/2023]
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48
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A Review of Primary Vasculitis Mimickers Based on the Chapel Hill Consensus Classification. Int J Rheumatol 2020; 2020:8392542. [PMID: 32148510 PMCID: PMC7049422 DOI: 10.1155/2020/8392542] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 01/07/2020] [Indexed: 12/13/2022] Open
Abstract
Primary systemic vasculitides are rare diseases that may manifest similarly to more commonly encountered conditions. Depending on the size of the vessel affected (large vessel, medium vessel, or small vessel), different vasculitis mimics must be considered. Establishing the right diagnosis of a vasculitis mimic will prevent unnecessary immunosuppressive therapy.
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49
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Abstract
PURPOSE OF REVIEW Cutaneous vasculitis reflects a spectrum ranging from skin limited to severe systemic forms. To date, there is still no generally acknowledged nomenclature for cutaneous vasculitis. This review aims to summarize the recent advances in the nomenclature of cutaneous vasculitis. RECENT FINDINGS The most widely adopted vasculitis classification system is the one of 2012 Revised Chapel Hill Consensus Conference (CHCC) which represent not such a classification but a nomenclature system that name vasculitis on the basis of the size of the vessel affected. The CHCC 2012 did not deal with the special features of cutaneous vasculitis and did not explicitly discuss the presence of skin-limited or skin-dominant forms of vasculitis. Therefore, a consensus group was formed to propose an Addendum to CHCC 2012, focusing on cutaneous vasculitis. The Addendum better clarify the main aspects of some single-organ vasculitis, including IgM/IgG vasculitis, nodular vasculitis, erythema elevatum et diutinum and recurrent macular vasculitis in hypergammaglobulinemia. Moreover, it differentiated normocomplementemic from hypocomplementemic urticarial vasculitis. Finally, it recognized cutaneous polyarteritis nodosa as a distinct subtype of polyarteritis nodosa. SUMMARY Classification criteria are useful tools to standardize names and definitions for cutaneous vasculitis; however, they do not represent diagnostic criteria. Collaborative efforts are still needed to get a shared classification and valid diagnostic criteria for cutaneous vasculitis.
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50
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Ellis A, Billings SD, Khanna U, Warren CB, Piliang M, Vij A, Ko JS, Bergfeld WF, Fernandez AP. Diagnoses of hospitalized patients with skin abnormalities prompting biopsy by consulting dermatologists: A 3-year review from a tertiary care center. J Cutan Pathol 2019; 47:346-356. [PMID: 31845375 PMCID: PMC9291190 DOI: 10.1111/cup.13628] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 12/04/2019] [Accepted: 12/09/2019] [Indexed: 12/25/2022]
Abstract
Background Dermatologists play an important role in diagnosing and managing hospitalized patients with cutaneous abnormalities. Skin biopsies remain an indispensable tool for aiding dermatologists in accurate diagnosis and treatment. We aimed to determine the range of conditions, and the most common conditions, prompting skin biopsy by dermatology hospital consultation (HCON) services to aid in evaluation of hospitalized patients. Methods All hospitalized patients seen by a single tertiary care center dermatology HCON service between 2015 and 2018 who had associated skin biopsies were identified. Histologic features and clinical diagnoses of each patient were classified into 13 histologic reaction pattern categories. Results Eight hundred and thirty one inpatients evaluated by our dermatology HCON service had 914 skin biopsies. The most frequent diagnostic categories prompting biopsy were vasculopathic (17.6%), interface dermatitis (16.5%), infectious (12.6%), and spongiotic dermatitis (10.9%). The most frequent diagnostic categories included drug reaction (13.2%), leukocytoclastic vasculitis (8.5%), skin cancer (5.4%), graft‐vs‐host disease (3.5%), connective tissue disease (3.3%), and calciphylaxis (3.0%). Conclusion Our study suggests a variety of serious diseases affecting inpatients prompts biopsy by dermatology consultation services. Educational curricula for dermatology and pathology residents, fellows, and staff designed with these data may enhance knowledge that improves the quality of inpatient dermatology care.
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Affiliation(s)
- Ariana Ellis
- Northeast Ohio Medical University College of Medicine, Rootstown, Ohio.,Department of Dermatology, Cleveland Clinic, Cleveland, Ohio
| | - Steven D Billings
- Department of Dermatology, Cleveland Clinic, Cleveland, Ohio.,Department of Pathology, Cleveland Clinic, Cleveland, Ohio
| | - Urmi Khanna
- Department of Dermatology, Cleveland Clinic, Cleveland, Ohio
| | | | - Melissa Piliang
- Department of Dermatology, Cleveland Clinic, Cleveland, Ohio.,Department of Pathology, Cleveland Clinic, Cleveland, Ohio
| | - Alok Vij
- Department of Dermatology, Cleveland Clinic, Cleveland, Ohio
| | - Jennifer S Ko
- Department of Dermatology, Cleveland Clinic, Cleveland, Ohio.,Department of Pathology, Cleveland Clinic, Cleveland, Ohio
| | - Wilma F Bergfeld
- Department of Dermatology, Cleveland Clinic, Cleveland, Ohio.,Department of Pathology, Cleveland Clinic, Cleveland, Ohio
| | - Anthony P Fernandez
- Department of Dermatology, Cleveland Clinic, Cleveland, Ohio.,Department of Pathology, Cleveland Clinic, Cleveland, Ohio
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