1
|
Elshony H, Alzahrani M, Khafaji S, Almuhanna R, Khalil K, Mudassir R. Ischemic stroke as the initial presentation in acute myeloid leukemia vs. myelodysplastic syndrome: a case report and literature review with pathophysiological and clinical exploration. Neurol Sci 2024; 45:3297-3304. [PMID: 38351359 DOI: 10.1007/s10072-024-07367-1] [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: 12/12/2023] [Accepted: 01/25/2024] [Indexed: 06/15/2024]
Abstract
BACKGROUND Myelodysplastic syndromes (MDS) and acute myeloid leukemia (AML) present intricate challenges due to their diverse clinical manifestations and thrombotic complications. Thromboembolism (TE) incidence in newly diagnosed AML patients is noteworthy, with arterial TE linked to poorer overall survival. Ischemic strokes, although relatively low in prevalence, carry significant clinical implications. CASE DESCRIPTION We report the case of an 84-year-old male with Type 2 Diabetes, Hypertension, and Chronic Kidney Disease, presenting with seizures, focal neurological deficits, and pancytopenia. An unexpected diagnosis of AML or MDS emerged during the investigation. Despite interventions, the patient's condition deteriorated, leading to a fatal outcome weeks later. CONCLUSION This case underscores the intricate relationship between hematologic malignancies and ischemic stroke. The rarity of this complication emphasizes the importance of understanding the multifaceted mechanisms at play, including hyperleukocytosis, pro-inflammatory cytokine release, coagulation cascade activation, and direct interactions with endothelial cells. In our literature review, analysis of 15 cases, including ours, revealed a wide age range (3-87 years) and a gender bias towards females. AML diagnosis was predominant, with uniformly low platelet counts. Cortical infarctions, especially in the anterior circulation, were common. Hyperleukocytosis, disseminated intravascular coagulation (DIC), and fatal outcomes were observed in a subset of cases. Despite the grim statistics and often poor prognosis, the identification of specific risk factors, such as thrombocytopenia and cytogenetic abnormalities, offers avenues for targeted prevention and management.
Collapse
Affiliation(s)
- Hosna Elshony
- Department of Neuropsychiatry, Faculty of Medicine, Menoufiya University, Shebin El-kom, Egypt.
| | - Meshari Alzahrani
- Department of Neurology/Internal Medicine, Security Forces Hospital, Almashaer Street, Altaif road, Makkah, Saudi Arabia
| | - Salah Khafaji
- Department of Neurology/Internal Medicine, Security Forces Hospital, Almashaer Street, Altaif road, Makkah, Saudi Arabia
| | - Rakan Almuhanna
- Department of Neurology/Internal Medicine, Security Forces Hospital, Almashaer Street, Altaif road, Makkah, Saudi Arabia
| | - Khalid Khalil
- Department of Internal Medicine/Hematology, Security Forces Hospital, Makkah, Saudi Arabia
| | - Rabia Mudassir
- Department of Neurology/Internal Medicine, Security Forces Hospital, Almashaer Street, Altaif road, Makkah, Saudi Arabia
| |
Collapse
|
2
|
She CH, Hu D, Zou J, Bao HF, Shen Y, Cai JF, Ye JF, Luo D, Jian LL, Ma HF, Hou CC, Chen Y, Guan JL. Clinical phenotypes of adult-onset Behçet's syndrome: a comprehensive cross-sectional study in China. Clin Rheumatol 2024; 43:2261-2271. [PMID: 38724819 DOI: 10.1007/s10067-024-06995-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 04/13/2024] [Accepted: 05/03/2024] [Indexed: 06/19/2024]
Abstract
Behçet's syndrome (BS) is a variant vasculitis that can involve multiple organs with inflammatory manifestations. This study aimed to provide a more comprehensive analysis of the clinical phenotypes and characteristics of BS patients. We enrolled 2792 BS patients referred from China nationwide to Huadong Hospital Affiliated to Fudan University from October 2012 to December 2022. Detailed assessments of demographic information, clinical manifestations, laboratory results, gastroscopy, and medical imaging were conducted. Cluster analysis was performed based on 13 variables to determine the clinical phenotypes, and each phenotype was characterized according to the features of BS patients. A total of 1834 BS patients were included, while 958 invalid patients were excluded. The median age at onset was 31 years (IQR, 24-40 years), and the median disease duration was 10 years (IQR, 5-15 years). Eight clusters were identified, including mucocutaneous (n = 655, 35.7%), gastrointestinal (n = 363, 19.8%), articular (n = 184, 10%), ocular (n = 223, 12.2%), cardiovascular (n = 119, 6.5%), neurological (n = 118, 6.4%), vascular (n = 114, 6.2%), and hematological phenotype (n = 58, 3.2%). Ocular (RR = 1.672 (95% CI, 1.327-2.106); P < 0.001), gastrointestinal (RR = = 1.194 (95% CI, 1.031-1.383); P = 0.018), cardiovascular (RR = = 2.582 (95% CI, 1.842-3.620); P < 0.001), and vascular (RR = = 2.288 (95% CI, 1.600-3.272); P < 0.001) involvement were more prevalent in male BS patients, while the hematological (RR = 0.528 (95% CI, 0.360-0.776); P = 0.001) involvement was more common among female patients. BS presents significant heterogeneity and gender differences. The eight phenotypes of BS patients we propose hold the potential to assist clinicians in devising more personalized treatment and follow-up strategies. Key Points • This cluster analysis divided adult-onset BS into eight clinical phenotypes. • BS demonstrates a high level of clinical heterogeneity and gender differences. • Hematologic phenotypes of BS present distinctive clinical characteristics.
Collapse
Affiliation(s)
- Chun-Hui She
- Department of Rheumatology and Immunology, Huadong Hospital Affiliated to Fudan University, #221 Yan'an West Road200040, Shanghai, China
| | - Dan Hu
- Department of Rheumatology and Immunology, Huadong Hospital Affiliated to Fudan University, #221 Yan'an West Road200040, Shanghai, China
| | - Jun Zou
- Department of Rheumatology and Immunology, Huadong Hospital Affiliated to Fudan University, #221 Yan'an West Road200040, Shanghai, China
| | - Hua-Fang Bao
- Department of Rheumatology and Immunology, Huadong Hospital Affiliated to Fudan University, #221 Yan'an West Road200040, Shanghai, China
| | - Yan Shen
- Department of Rheumatology and Immunology, Huadong Hospital Affiliated to Fudan University, #221 Yan'an West Road200040, Shanghai, China
| | - Jian-Fei Cai
- Department of Rheumatology and Immunology, Huadong Hospital Affiliated to Fudan University, #221 Yan'an West Road200040, Shanghai, China
| | - Jing-Fen Ye
- Department of Rheumatology and Immunology, Huadong Hospital Affiliated to Fudan University, #221 Yan'an West Road200040, Shanghai, China
| | - Dan Luo
- Department of Rheumatology and Immunology, Huadong Hospital Affiliated to Fudan University, #221 Yan'an West Road200040, Shanghai, China
| | - Lei-Lei Jian
- Department of Rheumatology and Immunology, Huadong Hospital Affiliated to Fudan University, #221 Yan'an West Road200040, Shanghai, China
| | - Hai-Fen Ma
- Department of Rheumatology and Immunology, Huadong Hospital Affiliated to Fudan University, #221 Yan'an West Road200040, Shanghai, China
| | - Cheng-Cheng Hou
- Department of Rheumatology and Immunology, the First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Yong Chen
- Department of Rheumatology and Immunology, Affiliated Hospital of Zunyi Medical University, Guizhou, China
| | - Jian-Long Guan
- Department of Rheumatology and Immunology, Huadong Hospital Affiliated to Fudan University, #221 Yan'an West Road200040, Shanghai, China.
| |
Collapse
|
3
|
Ono R, Tominaga T, Nonaka T, Takamura Y, Oishi K, Shiraishi T, Hashimoto S, Noda K, Sawai T, Okano S, Nagayasu T. Intestinal Behçet's and suspected intestinal Behçet's disease: a report of four surgical cases. Surg Case Rep 2024; 10:3. [PMID: 38165549 PMCID: PMC10761645 DOI: 10.1186/s40792-023-01798-2] [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: 08/31/2023] [Accepted: 12/20/2023] [Indexed: 01/04/2024] Open
Abstract
BACKGROUND Intestinal Behçet's disease (BD) is often associated with ulceration that requires surgery, including perforation and abscess formation. However, no consensus has been reached on the optimal extent of resection or treatment strategy. This study reviewed four cases of intestinal or suspected intestinal BD. CASE PRESENTATIONS In Case 1, a 74-year-old woman diagnosed with BD 2 years earlier was treated with anti-tumor necrosis factor α antibody (Infliximab) and steroids. She had oral and pubic ulcers. After close investigation of abdominal pain, perforation of the gastrointestinal tract was suspected and surgery was performed. Multiple perforating ulcers and abscesses were found in the distal ileum, and the small intestine was resected. Postoperatively, the patient was treated with an increased steroid dose and symptoms have remained stable. Case 2 involved a 69-year-old woman with oral and pubic ulcers, ocular ulcer, and skin lesions. She experienced sudden onset of abdominal pain during treatment for lymphoma. She showed multiple perforating ulcers throughout the ileum and underwent resection of the small intestine and ileostomy. Upper abdominal pain appeared during postoperative treatment for high-output syndrome. The patient underwent omentoplasty after perforation of the upper gastrointestinal tract was diagnosed. Postoperatively, anti-interleukin-1 beta antibodies (canakinumab) was administered to control the disease. Case 3 involved an 81-year-old, previously healthy woman. She presented to her previous physician with complaints of pubic ulcer, hemorrhage and abdominal pain. Colonoscopy showed multiple ulcers throughout the entire colon. Steroid therapy was started, but bleeding proved difficult to control and total proctocolectomy was performed. Histopathology revealed multiple perforating ulcers and BD was diagnosed. Postoperatively, the patient remains under steroid control. Case 4 involved a 43-year-old man with abdominal pain who showed abscess formation in the ileocecal region. After excision of the ileocecal area, multiple ulcers were diagnosed. Two years later, abdominal pain recurred and free air was found in the abdomen on close imaging. Emergency anastomotic resection was performed due to ulceration and perforation of the anastomosis. CONCLUSIONS Intestinal BD may flare up after surgical treatment and require multiple surgeries. Introducing pharmacotherapy as soon as possible after surgical treatment is important to control the disease.
Collapse
Affiliation(s)
- Rika Ono
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Science, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Tetsuro Tominaga
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Science, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan.
| | - Takashi Nonaka
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Science, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Yuma Takamura
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Science, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Kaido Oishi
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Science, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Toshio Shiraishi
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Science, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Shintaro Hashimoto
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Science, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Keisuke Noda
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Science, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Terumitsu Sawai
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Science, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Shinji Okano
- Department of Pathology, Nagasaki University Graduate School of Biomedical Science, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Takeshi Nagayasu
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Science, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| |
Collapse
|
4
|
Takahashi R, Matsubara Y, Takahashi S, Yokoyama K, Ahyoung LL, Koga M, Sakamoto H, Boku N, Shida D, Yotsuyanagi H. Refractory Intestinal Behçet-Like Disease Associated with Trisomy 8 Myelodysplastic Syndrome Resolved by Parenteral Nutrition. Case Rep Gastroenterol 2023; 17:287-293. [PMID: 37928972 PMCID: PMC10624938 DOI: 10.1159/000533578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 08/08/2023] [Indexed: 11/07/2023] Open
Abstract
Intestinal Behçet disease (BD), associated with myelodysplastic syndrome (MDS), is often refractory to treatment. An 80-year-old man with trisomy 8 MDS (refractory anemia) developed intermittent fever. Despite investigations to exclude infectious disease, autoimmune disease, and malignancy as the cause of the fever, the etiology could not be determined. A colonoscopy revealed several shallow round ulcers in the ileocecal region and ascending colon, and the biopsy specimens showed nonspecific inflammation. Thereafter, the patient experienced abdominal pain and diarrhea. Other than an oral aphthous ulcer, the patient did not show symptoms to meet the diagnostic criteria for BD. The patient was diagnosed with intestinal ulcers (intestinal BD-like disease) with MDS and trisomy 8. After treatment failure with 5-aminosalicylic acid, steroid, colchicine, and azacitidine, cerebral infarction occurred. Eating was difficult because of the patient's impaired consciousness; hence, total parenteral nutrition (TPN) was commenced. The fever and abdominal symptoms improved with bowel rest over approximately 1 month. Small amounts of food were orally administered to the patient following recovery from the after-effects of the cerebral infarction, but diarrhea and fever repeatedly flared up. Therefore, TPN was continued at home. The patient has not experienced any further intestinal BD symptoms for approximately 1 year with bowel rest. Nutritional therapy, including bowel rest, may be an effective treatment option for intestinal BD with MDS, and might be used as an induction therapy of remission or a supportive therapy for other treatments.
Collapse
Affiliation(s)
- Ryo Takahashi
- Department of Surgery, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan
- Department of Surgery, Medical Corporation Shiba-daimonkai, Kanagawa, Japan
| | - Yasuo Matsubara
- Department of Oncology and General Medicine, IMSUT Hospital, Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - Satoshi Takahashi
- Deptartment of Hematology/Oncology, IMSUT Hospital, Institute of Medical Science, The University of Tokyo, Tokyo, Japan
- Division of Clinical Precision Research Platform, IMSUT Hospital, Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - Kazuaki Yokoyama
- Deptartment of Hematology/Oncology, IMSUT Hospital, Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - Lim Lay Ahyoung
- Department of Research, Kitasato Institute Hospital, Kitasato University, Tokyo, Japan
| | - Michiko Koga
- Department of Infectious Diseases and Applied Immunology, IMSUT Hospital of the Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - Hiroyuki Sakamoto
- Department of Infectious Diseases and Applied Immunology, IMSUT Hospital of the Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - Narikazu Boku
- Department of Oncology and General Medicine, IMSUT Hospital, Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - Dai Shida
- Department of Surgery, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - Hiroshi Yotsuyanagi
- Department of Infectious Diseases and Applied Immunology, IMSUT Hospital of the Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| |
Collapse
|
5
|
Chromosomal abnormalities related to fever of unknown origin in a Chinese pediatric cohort and literature review. Orphanet J Rare Dis 2022; 17:292. [PMID: 35897075 PMCID: PMC9327306 DOI: 10.1186/s13023-022-02444-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 07/14/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Fever of unknown origin (FUO) has been difficult to diagnose in pediatric clinical practice. With the gradual change in the disease spectrum, genetic factors have received increasing attention. Limited studies have shown an association between FUO and chromosomal abnormalities. In this study, we investigated the clinical and genetic characteristics of patients with FUO presenting with chromosomal abnormalities in a Chinese pediatric cohort. RESULTS Chromosomal abnormalities were detected in 5.5% (8/145) of the patients with FUO. Six patients with inflammatory fever presented with pharyngitis/amygdalitis (4/6), oral aphthous ulcer (2/6), digestive symptoms (3/6), developmental delay (4/6) and elevated C-reactive protein levels (6/6) during fever. These patients were often considered to have systemic inflammatory diseases, such as Behcet's disease or systemic juvenile idiopathic arthritis. Trisomy 8, 7q11.23 dup, 3p26.3-p26.1 del/17q12 dup, 22q11.21 del, and 6q23.3-q24.1 del were identified in patients with inflammatory fever. The TNFAIP3 gene was included in the 6q23.3-q24.1 deletion fragment. Two patients with central fever were characterized by facial anomalies, developmental delay, seizures and no response to antipyretic drugs and were identified as carrying the de novo 18q22.3-q23 del. By performing a literature review, an additional 19 patients who had FUO and chromosomal abnormalities were identified. Trisomy 8, 6q23.2-q24.3 del and 18q22.3-q23 del were reported to present as fever, similar to the findings of our study. CONCLUSIONS We emphasized the important role of detecting chromosomal abnormalities in patients with FUO, especially in patients with systemic inflammatory manifestations or developmental delay. Identifying chromosomal abnormalities may change the diagnosis and management of patients with FUO.
Collapse
|
6
|
Liu Z, Yang C, Bai X, Shen K, Qiao L, Wang Q, Yang H, Qian J. Clinical features and prognosis of patients with gastrointestinal Behcet's disease-like syndrome and myelodysplastic syndrome with and without trisomy 8. Semin Arthritis Rheum 2022; 55:152039. [DOI: 10.1016/j.semarthrit.2022.152039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 05/23/2022] [Accepted: 05/31/2022] [Indexed: 11/28/2022]
|
7
|
Mori Y, Iwamoto F, Kuno T, Kobayashi S, Yoshida T, Yamaguchi T, Takano S, Kondo T, Kirito K, Enomoto N. Trisomy 8-positive Polycythemia Vera Complicated with Intestinal Behçet's-like Disease: A New Perspective for a Clinical Approach. Intern Med 2022; 61:1713-1719. [PMID: 34744109 PMCID: PMC9259299 DOI: 10.2169/internalmedicine.8395-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Behçet's disease (BD) is a multisystem inflammatory disease of unknown origin. It rarely but occasionally occurs together with myelodysplastic syndrome and primary myelofibrosis. Trisomy 8 is one of the most common cytogenetic abnormalities in myeloid neoplasms; however, the association of BD with polycythemia vera (PV) and trisomy 8 has not been reported. A 70-year-old woman, diagnosed with PV and treated with hydroxyurea, had bloody stool due to multiple ulcers in the ileocecal region. Considering the lack of a response to treatment and other features, we suspected complication with intestinal Behçet's-like disease. Our case suggests relationships among BD, trisomy 8, and PV.
Collapse
Affiliation(s)
- Yuki Mori
- First Department of Internal Medicine, Faculty of Medicine, University of Yamanashi, Japan
| | - Fumihiko Iwamoto
- First Department of Internal Medicine, Faculty of Medicine, University of Yamanashi, Japan
| | - Toru Kuno
- First Department of Internal Medicine, Faculty of Medicine, University of Yamanashi, Japan
| | - Shoji Kobayashi
- First Department of Internal Medicine, Faculty of Medicine, University of Yamanashi, Japan
| | - Takashi Yoshida
- First Department of Internal Medicine, Faculty of Medicine, University of Yamanashi, Japan
| | - Tatsuya Yamaguchi
- First Department of Internal Medicine, Faculty of Medicine, University of Yamanashi, Japan
| | - Shinichi Takano
- First Department of Internal Medicine, Faculty of Medicine, University of Yamanashi, Japan
| | - Tetsuo Kondo
- Department of Pathology, Faculty of Medicine, University of Yamanashi, Japan
| | - Keita Kirito
- Department of Hematology and Oncology, University of Yamanashi, Japan
| | - Nobuyuki Enomoto
- First Department of Internal Medicine, Faculty of Medicine, University of Yamanashi, Japan
| |
Collapse
|
8
|
Hou CC, Luo D, Bao HF, Ye JF, Ma HF, Shen Y, Zou J, Guan JL. Clinical heterogeneity of ocular Behçet's syndrome versus intestinal Behçet's syndrome: a cross-sectional study from Shanghai Behçet's syndrome database. Arthritis Res Ther 2022; 24:98. [PMID: 35488313 PMCID: PMC9052578 DOI: 10.1186/s13075-022-02782-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 04/19/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Behçet's syndrome (BS) is a rare variant vasculitis which can involve the eyes and gastrointestinal systems. However, ocular involvement rarely overlaps with intestinal lesions. This study aimed to compare the clinical characteristics and laboratory parameters of ocular BS and intestinal BS patients in China and analyze the differences between two key phenotypes to verify the heterogeneous conditions in BS patients. METHODS A retrospective analysis was used to collect the demographic data, clinical characteristics, endoscopic findings, and laboratory parameters from 135 ocular BS and 174 intestinal BS patients. The Mann-Whitney U test and Pearson chi-square or continuity correction was used to analyze the differences between two groups. RESULTS Among 916 BS patients enrolled in this study, ocular BS and intestinal BS accounted for 14.74% (135 cases) and 19.00% (174 cases), respectively. Ocular and intestinal involvements overlapped in only 7 cases (0.76%). Male gender (74.8% vs. 51.1%, P=0.00), erythema nodosum (45.9% vs. 32.2%, P=0.01), and vascular involvement (6.7% vs. 1.7%, P=0.03) were more frequent in the ocular BS group compared with the intestinal BS group. On the contrary, hematologic involvement (7.5% vs. 0.0%, P=0.00) and fever (17.8% vs. 4.4%, P=0.00) were more frequent in the intestinal BS group compared with the ocular BS group. Additionally, the inflammation markers including ESR [26.5 (16.0-41.5) vs. 9.0 (5.0-15.0) mm/H, P=0.00], CRP [14.8 (4.8-33.0) vs. 4.1 (1.6-8.3) mg/L, P=0.00], serum amyloid A [27.4 (10.8-92.3) vs. 11.3 (6.0-24.0) mg/L, P=0.00], and interleukin 6 [8.4 (1.7-18.7) vs. 1.7 (1.5-3.2) pg/mL, P=0.00] were higher in the intestinal BS group than those in the ocular BS group, respectively. CONCLUSIONS Ocular BS was more prevalent in male patients and more likely to manifest with erythema nodosum and vascular involvement, while intestinal BS tends to have fever and hematologic disorders with higher inflammation markers. Ocular BS and intestinal BS are two distinct clinical phenotypes and very rarely overlapped.
Collapse
Affiliation(s)
- Cheng-cheng Hou
- Department of Rheumatology and Immunology, Huadong Hospital affiliated to Fudan University, #221 Yan’an West Road, Shanghai, 200040 People’s Republic of China
| | - Dan Luo
- Department of Rheumatology and Immunology, Huadong Hospital affiliated to Fudan University, #221 Yan’an West Road, Shanghai, 200040 People’s Republic of China
| | - Hua-fang Bao
- Department of Rheumatology and Immunology, Huadong Hospital affiliated to Fudan University, #221 Yan’an West Road, Shanghai, 200040 People’s Republic of China
| | - Jing-fen Ye
- Department of Rheumatology and Immunology, Huadong Hospital affiliated to Fudan University, #221 Yan’an West Road, Shanghai, 200040 People’s Republic of China
| | - Hai-fen Ma
- Department of Rheumatology and Immunology, Huadong Hospital affiliated to Fudan University, #221 Yan’an West Road, Shanghai, 200040 People’s Republic of China
| | - Yan Shen
- Department of Rheumatology and Immunology, Huadong Hospital affiliated to Fudan University, #221 Yan’an West Road, Shanghai, 200040 People’s Republic of China
| | - Jun Zou
- Department of Rheumatology and Immunology, Huadong Hospital affiliated to Fudan University, #221 Yan’an West Road, Shanghai, 200040 People’s Republic of China
| | - Jian-long Guan
- Department of Rheumatology and Immunology, Huadong Hospital affiliated to Fudan University, #221 Yan’an West Road, Shanghai, 200040 People’s Republic of China
| |
Collapse
|
9
|
Yamazaki S, Shimbo A, Kamiya T, Shimizu M, Mori M. Ankylosing spondylitis, Crohn's disease, and myelodysplasia in an adolescent. Pediatr Int 2022; 64:e15215. [PMID: 35791056 DOI: 10.1111/ped.15215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 03/22/2022] [Accepted: 04/14/2022] [Indexed: 01/05/2023]
Affiliation(s)
- Susumu Yamazaki
- Department of Lifetime Clinical Immunology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan.,Department of Pediatrics and Adolescent Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Asami Shimbo
- Department of Child Health and Development, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Takahiro Kamiya
- Department of Child Health and Development, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Masaki Shimizu
- Department of Child Health and Development, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Masaaki Mori
- Department of Lifetime Clinical Immunology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| |
Collapse
|
10
|
Oganesyan A, Hakobyan Y, Terrier B, Georgin-Lavialle S, Mekinian A. Looking beyond VEXAS: Coexistence of undifferentiated systemic autoinflammatory disease and myelodysplastic syndrome. Semin Hematol 2021; 58:247-253. [PMID: 34802547 DOI: 10.1053/j.seminhematol.2021.10.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 09/08/2021] [Accepted: 10/01/2021] [Indexed: 01/24/2023]
Abstract
It has been established that individuals with myelodysplastic syndromes (MDS) have a higher frequency of systemic inflammatory disorders. On the other hand, patients with autoimmune diseases are at increased risk of MDS development. Both diseases can be associated with various genetic lesions and share diverse pathogenetic mechanisms. Recently identified VEXAS (Vacuoles, E1 enzyme, X-linked, Autoinflammatory, Somatic) syndrome, associated with somatic mutations in UBA1, encompasses a range of inflammatory conditions involving multiple organs along with hematological pathologies, including MDS, as well as characteristic bone marrow vacuolization of myeloid and erythroid precursors. This novel syndrome drove further attention to complex associations between MDS and adult-onset inflammatory conditions. The present narrative literature review discusses the clinical presentation, pathophysiology, management of concurrent MDS and systemic inflammatory diseases in parallel to the clinical picture of VEXAS syndrome.
Collapse
Affiliation(s)
- Artem Oganesyan
- Department of Adult Hematology, Yeolyan Hematology Center, Yerevan, Armenia; Department of Hematology and Transfusion Medicine, National Institute of Health, Yerevan, Armenia
| | - Yervand Hakobyan
- Department of Adult Hematology, Yeolyan Hematology Center, Yerevan, Armenia; Department of Hematology and Transfusion Medicine, National Institute of Health, Yerevan, Armenia
| | - Benjamin Terrier
- Department of Internal Medicine, National Referral Center for Rare and Systemic Autoimmune Diseases, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Sophie Georgin-Lavialle
- Internal Medicine Department, National Reference Center for Autoinflammatory Diseases and Amyloidosis (CEREMAIA), Sorbonne Université, INSERM U938, Tenon Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Arsene Mekinian
- Internal Medicine Department and Inflammation-Immunopathology-Biotherapy Department (DHU i2B), Hospital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France; Centre de Recherche Saint-Antoine (CRSA), Sorbonne Universités, UMPC University Paris 06, INSERM U938, Paris, France.
| |
Collapse
|
11
|
Zou J, Luo JF, Shen Y, Cai JF, Guan JL. Cluster analysis of phenotypes of patients with Behçet's syndrome: a large cohort study from a referral center in China. Arthritis Res Ther 2021; 23:45. [PMID: 33514418 PMCID: PMC7847001 DOI: 10.1186/s13075-021-02429-7] [Citation(s) in RCA: 53] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 01/19/2021] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Behcet's syndrome (BS) is a complex, heterogeneous disorder. However, classification of its subgroups is still debated. The purpose of this study was to investigate the clinical features and aggregation of patients with BS in China, based on manifestations and organ involvements. METHODS This was a cross-sectional study of BS patients in Huadong Hospital of Fudan University between September 2012 and January 2020. We calculated relative risks (RRs) of clinical variables according to sex. Moreover, we conducted a hierarchical cluster analysis applied according to eighteen variables to determine subgroups of patients. RESULTS A total of 860 BS patients were included. Male sex was associated with ocular involvement (RR 2.32, 95% CI 1.67, 3.22, P < 0.0001), vascular involvement (RR 2.00, 95% CI 1.23, 3.23, P = 0.004), cardiac lesion (RR 5.46, 95% CI 2.33, 12.77, P < 0.0001), and central nervous system involvement (RR 2.95, 95% CI 1.07, 6.78, P = 0.007) and was negatively associated with genital ulcers (RR 0.84, 95% CI 0.79, 0.91, P < 0.0001). Five clusters (C1-C5) were observed. C1 (n = 307) showed the skin and mucosa type. In C2 (n = 124), all had articular involvement, barely having major organ involvement except for 18 cases with intestinal lesions. In C3 (n = 156), the gastrointestinal type, 144 patients presented with intestinal involvement, and 36 patients with esophageal ulcers. In C4 (n = 142), all subjects presented with uveitis. C5 (n = 131) consisted of 44 patients with cardiac lesions, 58 with vascular involvement, and 26 cases having central nervous system involvement. CONCLUSION Our analysis confirmed sex differences in phenotypes of BS. Cluster analysis identified gastrointestinal, uveitis, and cardiovascular involvement cluster separately in different subsets, which represents the most commonly involved organs. Further research is required to replicate and clarify the patterns of phenotype in BS.
Collapse
Affiliation(s)
- Jun Zou
- Division of Rheumatology and Immunology, Shanghai Key Laboratory of Clinical Geriatric Medicine, Research Center on Aging and Medicine, Huadong Hospital, Fudan University, 200040, Shanghai, People's Republic of China
| | - Jian-Feng Luo
- Department of Biostatistics, School of Public Health, Fudan University, Shanghai, People's Republic of China
| | - Yan Shen
- Division of Rheumatology and Immunology, Shanghai Key Laboratory of Clinical Geriatric Medicine, Research Center on Aging and Medicine, Huadong Hospital, Fudan University, 200040, Shanghai, People's Republic of China
| | - Jian-Fei Cai
- Division of Rheumatology and Immunology, Shanghai Key Laboratory of Clinical Geriatric Medicine, Research Center on Aging and Medicine, Huadong Hospital, Fudan University, 200040, Shanghai, People's Republic of China
| | - Jian-Long Guan
- Division of Rheumatology and Immunology, Shanghai Key Laboratory of Clinical Geriatric Medicine, Research Center on Aging and Medicine, Huadong Hospital, Fudan University, 200040, Shanghai, People's Republic of China.
| |
Collapse
|
12
|
How to treat myelodysplastic syndrome with clinical features resembling Behçet syndrome: a case-based systematic review. Ann Hematol 2020; 99:1193-1203. [DOI: 10.1007/s00277-020-03951-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Accepted: 02/03/2020] [Indexed: 01/30/2023]
|
13
|
Narazaki T, Shiratsuchi M, Tsuda M, Tsukamoto Y, Muta H, Masuda T, Kimura D, Takamatsu A, Nakanishi R, Oki E, Fujiwara M, Oda Y, Nakashima Y, Ogawa Y. Intestinal Behçet's Disease with Primary Myelofibrosis Involving Trisomy 8. Acta Haematol 2019; 142:253-256. [PMID: 31291615 DOI: 10.1159/000501019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 05/15/2019] [Indexed: 12/14/2022]
Abstract
Behçet's disease (BD) is a disorder characterized by systemic inflammation of multiple organs, including the intestines. Several studies have reported a relationship between myelodysplastic syndrome and BD, and trisomy 8 was frequently seen, especially in intestinal BD. However, the association of BD with primary myelofibrosis (PMF) has not been well documented. A 58-year-old Japanese female was diagnosed with PMF in 2014. The symptoms of PMF resolved with ruxolitinib. However, she developed fever and intestinal perforation due to multiple ulcers in the terminal ileum in 2017. Intestinal perforation recurred 1 month later, and the dose of ruxolitinib was tapered. After discontinuation of ruxolitinib, she presented with recurrent oral aphthous ulcers and uveitis. Subsequently, intestinal perforation recurred, and she was diagnosed with intestinal BD. Trisomy 8 was identified in her peripheral blood. She underwent steroid therapy, azathioprine, and infliximab. This case suggests relationships between PMF, trisomy 8, and BD.
Collapse
Affiliation(s)
- Taisuke Narazaki
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Motoaki Shiratsuchi
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan,
| | - Mariko Tsuda
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yasuhiro Tsukamoto
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Hiroki Muta
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Toru Masuda
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Daisaku Kimura
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Akiko Takamatsu
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Ryota Nakanishi
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Eiji Oki
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Minako Fujiwara
- Department of Anatomic Pathology, Pathological Sciences, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yoshinao Oda
- Department of Anatomic Pathology, Pathological Sciences, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yasuhiro Nakashima
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yoshihiro Ogawa
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- Department of Molecular Endocrinology and Metabolism, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| |
Collapse
|
14
|
Abstract
Patients with Behçet's disease (BD) suffer from episodic ocular and mucocutaneous attacks, resulting in a reduced quality of life. The phenotype of Japanese BD has been changing over the past 20 years, and the rate of human leukocyte antigen (HLA)-B*51-positive complete type is decreasing while that of intestinal type is increasing. This phenotypical evolution may be related to changes in as-yet-unknown environmental factors, as the immigration influx in Japan is low. Mechanisms discovered by genome-wide association studies include ERAP1-mediated HLA class I antigen bounding pathway, autoinflammation, Th17 cells, natural killer cells, and polarized macrophages, a similar genetic architecture to Crohn's disease, ankylosing spondylitis, and psoriasis. As for treatments, management guidelines have been implemented, and the development of tumor necrosis factor (TNF) inhibitors is markedly improving the outcome of BD, but evidence supporting treatment for special-type BD is limited. The classification of BD into distinct clusters based on clinical manifestations and genetic factors is crucial to the development of optimized medicine.
Collapse
Affiliation(s)
- Yohei Kirino
- Department of Stem Cell and Immune Regulation, Yokohama City University, Graduate School of Medicine, Japan
| | - Hideaki Nakajima
- Department of Stem Cell and Immune Regulation, Yokohama City University, Graduate School of Medicine, Japan
| |
Collapse
|
15
|
Gastrointestinal Behcet’s-like disease with myelodysplastic neoplasms with trisomy 8: a French case series and literature review. Leuk Lymphoma 2018; 60:1782-1788. [DOI: 10.1080/10428194.2018.1542152] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
|
16
|
Salmaninejad A, Gowhari A, Hosseini S, Aslani S, Yousefi M, Bahrami T, Ebrahimi M, Nesaei A, Zal M. Genetics and immunodysfunction underlying Behçet's disease and immunomodulant treatment approaches. J Immunotoxicol 2018; 14:137-151. [PMID: 28693405 DOI: 10.1080/1547691x.2017.1346008] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Behçet's disease (BD) is a chronic autoimmune condition primarily prevalent in populations along the Mediterranean Sea. The exact etiology of BD has not been fully explained yet, but the disease occurrence is associated with a genetic factor, human leukocyte antigen (HLA)-B51 antigen. Among the various immunodysfunctions that are found in BD, patients are increased neutrophil motility and superoxide production, as well as elevated production of tumor necrosis factor (TNF)-α and decreased production of interleukin (IL)-10. Elevated levels of inflammatory cytokines like IL-1 and IL-17 in BD have been found associated with aberrant expression of microRNA. Gene polymorphisms in BD patients have been observed in molecules involved in responses to pathogens that can ultimately modulate the host antimicrobial response. Moreover, several single nucleotide polymorphisms (SNPs) have been reported in genes encoding chemokines and adhesion molecules; many of these changes manifest as increases in vascular inflammation and vascular damage. Lastly, genetic and epigenetic changes have been suggested as involved in the pathogenesis of BD. Modifications in DNA methylation have been found in BD patient monocytes and lymphocytes, leading to adverse function of these cells. This review presents a comprehensive compilation of the literature with regard to the immunodysfunction underlying BD, as well as of the genetics, newly described clinical specifications and novel treatment strategies using immunomodulants based on the current understanding of BD.
Collapse
Affiliation(s)
- Arash Salmaninejad
- a Drug Applied Research Center , Tabriz University of Medical Sciences , Tabriz , Iran.,b Medical Genetics Research Center, Student Research Committee, Department of Medical Genetics, Faculty of Medicine , Mashhad University of Medical Sciences , Mashhad , Iran.,c Rheumatology Research Center , Tehran University of Medical Sciences , Tehran , Iran
| | - Arezoo Gowhari
- d Department of Immunology, Faculty of Medicine , Mashhad University of Medical Sciences , Mashhad , Iran
| | - Seyedmojtaba Hosseini
- b Medical Genetics Research Center, Student Research Committee, Department of Medical Genetics, Faculty of Medicine , Mashhad University of Medical Sciences , Mashhad , Iran
| | - Saeed Aslani
- c Rheumatology Research Center , Tehran University of Medical Sciences , Tehran , Iran
| | - Meysam Yousefi
- b Medical Genetics Research Center, Student Research Committee, Department of Medical Genetics, Faculty of Medicine , Mashhad University of Medical Sciences , Mashhad , Iran
| | - Tayyeb Bahrami
- e Genetics Research Center , University of Social Welfare and Rehabilitation Sciences , Tehran , Iran
| | - Masoume Ebrahimi
- f Department of Biology, Faculty of Sciences , University of Guilan , Rasht , Iran
| | - Abolfazl Nesaei
- g Department of Basic Sciences , Gonabad University of Medical Sciences , Gonabad , Iran
| | - Masoud Zal
- h Department of Medical Genetics , Shahid Beheshti University of Medical Sciences , Tehran , Iran
| |
Collapse
|
17
|
High Incidence of Gastrointestinal Ulceration and Cytogenetic Aberration of Trisomy 8 as Typical Features of Behçet's Disease Associated with Myelodysplastic Syndrome: A Series of 16 Consecutive Chinese Patients from the Shanghai Behçet's Disease Database and Comparison with the Literature. BIOMED RESEARCH INTERNATIONAL 2018; 2018:8535091. [PMID: 29854799 PMCID: PMC5941803 DOI: 10.1155/2018/8535091] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Revised: 02/24/2018] [Accepted: 03/04/2018] [Indexed: 12/16/2022]
Abstract
This study aimed to investigate the characteristics of Chinese patients with Behçet disease (BD) and myelodysplastic syndrome (MDS) and explore the role played by trisomy 8. This was a retrospective study of patients with BD and MDS from the Shanghai Behçet's disease database who were diagnosed between October 2012 and July 2017. There were 805 patients with BD and 16 also had MDS. Trisomy 8 was examined in patients with BD-MDS and some patients with gastrointestinal (GI) BD. Patients with BD and MDS (16/805; 2%) were more likely to be female and older; display fever and intestinal lesions; have lower leukocyte count, hemoglobin, platelet count; and show higher C-reactive protein and erythrocyte sedimentation rate (ESR) than patients with BD without MDS (all P < 0.05). Trisomy 8 was common (81.3%) in patients with BD-MDS. Ulcers in the ileocecal region were more frequently seen in intestinal patients with BD-MDS than in BD without MDS (90.0% versus 48.9%; P = 0.032). GI ulceration is common in patients with BD-MDS. Cytogenetic aberrations, especially trisomy 8, may play a role in the pathogenesis of intestinal involvement in patients with BD-MDS.
Collapse
|
18
|
Kono M, Komeda Y, Sakurai T, Okamoto A, Minaga K, Kamata K, Hagiwara S, Inoue H, Enoki E, Matsumura I, Watanabe T, Kudo M. Induction of Complete Remission by Azacitidine in a Patient with Myelodysplastic Syndrome-Associated Inflammatory Bowel Disease. J Crohns Colitis 2018; 12:499-502. [PMID: 29253109 DOI: 10.1093/ecco-jcc/jjx170] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Accepted: 12/13/2017] [Indexed: 01/09/2023]
Abstract
Myelodysplastic syndrome [MDS] is a clonal disorder of bone marrow [BM] cells, caused by acquired chromosomal abnormalities and gene mutations. Pro-inflammatory antigen-presenting cells [APCs] originating from BM cells bearing chromosomal abnormalities and gene mutations can cause immune-mediated disorders including inflammatory bowel disease [IBD]. Here, we report the first case with MDS-associated IBD that was successfully treated with the DNA methyltransferase inhibitor, azacitidine [AZA]. A 75-year-old man with a 5-year history of MDS was admitted for examination of diarrhoea and high fever. Blood examination revealed pancytopenia and a marked elevation of C-reactive protein. Colonoscopy revealed multiple round ulcers from the terminal ileum to the sigmoid colon. Pathological examination of the endoscopic biopsy specimens showed destruction of crypt architecture and infiltration of CD3+ T cells and CD68+ macrophages. Surprisingly, administration of AZA, which has been approved for the treatment of high-risk MDS, improved the symptoms, and the multiple round ulcers disappeared. AZA treatment markedly decreased the expressions of tumour necrosis factor-α, interleukin-12 (IL-12)/23p40 and IL-17 in colonic biopsy samples, as assessed by quantitative reverse transcription polymerase chain reaction. In contrast, AZA treatment did not change the expression of forkhead box P3, a master regulator of regulatory T cells. These data suggest that AZA treatment led to complete remission in MDS-associated IBD through suppression of pro-inflammatory cytokine responses.
Collapse
Affiliation(s)
- Masashi Kono
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Yoriaki Komeda
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Toshiharu Sakurai
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Ayana Okamoto
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Kosuke Minaga
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Ken Kamata
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Satoru Hagiwara
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Hiroaki Inoue
- Department of Hematology and Rheumatology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Eisuke Enoki
- Department of Pathology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Itaru Matsumura
- Department of Hematology and Rheumatology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Tomohiro Watanabe
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Masatoshi Kudo
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka, Japan
| |
Collapse
|
19
|
Wang S, Broder N, Marchetta P, Nowatzky J. Myelodysplastic syndrome presenting as a Behçet's-like disease with aortitis. BMJ Case Rep 2018; 2018:bcr-2017-220649. [PMID: 29545422 DOI: 10.1136/bcr-2017-220649] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
A 46-year-old Hispanic man presented with fever, genital ulcers, left eye redness and chest pain. Physical examination was notable for a healed oral ulcer and scrotal ulcers, and bilateral superficial thrombophlebitis. He was found to have new-onset pancytopenia. CT of the chest showed pericardial and pleural effusions and rapidly progressing inflammation of the aortic arch and ascending vessels. Although the patient had Behcet's disease (BD)-like symptoms, pancytopenia could not be explained by the diagnosis, prompting a bone marrow biopsy which showed myelodysplastic syndrome. This report highlights the importance of excluding alternate disorders before making a diagnosis of Behcet's disease if atypical, BD-incompatible or incomplete constellations of symptoms and findings are present.
Collapse
Affiliation(s)
- Shudan Wang
- Division of Rheumatology, Department of Medicine, NYU School of Medicine, New York, USA
| | - Noam Broder
- Department of Medicine, NYU School of Medicine, New York, USA
| | - Paula Marchetta
- Division of Rheumatology, Department of Medicine, NYU School of Medicine, New York, USA
| | - Johannes Nowatzky
- Division of Rheumatology, Department of Medicine, NYU School of Medicine, New York, USA
| |
Collapse
|
20
|
Mekinian A, Dervin G, Lapidus N, Kahn JE, Terriou L, Liozon E, Grignano E, Piette JC, Rauzy OB, Grobost V, Godmer P, Gillard J, Rossignol J, Launay D, Aouba A, Cardon T, Bouillet L, Broner J, Vinit J, Ades L, Carrat F, Salvado C, Toussirot E, Versini M, Costedoat-Chalumeau N, Fraison JB, Guilpain P, Fenaux P, Fain O. Biologics in myelodysplastic syndrome-related systemic inflammatory and autoimmune diseases: French multicenter retrospective study of 29 patients. Autoimmun Rev 2017; 16:903-910. [DOI: 10.1016/j.autrev.2017.07.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 05/17/2017] [Indexed: 12/23/2022]
|
21
|
Bae HW, Kim HD, Choi SW, Han N, Eom MJ. Acute Cerebral Infarction as a Rare Thrombotic Event in Myelodysplastic Syndrome: A Case Report. Ann Rehabil Med 2016; 40:1144-1148. [PMID: 28119848 PMCID: PMC5256339 DOI: 10.5535/arm.2016.40.6.1144] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Accepted: 05/11/2016] [Indexed: 01/26/2023] Open
Abstract
Myelodysplastic syndrome (MDS) is a bone marrow failure syndrome characterized by cytopenia that results in high risks of infection and bleeding. However, there are few reports of cerebral infarction in MDS. We reported a 72-year-old female with MDS who developed acute cerebral infarction. Clinical history of the patient revealed no definite risk factors for stroke except diabetes mellitus and dyslipidemia that was well controlled. This case represented the rare occurrence of arterial thrombosis causing acute cerebral infarction in MDS, which may be due to complex chromosomal abnormality and inflammatory processes.
Collapse
Affiliation(s)
- Hyun Woo Bae
- Department of Physical Medicine and Rehabilitation, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Hyun Dong Kim
- Department of Physical Medicine and Rehabilitation, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Sung Won Choi
- Department of Physical Medicine and Rehabilitation, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Nami Han
- Department of Physical Medicine and Rehabilitation, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Mi Ja Eom
- Department of Physical Medicine and Rehabilitation, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| |
Collapse
|
22
|
Multiple colonic ulcers associated with trisomy 8: serial changes in colonoscopic findings. Clin J Gastroenterol 2016; 9:298-301. [PMID: 27412026 DOI: 10.1007/s12328-016-0671-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 07/03/2016] [Indexed: 12/20/2022]
Abstract
We report a 54-year-old female patient with myelodysplastic syndrome (MDS) associated with trisomy 8, who had multiple colonic ulcers. The patient had been diagnosed as having MDS of refractory cytopenia with trisomy 8 10 years previously. She underwent colonoscopy for abdominal pain, which revealed severe circumferential stenosis with multiple ulcers in the ileocecal region and a discrete excavating ulcer in the transverse colon. The patient had been free from any dermatological, oral, genital or ocular symptoms suggestive of Behçet's disease (BD). A diagnosis of multiple colonic ulcers associated with MDS with trisomy 8 was thus suggested. Follow-up colonoscopies 5 and 6 years later revealed progression of the ileocecal stenosis to a circumferential ulcer, while the ulcer in the transverse colon had not changed. Because our patient lacked extraintestinal symptoms of BD, trisomy 8 was presumed to be responsible for her colonic ulcers.
Collapse
|
23
|
Petrova-Drus K, Hasserjian R, Pozdnyakova O, Dal Cin P, Mathew S, Margolskee E, Orazi A, Geyer JT. Clinicopathologic evaluation of cytopenic patients with isolated trisomy 8: a detailed comparison between idiopathic cytopenia of unknown significance and low-grade myelodysplastic syndrome. Leuk Lymphoma 2016; 58:569-577. [PMID: 27389864 DOI: 10.1080/10428194.2016.1203432] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The significance of an isolated trisomy 8 (+8) in the diagnosis of myelodysplastic syndrome (MDS) is not well established. It is common in MDS, but is not considered as an MDS-defining abnormality in the absence of morphologic dysplasia. We evaluated two groups of patients with isolated +8 and either low-grade MDS (LG-MDS) or idiopathic cytopenia of undetermined significance (ICUS). At presentation, ICUS patients had a lower platelet count (85.0 vs 163.5 × 109 cells/L; p = 0.02), while MDS patients had more frequent incidence of isolated anemia (64% vs 0%, p = 0.007). A subset (36%) of ICUS patients progressed to MDS or AML. These patients presented with more severe neutropenia (0.9 vs 3.1 × 103/μL, p = 0.01) and a trend toward a higher proportion (>50%) of +8 metaphases compared to those that did not progress (p = 0.05). Thus, ICUS patients with isolated +8 may progress to MDS and AML and deserve close clinical follow-up.
Collapse
Affiliation(s)
- Kseniya Petrova-Drus
- a Department of Pathology and Laboratory Medicine , New York Presbyterian Hospital - Weill Cornell Medicine , New York , NY , USA
| | - Robert Hasserjian
- b Department of Pathology , Massachusetts General Hospital , Boston , MA , USA
| | - Olga Pozdnyakova
- c Department of Pathology , Brigham and Women's Hospital , Boston , MA , USA
| | - Paola Dal Cin
- d Center of Advanced Molecular Diagnostics , Brigham & Women's Hospital , Boston , MA , USA
| | - Susan Mathew
- a Department of Pathology and Laboratory Medicine , New York Presbyterian Hospital - Weill Cornell Medicine , New York , NY , USA
| | - Elizabeth Margolskee
- a Department of Pathology and Laboratory Medicine , New York Presbyterian Hospital - Weill Cornell Medicine , New York , NY , USA
| | - Attilio Orazi
- a Department of Pathology and Laboratory Medicine , New York Presbyterian Hospital - Weill Cornell Medicine , New York , NY , USA
| | - Julia T Geyer
- a Department of Pathology and Laboratory Medicine , New York Presbyterian Hospital - Weill Cornell Medicine , New York , NY , USA
| |
Collapse
|
24
|
Wolach O, Stone R. Autoimmunity and Inflammation in Myelodysplastic Syndromes. Acta Haematol 2016; 136:108-17. [PMID: 27337745 DOI: 10.1159/000446062] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 04/06/2016] [Indexed: 01/28/2023]
Abstract
Autoimmune and inflammatory conditions (AICs) are encountered in up to 25% of patients with myelodysplastic syndromes (MDS). A wide range of AICs have been reported in association with MDS and can range from limited clinical manifestations to systemic diseases affecting multiple organs. Vasculitides, connective tissue diseases, and inflammatory arthritis are frequently reported in different studies; noninfectious fever and constitutional symptoms at presentation are common. Associations between AICs and specific MDS characteristics vary by study, but the available data suggest that AICs cluster more often in younger patients with higher-risk MDS. In general, AICs do not seem to confer worse survival, although certain AICs may be associated with adverse outcome (e.g. vasculitis) or progression of MDS (Sweet's syndrome). Nonetheless, these complications may have a significant impact on quality of life and affect the timing and type of MDS-directed therapy. The mainstay of management of these complications in the short term relies on immunosuppressive drugs. Increasing evidence suggests that hypomethylating agents may be effective in treating these complications and reduce steroid dependence. While the pathogenesis of AICs is incompletely understood, growing appreciation of cellular immune deregulation, cytokine hypersecretion, and the genetic heterogeneity underlying MDS may improve our understanding of common pathways linking MDS, inflammation, and autoimmunity.
Collapse
Affiliation(s)
- Ofir Wolach
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Mass., USA
| | | |
Collapse
|
25
|
Lee SJ, Park JK, Lee EY, Joo SH, Jung KC, Lee EB, Song YW, Yoon SS. Certain Autoimmune Manifestations Are Associated With Distinctive Karyotypes and Outcomes in Patients With Myelodysplastic Syndrome: A Retrospective Cohort Study. Medicine (Baltimore) 2016; 95:e3091. [PMID: 27043672 PMCID: PMC4998533 DOI: 10.1097/md.0000000000003091] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Autoimmune manifestations (AIMs) are common in patients with myelodysplastic syndrome (MDS). This study aimed to investigate whether AIMs are associated with a specific cytogenetic abnormalities and worse survival in patients with MDS. A total of 67 MDS patients with AIMs and 134 age- and sex-matched MDS patients without AIMs, all of whom received medical care at Seoul National University Hospital from January 2000 through July 2014, were enrolled. The clinical features, chromosomal abnormalities, and outcomes were examined. The effect of AIMs on mortality was estimated after adjusting for age, sex, and the International Prognostic Scoring System. The mean age (±SD) at the time of MDS diagnosis was 54.5 ± 17.1 years, and 44.8% of patients were male. Neutrophilic dermatosis (ND; Sweet syndrome and pyoderma gangrenosum) was the most prevalent AIM (n = 24 36%]), followed by Behcet disease (10 [15%]), rheumatoid arthritis (9 [13%]), vasculitis (8 [12%]), myositis (3 [4%]), spondyloarthropathy (3 [4%]), and systemic lupus erythematous (2 [3%]). ND and vasculitis occurred at the time of MDS diagnosis, whereas other AIMs occurred years after MDS diagnosis. Deletion of 5q was associated with ND (P = 0.001), whereas trisomy 8 was associated with Behcet disease (P = 0.015). Strikingly, ND was associated with a 1.8-fold increase in mortality (95% CI 1.033-3.093; P = 0.038). Certain AIMs in MDS patients are associated with distinctive karyotypes and worse survival. A larger study is needed to confirm whether the presence of AIMs influences disease outcome in MDS.
Collapse
Affiliation(s)
- Sang Jin Lee
- From the Division of Rheumatology (SJL, JKP, EYL, EBL, YWS), Seoul National University Hospital; Department of Molecular Medicine and Biopharmaceutical Sciences (SJL, JKP, YWS), Graduate School of Convergence Science and Technology, and College of Medicine, Medical Research Institute, Seoul National University, Seoul; Division of Rheumatology (SHJ), Chung Buk University Hospital, Cheongju, Department of Pathology (KCJ); and Division of Hematology and Oncology (S-SY), Seoul National University Hospital, Seoul, Korea
| | | | | | | | | | | | | | | |
Collapse
|
26
|
18F-FDG PET/CT Findings in Two Cases With Myelodysplastic Syndrome Accompanied by Behçet's Disease. Clin Nucl Med 2016; 41:e392-3. [PMID: 26909715 DOI: 10.1097/rlu.0000000000001198] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Recently, the co-occurrence of myelodysplastic syndrome (MDS) and Behçet's disease (BD) has been reported in association with trisomy 8 and HLA 51, with the pathology varying from vasculitis to acute neutrophilic inflammation. We report for the first time about imaging findings of F-fluorodeoxyglucose (FDG) positron emission/computed tomography (PET/CT) in 2 cases having MDS accompanied by BD. In these cases, 18 F-FDG PET/CT images clearly revealed high uptake by bone marrow in MDS and by genital aphthous or ileocecal ulcers in BD. F-FDG PET/CT may be the ideal modality for the detection of comorbidity of MDS and BD.
Collapse
|
27
|
Oshima T, Ikutomi M, Shinohara H, Ishiwata J, Fukino K, Amaki T, Nakamura F. Acute Myocardial Infarction Caused by Thrombotic Microangiopathy Complicated With Myelodysplastic Syndrome. Int Heart J 2016; 57:634-6. [DOI: 10.1536/ihj.16-100] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Tsukasa Oshima
- Third Department of Internal Medicine, Teikyo University Chiba Medical Center
| | - Masayasu Ikutomi
- Third Department of Internal Medicine, Teikyo University Chiba Medical Center
| | - Hiroki Shinohara
- Third Department of Internal Medicine, Teikyo University Chiba Medical Center
| | - Jumpei Ishiwata
- Third Department of Internal Medicine, Teikyo University Chiba Medical Center
| | - Keiko Fukino
- Third Department of Internal Medicine, Teikyo University Chiba Medical Center
| | - Toshihiro Amaki
- Third Department of Internal Medicine, Teikyo University Chiba Medical Center
| | - Fumitaka Nakamura
- Third Department of Internal Medicine, Teikyo University Chiba Medical Center
| |
Collapse
|
28
|
Endo M, Sekikawa A, Tsumura T, Maruo T, Osaki Y. A Case of Myelodysplastic Syndrome with Intestinal Behçet's Disease-Like Symptoms Treated by Prednisolone and Azacitidine. AMERICAN JOURNAL OF CASE REPORTS 2015; 16:827-31. [PMID: 26590106 PMCID: PMC4662094 DOI: 10.12659/ajcr.895431] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Patient: Female, 68 Final Diagnosis: Myelodysplastic Syndrome with Intestinal Behçet’s Disease-Like Symptoms Symptoms: Abdominal pain • fever • oral ulcer Medication: — Clinical Procedure: CT • bone marrow examination • colonoscopy Specialty: Hematology
Collapse
Affiliation(s)
- Masatsugu Endo
- Department of Gastroenterology and Hepatology, Osaka Red Cross Hospital, Osaka, Japan
| | - Akira Sekikawa
- Department of Gastroenterology and Hepatology, Osaka Red Cross Hospital, Osaka, Japan
| | - Takehiko Tsumura
- Department of Gastroenterology and Hepatology, Osaka Red Cross Hospital, Osaka, Japan
| | - Takanori Maruo
- Department of Gastroenterology and Hepatology, Osaka Red Cross Hospital, Osaka, Japan
| | - Yukio Osaki
- Department of Gastroenterology and Hepatology, Osaka Red Cross Hospital, Osaka, Japan
| |
Collapse
|
29
|
Kimura M, Tsuji Y, Iwai M, Inagaki M, Madian A, Yoshino T, Matsuura M, Nakase H. Usefulness of Adalimumab for Treating a Case of Intestinal Behçet's Disease With Trisomy 8 Myelodysplastic Syndrome. Intest Res 2015; 13:166-9. [PMID: 25932002 PMCID: PMC4414759 DOI: 10.5217/ir.2015.13.2.166] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Revised: 02/13/2015] [Accepted: 02/27/2015] [Indexed: 01/13/2023] Open
Abstract
Behçet's disease (BD) is a systemic vasculitis, while myelodysplastic syndrome (MDS) is a heterogeneous group of clonal hematologic disorders characterized by ineffective hematopoiesis. Some studies suggest a relationship between MDS and BD, especially intestinal BD, and trisomy 8 seems to play an important role in both diseases. There are several reports on patients with BD comorbid with MDS involving trisomy 8 that frequently have intestinal lesions refractory to conventional medical therapies. Tumor necrosis factor (TNF)-α is strongly involved in the pathophysiology of several autoimmune diseases such as rheumatoid arthritis, inflammatory bowel disease, and BD. In addition, TNF-α plays an important role in the pathophysiology of MDS by inhibiting normal hematopoiesis and inducing the programmed cell death of normal total bone marrow cells and normal CD34+ cells. Recent clinical reports demonstrate the favorable effect of TNF-α antagonists in patients with refractory intestinal BD and in those with MDS. We present the case of a patient with intestinal BD and MDS involving trisomy 8 who was successfully treated with adalimumab.
Collapse
Affiliation(s)
- Masamichi Kimura
- Department of Gastroenterology and Hepatology, Kyoto University Hospital, Kyoto, Japan
| | - Yoshihisa Tsuji
- Department of Gastroenterology and Hepatology, Kyoto University Hospital, Kyoto, Japan
| | - Masako Iwai
- Department of Gastroenterology and Hepatology, Kyoto University Hospital, Kyoto, Japan
| | - Masahiro Inagaki
- Department of Gastroenterology and Hepatology, Kyoto University Hospital, Kyoto, Japan
| | - Ali Madian
- Department of Internal Medicine, Al Azhar University, Assint, Egypt
| | - Takuya Yoshino
- Department of Gastroenterology and Hepatology, Kyoto University Hospital, Kyoto, Japan
| | - Minoru Matsuura
- Department of Gastroenterology and Hepatology, Kyoto University Hospital, Kyoto, Japan
| | - Hiroshi Nakase
- Department of Gastroenterology and Hepatology, Kyoto University Hospital, Kyoto, Japan
| |
Collapse
|
30
|
Behçet’s disease and comorbidity: internal case reports and literature review. Rheumatol Int 2015; 35:1743-7. [PMID: 25677835 DOI: 10.1007/s00296-015-3232-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Accepted: 02/03/2015] [Indexed: 11/25/2022]
|
31
|
Kim MJ, Song HJ, Kim WK, Kim SH. Superior mesenteric vein thrombosis as an early presentation of myelodysplastic syndrome: a case report. Intest Res 2014; 12:157-61. [PMID: 25349584 PMCID: PMC4204708 DOI: 10.5217/ir.2014.12.2.157] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2013] [Revised: 11/02/2013] [Accepted: 11/04/2013] [Indexed: 01/14/2023] Open
Abstract
Mesenteric venous thrombosis (MVT) is a serious condition due to its potential association with mesenteric ischemia and infarction of the small bowel. Symptoms of MVT are often vague, making accurate diagnosis and sufficient treatment difficult. However, increased awareness and new imaging modalities for this condition have improved outcomes for patients with MVT. Treatment includes anticoagulation, transcatheter therapy, and surgery. In the present report, we describe the case study of a 62-year-old woman with a presenting diagnosis of superior MVT, who was finally diagnosed with myelodysplastic syndrome. The superior MVT spontaneously dissolved after the patient underwent 6 months of systemic anticoagulation therapy. Invasive surgery or bowel resection was not required.
Collapse
Affiliation(s)
- Min Jung Kim
- Department of Surgery, Jeju National University School of Medicine, Jeju, Korea
| | - Hyun Joo Song
- Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea
| | - Woo Kun Kim
- Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea
| | - Sun Hyung Kim
- Department of Laboratory Medicine, Jeju National University School of Medicine, Jeju, Korea
| |
Collapse
|
32
|
Giannouli S, Voulgarelis M. A comprehensive review of myelodysplastic syndrome patients with autoimmune diseases. Expert Rev Clin Immunol 2014; 10:1679-88. [DOI: 10.1586/1744666x.2014.970181] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
|
33
|
Hisamatsu T, Naganuma M, Matsuoka K, Kanai T. Diagnosis and management of intestinal Behçet's disease. Clin J Gastroenterol 2014; 7:205-12. [PMID: 24883128 PMCID: PMC4037558 DOI: 10.1007/s12328-014-0488-0] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2014] [Accepted: 04/01/2014] [Indexed: 12/12/2022]
Abstract
Behçet’s disease (BD) is a chronic relapsing disease with multiple organ system involvement characterized clinically by oral and genital aphthae, cutaneous lesions, and ophthalmological, neurological, and/or gastrointestinal manifestations. Little clinical evidence is available regarding the management of patients with intestinal BD, despite recognition that the presence of intestinal lesions is a poor prognostic factor, causing perforation and massive bleeding. Many recent case reports have suggested that anti-tumor necrosis factor alpha (TNF)α monoclonal antibodies (mAbs) are effective in patients with intestinal BD. Adalimumab, a fully human anti-TNFα mAb, has been approved in Japan for the treatment of intestinal BD. Here, we review the pathogenesis, diagnosis and management of intestinal BD, including evidence of the efficacy of anti-TNFα mAbs.
Collapse
Affiliation(s)
- Tadakazu Hisamatsu
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582 Japan
| | - Makoto Naganuma
- Center for Diagnostic and Therapeutic Endoscopy, School of Medicine, Keio University, Tokyo, Japan
| | - Katsuyoshi Matsuoka
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582 Japan
| | - Takanori Kanai
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582 Japan
| |
Collapse
|
34
|
Hasegawa H, Iwamasa K, Hatta N, Fujita S. Behçet's disease associated with myelodysplastic syndrome with elevated levels of inflammatory cytokines. Mod Rheumatol 2014; 13:350-5. [PMID: 24387258 DOI: 10.3109/s10165-003-0245-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract We report the case of a 56-year-old Japanese woman with Behçet's disease and myelodysplastic syndrome (MDS), who had a history of episodic high-grade fever, recurrent oral and genital ulcers, and erythema nodosum, during a 13-year period from 1989 to 2002. Bone marrow aspirates obtained in January 1995 showed refractory anemia with trisomy 8, a subtype of MDS. Her serum levels of soluble interleukin-2 receptor (IL-2R), interferon-γ, IL-1β, IL-6, IL-8, and granulocyte-macrophage colony stimulating factor in the active state were higher than those in the inactive state, whereas those of tumor necrosis factor-α and IL-10 did not increase even in the active state. In this case, it was speculated that a T-cell immune response might have been involved in the disease pathogenesis, and that the repeated febrile episodes might have been a manifestation of neutrophil hyperfunction induced by increased serum levels of inflammatory cytokines.
Collapse
Affiliation(s)
- Hitoshi Hasegawa
- First Department of Internal Medicine, Ehime University School of Medicine , Ehime 791-0295 , Japan
| | | | | | | |
Collapse
|
35
|
Adachi Y, Tsutsumi A, Murata H, Takemura H, Chino Y, Takahashi R, Ebitsuka T, Sumida T. Behçet's disease accompanied by myelodysplastic syndrome with trisomy 8: two case reports and a review of 15 Japanese cases. Mod Rheumatol 2014; 13:90-4. [PMID: 24387124 DOI: 10.3109/s101650300015] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract We describe two cases of Behçet's disease associated with myelodysplastic syndrome (MDS) with trisomy 8. Both cases developed ulceration in the cecum as a gastrointestinal complication of Behçet's disease, after a diagnosis of MDS. We summarized recent case reports of Behçet's disease associated with myelodysplastic syndrome, and studied the clinical manifestations. Most cases showed trisomy 8 as a chromosomal abnormality. Gastrointestinal involvement without eye lesions seems to be characteristic of Behçet's disease associated with MDS.
Collapse
Affiliation(s)
- Y Adachi
- Division of Rheumatology, Department of Internal Medicine, Institute of Clinical Medicine, University of Tsukuba , 1-1-1 Tennodai, Tsukuba 305-8575 , Japan
| | | | | | | | | | | | | | | |
Collapse
|
36
|
Hojo N, Hasegawa H, Iwamasa K, Hojo S, Fujita S. A case of Weber–Christian disease associated with myelodysplastic syndrome. Mod Rheumatol 2014. [DOI: 10.3109/s10165-003-0270-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
37
|
Fujimura T, Yukawa N, Nakashima R, Imura Y, Kawabata D, Nojima T, Ohmura K, Fujii T, Usui T, Mimori T. Periodic fever and erythema nodosum associated with MDS with trisomy 8: report of two cases and review of the literature. Mod Rheumatol 2014. [DOI: 10.3109/s10165-010-0291-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
|
38
|
Kang MH, Sim KS, Choi YH, Lee SK, Park EY. Anesthetic experience for laparoscopic cholecystectomy in a patient with myelodysplastic syndrome with trisomy 8 mosaicism syndrome. Korean J Anesthesiol 2014; 67:S3-4. [PMID: 25598895 PMCID: PMC4295969 DOI: 10.4097/kjae.2014.67.s.s3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Mae Hwa Kang
- Department of Anesthesiology and Pain Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Kyeung Sin Sim
- Department of Anesthesiology and Pain Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Yi Hwa Choi
- Department of Anesthesiology and Pain Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Soo Kyung Lee
- Department of Anesthesiology and Pain Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Eun Young Park
- Department of Anesthesiology and Pain Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea
| |
Collapse
|
39
|
Braun T, Fenaux P. Myelodysplastic Syndromes (MDS) and autoimmune disorders (AD): Cause or consequence? Best Pract Res Clin Haematol 2013; 26:327-36. [DOI: 10.1016/j.beha.2013.09.003] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
|
40
|
Arai Y, Yamashita K, Mizugishi K, Takaori-Kondo A, Chiba T, Watanabe T. The implications of myelodysplastic syndrome - associated chromosomal abnormalities in the development of graft-versus-host disease. Eur J Haematol 2013; 90:525-30. [DOI: 10.1111/ejh.12100] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/27/2013] [Indexed: 12/19/2022]
Affiliation(s)
- Yasuyuki Arai
- Department of Hematology and Oncology, Graduate School of Medicine; Kyoto University; Kyoto; Japan
| | - Kouhei Yamashita
- Department of Hematology and Oncology, Graduate School of Medicine; Kyoto University; Kyoto; Japan
| | - Kiyomi Mizugishi
- Department of Hematology and Oncology, Graduate School of Medicine; Kyoto University; Kyoto; Japan
| | - Akifumi Takaori-Kondo
- Department of Hematology and Oncology, Graduate School of Medicine; Kyoto University; Kyoto; Japan
| | - Tsutomu Chiba
- Department of Gastroenterology and Hepatology, Graduate School of Medicine; Kyoto University; Kyoto; Japan
| | | |
Collapse
|
41
|
Cornfield D, Shah U, Cross N, Bennett C, Sun G. Philadelphia Chromosome-Negative Myeloproliferative Neoplasm With a Novel Platelet-Derived Growth Factor Receptor-β Rearrangement Responsive to Imatinib. J Clin Oncol 2012; 30:e109-11. [DOI: 10.1200/jco.2011.39.0377] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
42
|
Chen HC, Chiu YM. Large-vessel thrombosis in intestinal Behçet’s disease complicated with myelodysplastic syndrome and trisomy 8. World J Gastroenterol 2012; 18:1137-40. [PMID: 22416191 PMCID: PMC3296990 DOI: 10.3748/wjg.v18.i10.1137] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2011] [Revised: 06/24/2011] [Accepted: 01/18/2012] [Indexed: 02/06/2023] Open
Abstract
Behçet’s disease is characterized by recurrent oral ulcers, genital ulcers, uveitis and skin lesions. Myelodysplastic syndrome (MDS) is characterized by problems due to ineffective hematopoiesis. Several studies have identified a relationship between MDS and Behçet’s disease, especially intestinal Behçet’s disease. Trisomy 8 seems to play an important role in these disorders as well. The present case was a 24-year-old woman who had a huge tonsil ulcer with initial symptoms of odynophagia and intermittent fever. We also noted folliculitis on her upper back. Five days later, she began to experience diarrhea and abdominal pain. Abdominal computed tomography and subsequent surgery revealed ileum perforation and enterocolitis with multiple ulcers. Later, she was admitted again for a vulvar suppurative ulcer and suspicious Bartholin’s cyst infection. The patient’s clinical presentations met the criteria for Behçet’s disease. Six months after the bowel perforation event, we noted the development of pancytopenia in a routine laboratory examination. All the examinations led to the diagnosis of MDS with trisomy 8. The most unusual finding was that multiple large vessel thrombi developed during follow-up. Previous studies have suggested that trisomy 8 in MDS leads to concurrent intestinal Behçet’s disease. Moreover, the inflammatory and immune genes related to thrombus formation are overexpressed in cases of MDS with trisomy 8. Trisomy 8 must play a role in thrombosis. Further studies are needed to help clarify the pathophysiology and pathogenesis of these disorders.
Collapse
|
43
|
Nishida A, Miyamoto A, Yamamaoto H, Uchida N, Izutsu K, Wake A, Ohta Y, Fujii T, Araoka H, Taniguchi S, Kishi K. Possible association of trisomy 8 with secondary pulmonary alveolar proteinosis in myelodysplastic syndrome. Am J Respir Crit Care Med 2011; 184:279-80. [PMID: 21765036 DOI: 10.1164/ajrccm.184.2.279a] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
|
44
|
Fain O, Braun T, Stirnemann J, Fenaux P. Manifestations systémiques et auto-immunes des syndromes myélodysplasiques. Rev Med Interne 2011; 32:552-9. [DOI: 10.1016/j.revmed.2010.08.005] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2010] [Revised: 07/26/2010] [Accepted: 08/11/2010] [Indexed: 12/18/2022]
|
45
|
Shigemura T, Agematsu K, Yamazaki T, Sakashita K, Nakayama Y, Higuchi Y, Matsuda K, Koike K. A case of Behcet's disease associated with myelodysplastic syndrome involving trisomy 8 and a gain-of-function mutation in SHP-2. Rheumatology (Oxford) 2011; 50:1342-4. [DOI: 10.1093/rheumatology/ker137] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
|
46
|
Periodic fever and erythema nodosum associated with MDS with trisomy 8: report of two cases and review of the literature. Mod Rheumatol 2010; 20:413-9. [PMID: 20376686 DOI: 10.1007/s10165-010-0291-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2010] [Accepted: 02/25/2010] [Indexed: 10/19/2022]
Abstract
We report two cases of myelodysplastic syndrome (MDS) with trisomy 8 who had periodic fever and erythema nodosum (EN). A 74-year-old man showed periodic fever and EN. A diagnosis of MDS with trisomy 8 was made, and he was successfully treated with prednisolone (PSL). A 71-year-old man presented with intermittent fever, EN, and recurrent elevation of myogenic enzymes. Despite sustained inflammation, laboratory tests showed macrocytic anemia and thrombocytopenia. Marrow aspiration showed MDS with the chromosomal abnormality trisomy 8. He was successfully treated with PSL without repeated transient fever and elevation of creatine kinase. The results of a literature review of 35 cases of MDS with trisomy 8 and Behçet's disease-like symptoms, such as EN, oral ulcer and intestinal ulcer, suggest that the disease entity of "trisomy 8 syndrome" may be considered, and that it is an important differential diagnosis of periodic fever and EN.
Collapse
|
47
|
Phillips AA, Willim RD, Savage DG, Horwitz SM, Isola L, Zain JM, O'connor OA. A multi-institutional experience of autologous stem cell transplantation in North American patients with human T-cell lymphotropic virus type-1 adult T-cell leukemia/lymphoma suggests ineffective salvage of relapsed patients. Leuk Lymphoma 2009; 50:1039-42. [DOI: 10.1080/10428190902887571] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
48
|
Ahn JK, Cha HS, Koh EM, Kim SH, Kim YG, Lee CK, Yoo B. Behcet's disease associated with bone marrow failure in Korean patients: clinical characteristics and the association of intestinal ulceration and trisomy 8. Rheumatology (Oxford) 2008; 47:1228-30. [PMID: 18550640 DOI: 10.1093/rheumatology/ken162] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVES The aim of this study was to determine the clinical characteristics of Behcet's disease (BD) associated with bone marrow failure (BMF), classified as conditions such as myelodysplastic syndrome (MDS) or aplastic anaemia (AA), in Korea. METHODS A retrospective analysis was made of 13 patients with BD associated with BMF (MDS 8 cases, AA 5 cases) and 66 patients with BD not associated with BMF. These patients all fulfilled the diagnostic criteria of the international BD study group. RESULTS BD patients with BMF showed significantly lower leucocyte count, haemoglobin level and platelet count when compared with patients without BMF (P < 0.001). BD patients with BMF had significantly higher serum CRP level at the time of BD diagnosis compared with patients without BMF (P = 0.03). Intestinal lesions were more frequent in BD patients with BMF than those without BMF (61.5% vs 13.6%, P = 0.001). Cytogenetic abnormality was observed in 90.9% of BD patients with BMF. Of the cytogenetic abnormalities, trisomy 8 was most common, occurring in 70% of the patients. In four patients with refractory BD associated with BMF, successful treatment of BMF by haematopoietic stem cell transplantation resulted in clinical remission of BD. CONCLUSIONS Our study indicates that intestinal ulceration is a characteristic finding in BD associated with BMF. It also suggests that cytogenetic aberration, especially trisomy 8, may play an important role in the pathogenesis of BD associated with BMF.
Collapse
Affiliation(s)
- J K Ahn
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 IIwon-Dong, Gangnam-Gu, Seoul 135-710, Republic of Korea
| | | | | | | | | | | | | |
Collapse
|
49
|
|
50
|
Thachil JV, Salim R, Field A, Moots R, Bolton-Maggs P. Myelodysplastic syndrome with trisomy 8 associated with Behçet syndrome: an immunologic link to a karyotypic abnormality. Pediatr Blood Cancer 2008; 50:649-51. [PMID: 17066465 DOI: 10.1002/pbc.21075] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Myelodysplastic syndrome (MDS) in children is often associated with chromosomal anomalies and trisomy 8 is a characteristic karyotypic feature in up to 20% of the cases. Behçet disease is a rare multisystem inflammatory disorder characterized by recurrent mouth and genital ulcers. MDS with trisomy 8 has been observed in adult patients with Behçet syndrome with some cases developing prior to the clinical manifestations of the latter. We present a female with a similar association and explain the importance of identifying the coexisting conditions. The immunological abnormalities, which may be observed in MDS and their possible mechanisms, are also discussed.
Collapse
Affiliation(s)
- Jecko V Thachil
- Department of Haematology, Royal Liverpool University Hospital, Liverpool, United Kingdom.
| | | | | | | | | |
Collapse
|