1
|
Krol RM, Remmelts HHF, Klaasen R, Frima A, Hagen EC, Kamalski DMA, Heijstek MW, Spierings J. Systemic and Local Medical or Surgical Therapies for Ear, Nose and/or Throat Manifestations in ANCA-Associated Vasculitis: A Systematic Literature Review. J Clin Med 2023; 12:jcm12093173. [PMID: 37176613 PMCID: PMC10179364 DOI: 10.3390/jcm12093173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 04/21/2023] [Accepted: 04/23/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND Ear, nose and throat (ENT) manifestations are common in patients with antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV), yet how to treat these manifestations remains controversial. Therefore, we systematically reviewed the literature on the efficacy of therapies on ENT manifestations in AAV. METHODS A systematic review was conducted in accordance with the PRISMA guidelines, searching Medline, Embase and Cochrane libraries, including clinical studies between January 2005 and January 2022, in adults with AAV and ENT involvement, reporting on the effects of local and systemic therapy. The critical appraisal was performed using tools provided by the Cochrane Library and the level of evidence (LoE) was scored according to the Oxford Centre for Evidence-based Medicine. RESULTS After screening 5609 identified studies, 136 full-text articles were assessed. Finally, 31 articles were included for critical appraisal and data-extraction. Nearly all studies (n = 29) were retrospective and scored low on LoE. The included studies evaluated local interventions (n = 11), glucocorticoids combined with conventional synthetic disease modifying anti-rheumatic drugs (csDMARDs) (n = 8), rituximab (n = 6), or mepolizumab (n = 6). Due to heterogeneity across studies meta-analysis was not performed. Four studies on mepolizumab for sinonasal symptoms (n = 92) showed response in 33-100% and relapse in 35%. Local therapy for subglottic stenosis was effective in 80-100% of patients in 11 studies (n = 157), but relapses were common (up to 83%). In five studies, hearing improvement was observed in 56-100%, with better outcomes when glucocorticoids were combined with csDMARDs compared to glucocorticoids only. CONCLUSION Response rates of ENT manifestations varied widely in studies and relapses were observed frequently. Heterogeneity among studies impaired comparison.
Collapse
Affiliation(s)
- Roline M Krol
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
| | - Hilde H F Remmelts
- Department of Nephrology, Meander Medical Center, 3813 TZ Amersfoort, The Netherlands
| | - Ruth Klaasen
- Department of Rheumatology, Meander Medical Center, 3813 TZ Amersfoort, The Netherlands
| | - Annelies Frima
- Department of Otorhinolaryngology, Meander Medical Center, 3813 TZ Amersfoort, The Netherlands
| | - E Christiaan Hagen
- Department of Nephrology, Meander Medical Center, 3813 TZ Amersfoort, The Netherlands
| | - Digna M A Kamalski
- Department of Otorhinolaryngology-Head and Neck Surgery, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
| | - Marloes W Heijstek
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
| | - Julia Spierings
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
| |
Collapse
|
2
|
Krol RM, Schaap CM, Welsing PMJ, Klaasen R, Remmelts HHF, Hagen EC, Heijstek MW, Spierings J. Immunosuppressive Therapies in Ear, Nose, and Throat Involvement in Antineutrophil Cytoplasmic Antibody-Associated Vasculitis: Results From a Multicenter Retrospective Cohort Study. J Rheumatol 2023; 50:384-389. [PMID: 36243413 DOI: 10.3899/jrheum.220343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The aim of this study was to evaluate the response of ear, nose, and throat (ENT) symptoms to different immunosuppressive therapies in patients with antineutrophil cytoplasmic antibody-associated vasculitis (AAV). METHODS In this cohort study, patients with AAV treated between January 2010 and April 2020 at 2 Dutch hospitals were included. Clinical, histological, and laboratory data were collected retrospectively. ENT involvement was defined as follows: (1) ≥ 1 ENT symptom according to the Birmingham Vasculitis Activity Score (version 3; BVAS3), and/or (2) presence of saddle nose deformity. Associations between therapy and ENT activity were assessed using logistic regression analysis. RESULTS A total of 320 patients with AAV were included, of whom 209 (65.3%) had ENT involvement at some point throughout the disease course. In these 209 patients, median age at disease onset was 52.0 years (IQR 40.0-62.0) and 45.5% were male. Median BVAS3 was 12.0 (IQR 6.0-18.0) at diagnosis. Despite immunosuppressive therapy, 50% (n = 77) of the patients had ENT symptoms at relapse and 29.1% (n = 59) had ENT activity at their last visit. No statistically significant difference in ENT activity at last visit was observed between patients treated with oral or intravenous cyclophosphamide (CYC, n = 137) compared to rituximab (RTX, n = 55; adjusted odds ratio 0.59, 95% CI 0.33-1.06; P = 0.08). Lower age at disease onset and female sex were independently associated with ENT activity at last follow-up. CONCLUSION In this cohort, CYC and RTX therapy had similar therapeutic effects on ENT symptoms in AAV. Persistent ENT activity is a common feature despite immunosuppressive therapy.
Collapse
Affiliation(s)
- Roline M Krol
- R.M. Krol, MD, C.M. Schaap, MD, P.M.J. Welsing, PhD, M.W. Heijstek, MD, PhD, J. Spierings, MD, PhD, Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht
| | - Caroline M Schaap
- R.M. Krol, MD, C.M. Schaap, MD, P.M.J. Welsing, PhD, M.W. Heijstek, MD, PhD, J. Spierings, MD, PhD, Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht
| | - Paco M J Welsing
- R.M. Krol, MD, C.M. Schaap, MD, P.M.J. Welsing, PhD, M.W. Heijstek, MD, PhD, J. Spierings, MD, PhD, Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht
| | - Ruth Klaasen
- R. Klaasen, MD, PhD, Department of Rheumatology, Meander Medical Center, Amersfoort
| | - Hilde H F Remmelts
- H.H.F. Remmelts, MD, PhD, E.C. Hagen, MD, PhD, Department of Nephrology, Meander Medical Center, Amersfoort, the Netherlands
| | - E Christiaan Hagen
- H.H.F. Remmelts, MD, PhD, E.C. Hagen, MD, PhD, Department of Nephrology, Meander Medical Center, Amersfoort, the Netherlands
| | - Marloes W Heijstek
- R.M. Krol, MD, C.M. Schaap, MD, P.M.J. Welsing, PhD, M.W. Heijstek, MD, PhD, J. Spierings, MD, PhD, Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht
| | - Julia Spierings
- R.M. Krol, MD, C.M. Schaap, MD, P.M.J. Welsing, PhD, M.W. Heijstek, MD, PhD, J. Spierings, MD, PhD, Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht;
| |
Collapse
|
3
|
Dirikgil E, van Leeuwen JR, Bredewold OW, Ray A, Jonker JT, Soonawala D, Remmelts HHF, van Dam B, Bos WJ, van Kooten C, Rotmans J, Rabelink T, Teng YKO. ExploriNg DUrable Remission with Rituximab in ANCA-associatEd vasculitis (ENDURRANCE trial): protocol for a randomised controlled trial. BMJ Open 2022; 12:e061339. [PMID: 36130755 PMCID: PMC9494556 DOI: 10.1136/bmjopen-2022-061339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Both rituximab (RTX) and cyclophosphamide (CYC) are effectively used in combination with steroids as remission induction therapy for patients with antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV). Several studies have shown that the effect on achieving (clinical) remission, frequency and severity of relapses is equivalent for both therapies, but there is accumulating data that the long-term safety profile of RTX might outperform CYC. Combination of RTX with low-dose CYC (LD-CYC) has been investigated in only a few uncontrolled cohort studies, in which clinical remission and a favourable immunological state with low relapse rates was quickly achieved. In this randomised controlled trial, we aim to investigate whether the combination treatment (RTX+LD CYC) is superior in comparison to standard care with RTX only. METHODS AND ANALYSIS This study is an open-label, multicentre, 1:1 randomised, prospective study for patients with AAV with generalised disease, defined as involvement of major organs, that is, kidneys, lungs, heart and nervous system. In total, 100 patients will be randomised 1:1 to receive either remission induction therapy with standard of care (RTX) or combination treatment (RTX+LD CYC) in addition to steroids and both arms are followed by maintenance with RTX retreatments (tailored to B-cell and ANCA status). Our primary outcome is the number of retreatments needed to maintain clinical remission over 2 years. Secondary outcomes are relevant clinical endpoints, safety, quality of life and immunological responses. ETHICS AND DISSEMINATION This study has received approval of the Medical Ethics Committee of the Leiden University Medical Center (P18.216, NL67515.058.18, date: 7 March 2019). The results of this trial (positive and negative) will be submitted for publication in relevant peer-reviewed publications and the key findings presented at national and international conferences. TRIAL REGISTRATION NUMBER NCT03942887.
Collapse
Affiliation(s)
- Ebru Dirikgil
- Department of Nephrology, Leiden University Medical Center, Leiden, Zuid-Holland, The Netherlands
| | - Jolijn R van Leeuwen
- Department of Nephrology, Leiden University Medical Center, Leiden, Zuid-Holland, The Netherlands
| | - Obbo W Bredewold
- Department of Nephrology, Leiden University Medical Center, Leiden, Zuid-Holland, The Netherlands
| | - Argho Ray
- Department of Nephrology, Leiden University Medical Center, Leiden, Zuid-Holland, The Netherlands
| | - Jacqueline T Jonker
- Department of Nephrology, Leiden University Medical Center, Leiden, Zuid-Holland, The Netherlands
- Department of Nephrology, Alrijne Hospital, Leiderdorp, Zuid-Holland, The Netherlands
| | - Darius Soonawala
- Department of Nephrology, HagaZiekenhuis, Den Haag, Zuid-Holland, The Netherlands
| | - Hilde H F Remmelts
- Department of Nephrology, Meander Medical Centre, Amersfoort, Utrecht, The Netherlands
| | - Bastiaan van Dam
- Noordwest Ziekenhuisgroep, Alkmaar, Noord-Holland, The Netherlands
| | - Willem Jan Bos
- Department of Nephrology, Leiden University Medical Center, Leiden, Zuid-Holland, The Netherlands
- Department of Internal Medicine, St. Antoniusziekenhuis, Nieuwegein, Netherlands
| | - Cees van Kooten
- Department of Nephrology, Leiden University Medical Center, Leiden, Zuid-Holland, The Netherlands
| | - Joris Rotmans
- Department of Nephrology, Leiden University Medical Center, Leiden, Zuid-Holland, The Netherlands
| | - Ton Rabelink
- Department of Nephrology, Leiden University Medical Center, Leiden, Zuid-Holland, The Netherlands
| | - Y K Onno Teng
- Department of Nephrology, Leiden University Medical Center, Leiden, Zuid-Holland, The Netherlands
| |
Collapse
|
4
|
Dirikgil E, Tas SW, Verburgh CA, Soonawala D, Hak AE, Remmelts HHF, IJpelaar D, Laverman GD, Rutgers A, van Laar JM, Moens HJB, Verhoeven PMJ, Rabelink TJ, Bos WJW, Teng YKO. Identifying relevant determinants of in-hospital time to diagnosis for ANCA-associated vasculitis patients. Rheumatol Adv Pract 2022; 6:rkac045. [PMID: 35784016 PMCID: PMC9245319 DOI: 10.1093/rap/rkac045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 05/10/2022] [Indexed: 11/13/2022] Open
Abstract
Objectives Diagnosing patients with ANCA-associated vasculitis (AAV) can be challenging owing to
its rarity and complexity. Diagnostic delay can have severe consequences, such as
chronic organ damage or even death. Given that few studies have addressed diagnostic
pathways to identify opportunities to improve, we performed a clinical audit to evaluate
the diagnostic phase. Methods This retrospective, observational study of electronic medical records data in hospitals
focused on diagnostic procedures during the first assessment until diagnosis. Results We included 230 AAV patients from nine hospitals. First assessments were mainly
performed by a specialist in internal medicine (52%), pulmonology (14%), ENT (13%) or
rheumatology (10%). The overall median time to diagnosis was 13 [interquartile range:
2–49] days, and in patients primarily examined by a specialist in internal medicine it
was 6 [1–25] days, rheumatology 14 [4–45] days, pulmonology 15 [5–70] days and ENT 57
[16–176] days (P = 0.004). Twenty-two of 31 (71%) patients primarily
assessed by a specialist in ENT had non-generalized disease, of whom 14 (64%) had
ENT-limited activity. Two hundred and nineteen biopsies were performed in 187 patients
(81%). Histopathological support for AAV was observed in 86% of kidney biopsies, 64% of
lung biopsies and 34% of ENT biopsies. Conclusion In The Netherlands, AAV is diagnosed and managed predominantly by internal medicine
specialists. Diagnostic delay was associated with non-generalized disease and ENT
involvement at presentation. Additionally, ENT biopsies had a low diagnostic yield, in
contrast to kidney and lung biopsies. Awareness of this should lead to more frequent
consideration of AAV and early referral for a multidisciplinary approach when AAV is
suspected.
Collapse
Affiliation(s)
- Ebru Dirikgil
- Department of Nephrology, Leiden University Medical Center , Leiden
| | - Sander W Tas
- Department of Rheumatology and Clinical Immunology, Amsterdam University Medical Centers , Amsterdam
| | | | | | - A Elisabeth Hak
- Department of Rheumatology and Clinical Immunology, Amsterdam University Medical Centers , Amsterdam
| | | | | | | | - Abraham Rutgers
- Department of Rheumatology and Clinical Immunology, University Medical Center Groningen , Groningen
| | - Jaap M van Laar
- Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht , Utrecht
| | - Hein J Bernelot Moens
- Department of Rheumatology and Clinical Immunology, Ziekenhuisgroep Twente , Almelo/Hengelo
| | | | - Ton J Rabelink
- Department of Nephrology, Leiden University Medical Center , Leiden
| | - Willem Jan W Bos
- Department of Nephrology, Leiden University Medical Center , Leiden
- Department of Internal Medicine, St. Antonius Hospital , Nieuwegein, The Netherlands
| | - Y K Onno Teng
- Department of Nephrology, Leiden University Medical Center , Leiden
| |
Collapse
|
5
|
Balder JW, Blok BA, Meijer E, Franssen C, Luik PT, Remmelts HHF. [Glomerular hematuria: an atypical presentation of anti-glomerular basement membrane nephritis]. Ned Tijdschr Geneeskd 2022; 166:D6126. [PMID: 35138706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND Urologic diseases can cause hematuria, but dysmorphic erythrocytes directs to a glomerular disease. The latter might occur isolated or in the presence of systemic complaints, proteinuria or kidney failure. These factors determine the differential diagnosis that ranges from an innocent IgA nephropathy to a fatal anti-glomerular basement membrane (GBM) nephritis. CASE A 30-year old patient attended the outpatient clinic because of glomerular hematuria and normal kidney function with working diagnosis IgA nephropathy. Three months later he presented to the emergency department with a severe acute kidney injury duo to an anti-GBM nephritis. In retrospect, the anti-GBM titer was already high during the outpatient clinic phase, but due to the preserved kidney function, anti-GBM nephritis was not added to the differential diagnosis. CONCLUSION Glomerular hematuria with a preserved kidney function could in a rare instance be caused by a subclinical anti-GBM nephritis. Follow-up of the kidney function and comprehensive laboratory testing - or even a kidney biopsy - could potentially lead to an early diagnosis of anti-GBM nephritis.
Collapse
Affiliation(s)
- Jan-Willem Balder
- Meander Medisch Centrum, afd. Interne Geneeskunde, Amersfoort
- Contact: Jan-Willem Balder
| | - Bastiaan A Blok
- Meander Medisch Centrum, afd. Interne Geneeskunde, Amersfoort
| | | | | | - Peter T Luik
- Meander Medisch Centrum, afd. Interne Geneeskunde, Amersfoort
| | | |
Collapse
|
6
|
Dirikgil E, Tas SW, Rutgers A, Verhoeven PMJ, van Laar JM, Hagen EC, Tekstra J, L Hak AE, van Paassen P, Kok MR, Goldschmeding R, van Dam B, Douma CE, Remmelts HHF, Sanders JF, Jonker JT, Rabelink TJ, Damoiseaux JGMC, Bernelot Moens HJ, J W Bos W, Teng YKO. A Dutch consensus statement on the diagnosis and treatment of ANCA-associated vasculitis. Neth J Med 2020; 78:71-82. [PMID: 32332176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Despite the availability of several guidelines on the diagnosis and treatment of antineutrophil cytoplasmic antibody-associated vasculitis (AAV), clinical routine practice will only improve when an implementation strategy is in place to support clinical decision making and adequate implementation of guidelines. We describe here an initiative to establish national and multidisciplinary consensus on broad aspects of the diagnosis and treatment of AAV relevant to daily clinical practice in the Netherlands. METHODS A multidisciplinary working group of physicians in the Netherlands with expertise on AAV addressed the broad spectrum of diagnosis, terminology, and immunosuppressive and non-immunosuppressive treatment, including an algorithm for AAV patients. Based on recommendations from (inter)national guidelines, national consensus was established using a Delphi-based method during a conference in conjunction with a nationally distributed online consensus survey. Cut-off for consensus was 70% (dis)agreement. RESULTS Ninety-eight professionals were involved in the Delphi procedure to assess consensus on 50 statements regarding diagnosis, treatment, and organisation of care for AAV patients. Consensus was achieved for 37/50 statements (74%) in different domains of diagnosis and treatment of AAV including consensus on the treatment algorithm for AAV. CONCLUSION We present a national, multidisciplinary consensus on a diagnostic strategy and treatment algorithm for AAV patients as part of the implementation of (inter)national guideline-derived recommendations in the Netherlands. Future studies will focus on evaluating local implementation of treatment protocols for AAV, and assessments of current and future clinical practice variation in the care for AAV patients in the Netherlands.
Collapse
Affiliation(s)
- E Dirikgil
- Leiden University Medical Center, Leiden, the Netherlands
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
7
|
Remmelts HHF, Spoorenberg SMC, Oosterheert JJ, Bos WJW, de Groot MCH, van de Garde EMW. The role of vitamin D supplementation in the risk of developing pneumonia: three independent case–control studies. Thorax 2013; 68:990-6. [DOI: 10.1136/thoraxjnl-2013-203623] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
8
|
Remmelts HHF, van de Garde EMW, Meijvis SCA, Peelen ELGCA, Damoiseaux JGMC, Grutters JC, Biesma DH, Bos WJW, Rijkers GT. Addition of Vitamin D Status to Prognostic Scores Improves the Prediction of Outcome in Community-Acquired Pneumonia. Clin Infect Dis 2012; 55:1488-94. [DOI: 10.1093/cid/cis751] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
|
9
|
Meijvis SCA, Hardeman H, Remmelts HHF, Heijligenberg R, Rijkers GT, van Velzen-Blad H, Voorn GP, van de Garde EMW, Endeman H, Grutters JC, Bos WJW, Biesma DH. Dexamethasone and length of hospital stay in patients with community-acquired pneumonia: a randomised, double-blind, placebo-controlled trial. Lancet 2011; 377:2023-30. [PMID: 21636122 DOI: 10.1016/s0140-6736(11)60607-7] [Citation(s) in RCA: 234] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Whether addition of corticosteroids to antibiotic treatment benefits patients with community-acquired pneumonia who are not in intensive care units is unclear. We aimed to assess effect of addition of dexamethasone on length of stay in this group, which might result in earlier resolution of pneumonia through dampening of systemic inflammation. METHODS In our double-blind, placebo-controlled trial, we randomly assigned adults aged 18 years or older with confirmed community-acquired pneumonia who presented to emergency departments of two teaching hospitals in the Netherlands to receive intravenous dexamethasone (5 mg once a day) or placebo for 4 days from admission. Patients were ineligible if they were immunocompromised, needed immediate transfer to an intensive-care unit, or were already receiving corticosteroids or immunosuppressive drugs. We randomly allocated patients on a one-to-one basis to treatment groups with a computerised randomisation allocation sequence in blocks of 20. The primary outcome was length of hospital stay in all enrolled patients. This study is registered with ClinicalTrials.gov, number NCT00471640. FINDINGS Between November, 2007, and September, 2010, we enrolled 304 patients and randomly allocated 153 to the placebo group and 151 to the dexamethasone group. 143 (47%) of 304 enrolled patients had pneumonia of pneumonia severity index class 4-5 (79 [52%] patients in the dexamethasone group and 64 [42%] controls). Median length of stay was 6·5 days (IQR 5·0-9·0) in the dexamethasone group compared with 7·5 days (5·3-11·5) in the placebo group (95% CI of difference in medians 0-2 days; p=0·0480). In-hospital mortality and severe adverse events were infrequent and rates did not differ between groups, although 67 (44%) of 151 patients in the dexamethasone group had hyperglycaemia compared with 35 (23%) of 153 controls (p<0·0001). INTERPRETATION Dexamethasone can reduce length of hospital stay when added to antibiotic treatment in non-immunocompromised patients with community-acquired pneumonia. FUNDING None.
Collapse
Affiliation(s)
- Sabine C A Meijvis
- Department of Internal Medicine, St Antonius Hospital, Nieuwegein, Netherlands.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
10
|
Remmelts HHF, van den Brink JW, Laan R, Bac DJ. Herpes simplex virus oesophagitis in a pregnant woman. Neth J Med 2011; 69:76-78. [PMID: 21411844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Herpes simplex virus (HSV) oesophagitis is well described in immunocompromised patients. In immunocompetent individuals HSV oesophagitis is rare. We present a case of HSV oesophagitis in a pregnant woman. A possible explanation for HSV oesophagitis during pregnancy is the decreased cellular immunity, leading to an increased frequency and severity of viral infections. Antiviral therapy is advocated in pregnancy.
Collapse
Affiliation(s)
- H H F Remmelts
- Department of Internal Medicine and Gastroenterology, Gelderse Vallei Hospital, Ede, the Netherlands.
| | | | | | | |
Collapse
|
11
|
Remmelts HHF, Banga JD. Popping pneumothorax. Neth J Med 2010; 68:187. [PMID: 20421663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
|