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Ueda R, Imai K, Yamamoto A, Ioku T, Kadoya M, Hamanaka M. [Eosinophilic granulomatosis with polyangiitis presenting with Guillain-Barré syndrome-like acute course. A case report]. Rinsho Shinkeigaku 2021; 61:624-629. [PMID: 34433743 DOI: 10.5692/clinicalneurol.cn-001601] [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] [Indexed: 11/05/2022]
Abstract
A 57-years-old man with a history of bronchial asthma and pansinusitis developed acute progressive muscle weakness and sensory disturbance of the distal limbs after upper respiratory infection. On day 15 after onset of sensory disturbance and muscle weakness, the patient admitted to our hospital. A neurological examination revealed asymmetry weakness of both proximal and distal muscles, "glove and stocking type" hypoesthesia, and paresthesia without obvious pain. Blood tests and a nerve conduction study demonstrated eosinophilia and elevation of MPO-ANCA, axonal multiple mononeuropathy, respectively. The cerebrospinal fluid was normal. Eosinophilic granulomatosis with polyangiitis (EGPA) or Guillain-Barré syndrome (GBS) were suspected. So intravenous immunoglobulin therapy (IVIg) and high dose methylprednisolone pulse therapy (HDMP) followed by oral prednisolone were started. However, neurological symptoms did not improve. Sural nerve biopsy on day 31 revealed varying myelinating fiber loss at every nerve bundle and perivascular lymphocytic infiltration. The results did not fulfill the pathologic criteria for EGPA, but supported the changes of vasculitis. Cyclophosphamide (CPA) pulse therapy was administered for the additional therapy. Neurological symptoms did not improve and worsened again after decreasing oral prednisolone; therefore, combined therapy with IVIg, HDMP, and CPA was administered. Neurological symptoms then diminished gradually and the MPO-ANCA level and number of eosinophils normalized. This case suggests the importance of early nerve biopsy to obtain pathological findings supportive of EGPA diagnosis to allow introduction of aggressive immunosuppressive therapy such as CPA in a case with acute progressive motor-sensory neuropathy due to EGPA mimicking GBS.
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Affiliation(s)
- Ryota Ueda
- Department of Neurology and Stroke Treatment, Kyoto Daiichi Red Cross Hospital
| | - Keisuke Imai
- Department of Neurology and Stroke Treatment, Kyoto Daiichi Red Cross Hospital
| | - Atsushi Yamamoto
- Department of Neurology and Stroke Treatment, Kyoto Daiichi Red Cross Hospital
| | - Tetsuya Ioku
- Department of Neurology and Stroke Treatment, Kyoto Daiichi Red Cross Hospital
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Moroni G, Raffiotta F, Trezzi B, Giglio E, Mezzina N, Del Papa N, Meroni P, Messa P, Sinico AR. Rituximab vs mycophenolate and vs cyclophosphamide pulses for induction therapy of active lupus nephritis: a clinical observational study. Rheumatology (Oxford) 2014; 53:1570-7. [PMID: 24505125 DOI: 10.1093/rheumatology/ket462] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE We report the first comparison between rituximab (RTX) and either MMF or CYC pulses in the treatment of active LN. METHODS Fifty-four patients with active LN received three methylprednisolone pulses for 3 consecutive days followed by oral prednisone and RTX 1 g at days 3 and 18 (17 patients) or MMF 2-2.5 g/day (17 patients) or six CYC pulses (0.5 g every fortnight) (20 patients). At 4 months MMF, AZA or ciclosporin were associated to prednisone as a consolidation/maintenance therapy in all groups. The outcomes of the three groups were compared at 3 and 12 months. RESULTS Patients in the RTX group were older, had a longer duration of SLE and LN, had more renal flares, had higher activity and had higher chronicity indexes at renal biopsy than the other two groups. Four patients in each group had acute renal dysfunction and ∼50% had nephrotic syndrome. At 3 months, proteinuria was reduced by 50% in 58.8% of patients on RTX, in 64.7% on MMF and in 63.1% on CYC. At 12 months, complete remission was present in 70.6% of patients on RTX, in 52.9% on MMF, and in 65% on CYC. Partial remission was reached in 29.4% on RTX, 41.2% on MMF, and 25% on CYC. CONCLUSION RTX seems to be at least as effective as MMF and CYC pulses in inducing remission. Considering that patients treated with RTX had more negative renal prognostic factors, this drug should be considered a viable alternative for the treatment of active LN.
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Affiliation(s)
- Gabriella Moroni
- Divisione di Nefrologia & Dialisi, IRCCS Fondazione Ca' Granda, Ospedale Maggiore, Mangiagalli, Regina Elena, Divisone di Nefrologia e Immunologia clinica, Ospedale San Carlo Borromeo, Dipartimento di Reumatologia, Unita' Operativa di Day Hospital, Istituto G. Pini and Dipartimento di Reumatologia, Istituto G. Pini and IRCCS Istituto Auxologico Italiano, Milano, Italy.
| | - Francesca Raffiotta
- Divisione di Nefrologia & Dialisi, IRCCS Fondazione Ca' Granda, Ospedale Maggiore, Mangiagalli, Regina Elena, Divisone di Nefrologia e Immunologia clinica, Ospedale San Carlo Borromeo, Dipartimento di Reumatologia, Unita' Operativa di Day Hospital, Istituto G. Pini and Dipartimento di Reumatologia, Istituto G. Pini and IRCCS Istituto Auxologico Italiano, Milano, Italy
| | - Barbara Trezzi
- Divisione di Nefrologia & Dialisi, IRCCS Fondazione Ca' Granda, Ospedale Maggiore, Mangiagalli, Regina Elena, Divisone di Nefrologia e Immunologia clinica, Ospedale San Carlo Borromeo, Dipartimento di Reumatologia, Unita' Operativa di Day Hospital, Istituto G. Pini and Dipartimento di Reumatologia, Istituto G. Pini and IRCCS Istituto Auxologico Italiano, Milano, Italy
| | - Elisa Giglio
- Divisione di Nefrologia & Dialisi, IRCCS Fondazione Ca' Granda, Ospedale Maggiore, Mangiagalli, Regina Elena, Divisone di Nefrologia e Immunologia clinica, Ospedale San Carlo Borromeo, Dipartimento di Reumatologia, Unita' Operativa di Day Hospital, Istituto G. Pini and Dipartimento di Reumatologia, Istituto G. Pini and IRCCS Istituto Auxologico Italiano, Milano, Italy
| | - Nicoletta Mezzina
- Divisione di Nefrologia & Dialisi, IRCCS Fondazione Ca' Granda, Ospedale Maggiore, Mangiagalli, Regina Elena, Divisone di Nefrologia e Immunologia clinica, Ospedale San Carlo Borromeo, Dipartimento di Reumatologia, Unita' Operativa di Day Hospital, Istituto G. Pini and Dipartimento di Reumatologia, Istituto G. Pini and IRCCS Istituto Auxologico Italiano, Milano, Italy
| | - Nicoletta Del Papa
- Divisione di Nefrologia & Dialisi, IRCCS Fondazione Ca' Granda, Ospedale Maggiore, Mangiagalli, Regina Elena, Divisone di Nefrologia e Immunologia clinica, Ospedale San Carlo Borromeo, Dipartimento di Reumatologia, Unita' Operativa di Day Hospital, Istituto G. Pini and Dipartimento di Reumatologia, Istituto G. Pini and IRCCS Istituto Auxologico Italiano, Milano, Italy
| | - Pierluigi Meroni
- Divisione di Nefrologia & Dialisi, IRCCS Fondazione Ca' Granda, Ospedale Maggiore, Mangiagalli, Regina Elena, Divisone di Nefrologia e Immunologia clinica, Ospedale San Carlo Borromeo, Dipartimento di Reumatologia, Unita' Operativa di Day Hospital, Istituto G. Pini and Dipartimento di Reumatologia, Istituto G. Pini and IRCCS Istituto Auxologico Italiano, Milano, Italy
| | - Piergiorgio Messa
- Divisione di Nefrologia & Dialisi, IRCCS Fondazione Ca' Granda, Ospedale Maggiore, Mangiagalli, Regina Elena, Divisone di Nefrologia e Immunologia clinica, Ospedale San Carlo Borromeo, Dipartimento di Reumatologia, Unita' Operativa di Day Hospital, Istituto G. Pini and Dipartimento di Reumatologia, Istituto G. Pini and IRCCS Istituto Auxologico Italiano, Milano, Italy
| | - Alberto Renato Sinico
- Divisione di Nefrologia & Dialisi, IRCCS Fondazione Ca' Granda, Ospedale Maggiore, Mangiagalli, Regina Elena, Divisone di Nefrologia e Immunologia clinica, Ospedale San Carlo Borromeo, Dipartimento di Reumatologia, Unita' Operativa di Day Hospital, Istituto G. Pini and Dipartimento di Reumatologia, Istituto G. Pini and IRCCS Istituto Auxologico Italiano, Milano, Italy
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