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Gendelman O, Kuntzman Y, Shovman O, Langevitz P, Tsur AM, Erez D, Levy Y, Amital H. Tumor-like Lesions in Patients with Granulomatosis with Polyangiitis: A Case Series. Isr Med Assoc J 2021; 23:350-352. [PMID: 34155847] [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: 06/13/2023]
Abstract
BACKGROUND Granulomatosis with polyangiitis (GPA) is a rare small vessel vasculitis. It usually involves the respiratory tract and kidney. Rarely, tumor-resembling inflammatory changes ensue. OBJECTIVES To report three unique cases of GPA presenting with tumor-like lesions in various organs. METHODS We presented three cases of GPA. Case 1 presented with typical upper respiratory symptoms of GPA and a mediastinal mass. Case 2 presented with low back pain, a large retroperitoneal mass, and nodular skin lesions. Case 3 presented with epigastric pain and a paravertebral inflammatory mass. RESULTS The patients were treated successfully with rituximab. CONCLUSIONS Clinicians should be aware of this presentation of granulomatosis with polyangiitis, which is known as Tumefaction Wegener's granulomatosis.
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Affiliation(s)
- Omer Gendelman
- Department of Medicine B, Sheba Medical Center, Tel Hashomer, Israel
- Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yuval Kuntzman
- Department of Medicine B, Sheba Medical Center, Tel Hashomer, Israel
- Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ora Shovman
- Department of Medicine B, Sheba Medical Center, Tel Hashomer, Israel
- Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Pnina Langevitz
- Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Avishai M Tsur
- Department of Medicine B, Sheba Medical Center, Tel Hashomer, Israel
- Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel Hashomer, Israel
- Israel Defense Forces, Medical Corps, Tel Hashomer, Ramat Gan, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Daniel Erez
- Department of Medicine D, Meir Medical Center, Kfar Saba, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yair Levy
- Department of Medicine E, Meir Medical Center, Kfar Saba, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Howard Amital
- Department of Medicine B, Sheba Medical Center, Tel Hashomer, Israel
- Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Kitamura N, Hamaguchi M, Nishihara M, Ikumi N, Sugiyama K, Nagasawa Y, Tsuzuki H, Yoshizawa S, Tanikawa Y, Oshima M, Asatani S, Kobayashi H, Takei M. The effects of mepolizumab on peripheral circulation and neurological symptoms in eosinophilic granulomatosis with polyangiitis (EGPA) patients. Allergol Int 2021; 70:148-149. [PMID: 32967778 DOI: 10.1016/j.alit.2020.08.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 08/18/2020] [Accepted: 08/19/2020] [Indexed: 12/17/2022] Open
Affiliation(s)
- Noboru Kitamura
- Division of Hematology and Rheumatology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan.
| | - Marina Hamaguchi
- Division of Hematology and Rheumatology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Masahiro Nishihara
- Division of Hematology and Rheumatology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Natsumi Ikumi
- Division of Hematology and Rheumatology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Kaita Sugiyama
- Division of Hematology and Rheumatology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Yosuke Nagasawa
- Division of Hematology and Rheumatology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Hiroshi Tsuzuki
- Division of Hematology and Rheumatology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Shoei Yoshizawa
- Division of Hematology and Rheumatology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Yutaka Tanikawa
- Division of Hematology and Rheumatology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Masashi Oshima
- Division of Hematology and Rheumatology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Shinya Asatani
- Division of Hematology and Rheumatology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Hitomi Kobayashi
- Division of Hematology and Rheumatology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Masami Takei
- Division of Hematology and Rheumatology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
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Fennelly E, Greenan E, Murphy CC. Corneal melt secondary to eosinophilic granulomatosis with polyangiitis. BMJ Case Rep 2019; 12:e229859. [PMID: 31229976 PMCID: PMC6605890 DOI: 10.1136/bcr-2019-229859] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2019] [Indexed: 11/04/2022] Open
Abstract
Eosinophilic granulomatosis with polyangiitis (EGPA) is a rare antineutrophil cytoplasmic antibody-associated vasculitis that can affect any organ system. It is most often characterised by chronic airway inflammation along with prominent peripheral blood eosinophilia, although the disease can affect the cardiovascular, gastrointestinal, renal or central nervous systems. Ocular manifestations are uncommon and when they do occur, are varied in their clinical presentations. To the best of our knowledge, this is the first case of corneal melt secondary to EGPA to have been reported.
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Affiliation(s)
- Evelyn Fennelly
- Dublin Mid-Leinster Intern Network, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Emily Greenan
- Department of Ophthalmology, Royal Victoria Eye and Ear Hospital, Dublin, Ireland
- Department of Ophthalmology, RCSI School of Medicine, Dublin, Ireland
| | - Conor C Murphy
- Department of Ophthalmology, Royal Victoria Eye and Ear Hospital, Dublin, Ireland
- Department of Ophthalmology, RCSI School of Medicine, Dublin, Ireland
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4
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Shovman O, Shoenfeld Y. IgG4-Related Disease and Eosinophilic Granulomatosis with Polyangiitis: Similarity or Coexistence? Isr Med Assoc J 2019; 21:122-123. [PMID: 30772965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Ora Shovman
- Department of Internal Medicine B, Sheba Medical Center, Tel Hashomer, Israel
- Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yehuda Shoenfeld
- Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Laboratory of the Mosaics of Autoimmunity, Saint Petersburg University, Saint Petersburg, Russian Federation
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5
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Deshayes S, Aouba A, Khoy K, Mariotte D, Lobbedez T, Martin Silva N. Hypocomplementemia is associated with worse renal survival in ANCA-positive granulomatosis with polyangiitis and microscopic polyangiitis. PLoS One 2018; 13:e0195680. [PMID: 29621352 PMCID: PMC5886583 DOI: 10.1371/journal.pone.0195680] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 03/27/2018] [Indexed: 11/18/2022] Open
Abstract
Recent data suggest the existence of a complement alternative pathway activation in the pathogenesis of antineutrophilic cytoplasmic antibody (ANCA)-associated vasculitis (AAV), a condition that remains poorly understood. This study aims to assess the clinical characteristics and outcomes of granulomatosis with polyangiitis (GPA) and microscopic polyangiitis (MPA) patients with regard to their plasma complement levels at diagnosis. A retrospective monocentric study carried out at Caen University Hospital led to the identification of proteinase-3- or myeloperoxidase-ANCA-positive GPA and MPA patients from January 2000 to June 2016 and from September 2011 to June 2016, respectively. All patients with available C3 and C4 levels at diagnosis were included. Patients were categorized in the hypocomplementemia group if their C3 and/or C4 levels at diagnosis were below the lower limit of the normal range. Among the 76 AAV patients (43 GPA, 33 MPA), 4 (5%) had hypocomplementemia, and the 72 remaining patients exhibited normal plasma complement levels. All 4 hypocomplementemia patients had renal involvement. Hypocomplementemia was followed in 1 patient whose post-treatment complement level normalized within 1 month. Among all clinical and ANCA specificity, including relapse-free survival (p = 0.093), only overall and renal survival rates were significantly lower in the hypocomplementemia group (p = 0.0011 and p<0.001, respectively). Hypocomplementemia with low C3 and/or C4 levels at GPA or MPA diagnosis may be responsible for worse survival and renal prognosis. These results argue for larger and prospective studies to better determine the epidemiology of the disease and to assess complement-targeting therapy in these patients.
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Affiliation(s)
| | - Achille Aouba
- Department of Internal Medicine, CHU de Caen, Caen, France
| | - Kathy Khoy
- Department of Immunology, CHU de Caen, Caen, France
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6
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Kühn D, Hospowsky C, Both M, Hey M, Laudien M. Manifestation of granulomatosis with polyangiitis in head and neck. Clin Exp Rheumatol 2018; 36 Suppl 111:78-84. [PMID: 29799391] [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] [Received: 10/10/2017] [Accepted: 03/05/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVES Granulomatosis with polyangiitis is a rare autoimmune disease of the group of antineutrophil cytoplasmic antibody (ANCA)-associated vasculitides. Involvement of the ear, nose and throat (ENT)-region is only described in a few case series and case reports. The objective of this study is to systematically characterise the ENT-involvement in a large series of GPA patients. METHODS GPA patients examined in the Department of Otorhinolayngology of the Christian-Albrechts-University of Kiel between 1990 and 2012 were included. Diagnosis was based on histological, serological and clinical parameters. GPA patients were examined in a standardised way based on the Ear Nose and Throat Activity Score (ENTAS) or its precursor. Medical history, ENT examination, diagnostic findings (ear, nose) and cranial radiology were documented cumulatively. RESULTS A total of 230 GPA patients were included in this study. Over 95% of them showed ENT-involvement. 59% of the patients showed nasal obstructions, 57% a loss of smell. A hearing loss was diagnosed in 23% of the patients, 50% involvement in MR or CT scans and 15% showed laryngeal involvement. CONCLUSIONS The data of the largest monocentric study presented here demonstrate a frequent ENT-involvement in GPA patients. Rhinological and ontological manifestations are most common.
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Affiliation(s)
- Dominik Kühn
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Kiel, Germany
| | - Charlotte Hospowsky
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Kiel, Germany
| | - Marcus Both
- Department of Radiology and Neuroradiology, University Hospital Schleswig-Holstein, Campus Kiel, Germany
| | - Matthias Hey
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Kiel, Germany
| | - Martin Laudien
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Kiel, Germany.
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7
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Fijołek J, Wiatr E, Petroniec V, Augustynowicz-Kopec E, Bednarek M, Gawryluk D, Martusewicz-Boros MM, Modrzewska K, Radzikowska E, Roszkowski-Sliz K. The presence of staphylococcal superantigens in nasal swabs and correlation with activity of granulomatosis with polyangiitis in own material. Clin Exp Rheumatol 2018; 36 Suppl 111:40-45. [PMID: 29745876] [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] [Received: 01/30/2018] [Accepted: 03/19/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVES Nasal carriage of Staphylococcus aureus and its superantigens (SAg) seem to be a risk factor disease exacerbation in granulomatosis with polyangiitis (GPA). We investigated the association between the presence of SAg in nasal swabs and activity of disease in GPA patients also taking into account correlation with an antimicrobial treatment. METHODS In a prospective study of a total of 150 GPA patients hospitalised in the period 2009-2016, nasal swabs were examined for the presence of Staphylococcus aureus and SAg. Subsequently, the association with disease activity was assessed. RESULTS Of 362 Staphylococcus aureus-positive nasal swab cultures from 115 of the 150 patients, the presence of at least one SAg in 126 samples (34.8%) from 56 patients (48.7%) was found. Among the 17 patients with limited to subglottic stenosis (SGS) disease, SAg were detected in 6 cases (35.3%). We did not find a significant correlation between the presence of SAg and disease activity (p=0.986), although when individual SAg were analysed separatively, SED and TSST-1 were more frequently present in active disease. Additionally, the results of the analysis demonstrated a protective effect of trimethoprim/sulfamethoxazole (T/S) treatment (0R 0.52, p<0.0092) in GPA patients. Interestingly, GPA limited to SGS appeared as an unfavourable factor associated with disease activity (0R 1.84, p=0.05). CONCLUSIONS The association between staphylococcal SAg in nasal swabs and GPA activity is not evident. Multiple mechanisms that may lead to disease activation still need to be investigated.
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Affiliation(s)
- Justyna Fijołek
- The Third Department of Pneumonology, National Research Institute of Tuberculosis and Lung Diseases, Warsaw, Poland.
| | - Elzbieta Wiatr
- The Third Department of Pneumonology, National Research Institute of Tuberculosis and Lung Diseases, Warsaw, Poland
| | - Violetta Petroniec
- Department of Microbiology, National Research Institute of Tuberculosis and Lung Diseases, Warsaw, Poland
| | - Ewa Augustynowicz-Kopec
- Department of Microbiology, National Research Institute of Tuberculosis and Lung Diseases, Warsaw, Poland
| | - Michal Bednarek
- The Second Department of Pneumonology, National Research Institute of Tuberculosis and Lung Diseases, Warsaw, Poland
| | - Dariusz Gawryluk
- The Third Department of Pneumonology, National Research Institute of Tuberculosis and Lung Diseases, Warsaw, Poland
| | | | - Katarzyna Modrzewska
- The Third Department of Pneumonology, National Research Institute of Tuberculosis and Lung Diseases, Warsaw, Poland
| | - Elzbieta Radzikowska
- The Third Department of Pneumonology, National Research Institute of Tuberculosis and Lung Diseases, Warsaw, Poland
| | - Kazimerz Roszkowski-Sliz
- The Third Department of Pneumonology, National Research Institute of Tuberculosis and Lung Diseases, Warsaw, Poland
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8
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Falkowski A, Wardyn KA, Życińska K. Peripheral Arterial Tonometry in Pulmonary Vasculitis. Advances in Experimental Medicine and Biology 2018; 1040:1-5. [PMID: 28889234 DOI: 10.1007/5584_2017_96] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2023]
Abstract
Vascular wall inflammation in primary vasculitides results in diminished vessel dilation and finally impaired blood flow, causing multiple organs dysfunction and ultimate damage. In granulomatosis with polyangiitis (GPA), the inflammatory process concerns small and medium sized vessels and its pulmonary location is often predominant. The pivotal role in the development of that pathology plays vascular endothelium. Endothelial vasodilatory function strongly depends on the instant production and release of nitrogen oxide (NO), a potent local factor controlling vascular tonus. NO output is triggered by a variety of stimuli, especially by ischemia. The endothelial vasodilatory ability can be measured indirectly by a few of methods, one of them is peripheral arterial tonometry (PAT). The method assesses reactive hyperemia, mediated mostly by NO release, as a response to vessel occlusion. The vasodilatory reaction depends on the quality of the endothelium which deteriorates with time of GPA disease progression. The aim of the present study was to estimate a correlation between the clinical status, reflected by the disease extent index (DEI), and the vasodilatory endothelial function reflected by the index of arterial reactive hyperemia (RHI), measured by PAT in 27 patients with GPA, having a significant pulmonary involvement. We found a moderate inverse correlation between DEI and log-transformed RHI (r = -0.46, p < 0.05). The conclusion is that impaired endothelial function, as assessed by RHI-PAT, might predict the GPA progression.
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Affiliation(s)
- A Falkowski
- Department of Family Medicine, Internal and Metabolic Diseases, Warsaw Medical University, and Systemic Vasculitis Outpatient Clinic Czerniakowski Hospital, Warsaw, Poland.
| | - K A Wardyn
- Department of Family Medicine, Internal and Metabolic Diseases, Warsaw Medical University, and Systemic Vasculitis Outpatient Clinic Czerniakowski Hospital, Warsaw, Poland
| | - K Życińska
- Department of Family Medicine, Internal and Metabolic Diseases, Warsaw Medical University, and Systemic Vasculitis Outpatient Clinic Czerniakowski Hospital, Warsaw, Poland
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9
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Pearce FA, Hubbard RB, Grainge MJ, Watts RA, Abhishek A, Lanyon PC. Can granulomatosis with polyangiitis be diagnosed earlier in primary care? A case-control study. QJM 2018; 111:39-45. [PMID: 29340693 DOI: 10.1093/qjmed/hcx194] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND People with granulomatosis with polyangiitis (GPA) commonly described long delays before diagnosis. AIM To study the natural history of GPA prior to diagnosis using primary care data, and determine whether clinical features could be identified to help earlier diagnosis. DESIGN Case-control study using the Clinical Practice Research Datalink. METHODS We compared primary care activity and clinical features between cases and 10 matched controls. RESULTS We identified 757 cases and matched 7546 controls. Compared to controls, cases had more GP consultations and overall healthcare activity in the 5 years prior to their diagnosis, with a marked increase in the year before diagnosis, and particularly in the last 3 months. However, consultations were mostly for symptoms that were not specifically related to GPA. In the year prior to diagnosis, the most frequent and strongly predictive clinical features of GPA were Ear Nose and Throat (ENT) symptoms [34.5% of cases, odds ratio (OR) 10.5, 95% confidence intervals (CI) 8.6-12.7], and general (constitutional) symptoms (21.5% of cases, OR 9.0, 95% CI 7.1-11.3). In the year before diagnosis a larger number of cases attended secondary care (382, 50.5%) than had records of clinical features of GPA. CONCLUSIONS After discussing our findings, we conclude that it would be difficult to identify cases of GPA earlier in primary care. Our results support a need for heightened awareness of this condition among secondary care clinicians, especially those assessing emergency admissions, and in the clinics which were most frequently attended by cases 3-12 months prior to diagnosis.
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Affiliation(s)
- F A Pearce
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK
| | - R B Hubbard
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK
| | - M J Grainge
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK
| | - R A Watts
- Department of Rheumatology, Ipswich Hospital, Ipswich, UK
| | - A Abhishek
- Division of Rheumatology, Orthopaedics and Dermatology, University of Nottingham, Nottingham, UK
| | - P C Lanyon
- Department of Rheumatology, Nottingham University Hospitals NHS Trust, Nottingham, UK
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10
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Zimba E, Olkhova O. [GRANULOMATOSIS WITH POLYANGIITIS (WEGENER'S): CLINICAL CASE]. Georgian Med News 2016:43-47. [PMID: 27348166] [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: 06/06/2023]
Abstract
Granulomatosis with polyangiitis (Wegener's disease) - systemic vasculitis, initial manifestations, the clinical picture may be present in a wide variety. This leads to difficulties in establishing a timely diagnosis. The prognosis in untreated generalized granulomatosis with polyangiitis is extremely poor. The present case report illustrates a late diagnosis of granulomatosis with polyangiitis. A 53-year-old woman was diagnosed with granulomatosis with polyangiitis only after ten months of onset of disease. Wrong diagnosis of tuberculosis of ear leads to a lot of delay in the treatment this type of vasculitis. At the time of diagnosis she had generalized form of disease presented with involvement of the eyes, upper and lower respiratory tracts, kidneys, and nervous system. Remission was achieved with methylprednisolone and cyclophosphamide but suffered a relapse shortly afterwards. Further treatment with rituximab achieved a second remission, but the patient continued to suffer from dry conjunctivitis. Symptomatic therapy in this case was ineffective. An effective pathogenic therapy for this condition was instillation of cyclosporine eye drops.
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Affiliation(s)
- E Zimba
- Danylo Halytsky Lviv National Medical University, Lviv, Ukraine; Andrey Krupynskyy Lviv Institute of Nursing and Laboratory Medicine, Ukraine
| | - O Olkhova
- Danylo Halytsky Lviv National Medical University, Lviv, Ukraine; Andrey Krupynskyy Lviv Institute of Nursing and Laboratory Medicine, Ukraine
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Marković I, Puksić S, Ozegović I, Culo MI, Mitrović J, Morović-Vergles J. [GRANULOMATOSIS WITH POLYANGIITIS (GPA) LIMITED TO UPPER RESPIRATORY TRACT--A CASE REPORT]. Lijec Vjesn 2016; 138:54-56. [PMID: 27290815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Granulomatosis with polyangiitis (Wegener's granulomatosis) is one of the anti-neutrophil cytoplasmic anti-body-associated small vessel vasculitides. Upper and lower respiratory system and kidneys are most commonly affected. The disease is characterized by granulomatous inflammation of the respiratory tract and necrotizing vasculitis of small to medium-sized blood vessels. Most patients show involvement of more than one organ systems at the time of diagnosis, and constitutional symptoms may be present. In around a quarter of patients the disease is initially localised, with involvement of upper respiratory tract or lungs. We report a 21-year-old female patient with chronic rhinitis, saddle nose deformity and subglottic stenosis who presented with inspiratory stridor and impending respiratory failure. Initially, urgent tracheotomy was performed. The patient was diagnosed with granulomatosis with polyangiitis limited to upper respiratory tract. Treatment with glucocorticoids and methotrexate was followed by clinical improvement.
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12
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Arous S, Bensahi I, Noureddine M, Habbal R. Un mode de révélation rare de la maladie de Wegener: une myocardite associée a une endocardite fibroblastique. Pan Afr Med J 2016; 23:133. [PMID: 27279960 PMCID: PMC4885686 DOI: 10.11604/pamj.2016.23.133.8323] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2015] [Accepted: 11/25/2015] [Indexed: 12/03/2022] Open
Abstract
Nous rapportons à travers cette observation le cas rare d'une maladie de Wegener révélée par une myocardite associée à une endocardite fibroblastique. Le patient a été admis initialement dans un tableau d'insuffisance cardiaque globale, avec un trouble du rythme type flutter auriculaire à l'ECG. A l’échocardiographie le ventricule gauche était non dilaté, siège d'une dysfonction sévère, avec un dosage des troponines positif. Une insuffisance rénale sévère a été découverte fortuitement nécessitant une hémodialyse, associée à une anémie inflammatoire confirmée par la férritinémie et le myélogramme. Le dosage des c-ANCA était fortement positif confirmant le diagnostic. La TDM thoracique avait objectivé une pneumopathie basale droite. Après avoir démarré un traitement adapté comprenant une corticothérapie et un traitement immunosuppresseur, l’évolution a été favorable avec normalisation de la fonction systolique du ventricule gauche. Bien que les manifestations cardiaques cliniques évidentes soient rares, l'atteinte cardiaque au cours de la maladie de Wegener est décrite, nécessitant une orientation diagnostic rapide et une connaissance rigoureuse de cette maladie grave.
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Affiliation(s)
- Salim Arous
- Service de Cardiologie, CHU Ibn Rochd, Casablanca, Maroc
| | - Ilham Bensahi
- Service de Cardiologie, CHU Ibn Rochd, Casablanca, Maroc
| | | | - Rachida Habbal
- Service de Cardiologie, CHU Ibn Rochd, Casablanca, Maroc
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13
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Hajj-Ali RA, Major J, Langford CA, Hoffman GS, Clark T, Zhang L, Sun Z, Silverstein RL. The interface of inflammation and subclinical atherosclerosis in granulomatosis with polyangiitis (Wegener's): a preliminary study. Transl Res 2015; 166:366-74. [PMID: 26024800 PMCID: PMC4862201 DOI: 10.1016/j.trsl.2015.04.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Revised: 03/27/2015] [Accepted: 04/01/2015] [Indexed: 11/18/2022]
Abstract
The objective of this study is to assess the relationship between inflammatory disease in granulomatosis with polyangiitis (GPA, Wegener's) and the development of subclinical atherosclerosis. A total of 46 adult patients with GPA were enrolled. Disease status was measured by Birmingham vasculitis assessment scores as modified for GPA, vasculitis damage index, disease duration, and number of relapses. Classic atherosclerotic risk factors, platelet aggregation responses, and circulating microparticle (MP) levels were recorded. All patients underwent carotid artery intima-media thickness (IMT) measurement as outcome for subclinical atherosclerosis. In univariate analyses, systolic and diastolic blood pressure, creatinine, and age were significantly associated with higher IMT (ρ values 0.37, 0.38, 0.35, and 0.054, respectively [P < 0.02 for all]). In a multiple regression model, greater number of relapses, older age at the onset of disease, and higher diastolic blood pressure were found to be associated with higher IMT (P values 0.003, <0.001, and 0.031, respectively). MP counts and platelet reactivity correlated well with disease activity in GPA. Furthermore, MPs were found to activate vascular endothelial cells and platelets in vitro. The cumulative burden of systemic inflammation in GPA correlated with the development of subclinical atherosclerosis. The correlation with subclinical atherosclerosis could be because of glucocorticoid use and not the inflammatory process in GPA, giving the inherent bias that exits with the use of glucocorticoid with each relapse. The findings of increased levels of circulating leukocyte-derived MPs and enhanced platelet reactivity during relapse suggest possible roles for MPs and platelets in disease pathogenesis and support a growing literature that links inflammation, atherosclerosis, and platelet activation. This hypothesis is further substantiated by our demonstration that MPs isolated from plasma of GPA patients can activate platelets and vascular endothelial cells.
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Affiliation(s)
- RA Hajj-Ali
- Cleveland Clinic, 9500 Euclid Avenue, Cleveland Ohio, 44195. USA
| | - J Major
- Cleveland Clinic, 9500 Euclid Avenue, Cleveland Ohio, 44195. USA
| | - CA Langford
- Cleveland Clinic, 9500 Euclid Avenue, Cleveland Ohio, 44195. USA
| | - GS Hoffman
- Cleveland Clinic, 9500 Euclid Avenue, Cleveland Ohio, 44195. USA
| | - T Clark
- Cleveland Clinic, 9500 Euclid Avenue, Cleveland Ohio, 44195. USA
| | - L Zhang
- University of California, San Francisco, 185 Berry Street, Suite 6614, UCSF Box 0981 San Francisco, CA 94107
| | - Z Sun
- Cleveland Clinic, 9500 Euclid Avenue, Cleveland Ohio, 44195. USA
| | - RL Silverstein
- Medical College of Wisconsin 9200 W Wisconsin Avenue Milwaukee, WI 53226
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Du G, Zhu J. [Laryngeal and tracheal stenosis caused by Wegener's granulomatosis]. Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2015; 29:862-864. [PMID: 26281073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Wegener's granulomatosis (WG) is a multisystem disease characterized by necrotizing granulomatous inflammation and vasculitis. WG classically involves the upper airway, lung and kidneys. Otolaryngologic manifestations are often the presenting symptoms in WG, Subglottic stenosis is a less common, but a life-threatening manifestation of WG, This paper studies about the laryngeal and tracheal stenosis diagnosis and surgical treatment of Wegener's granulomatosis in the past 20 years.
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Marzano AV, Balice Y, Tavecchio S, Desimine C, Colombo A, Berti E. Granulomatous vasculitis. GIORN ITAL DERMAT V 2015; 150:193-202. [PMID: 25791629] [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: 06/04/2023]
Abstract
Granulomatosis with polyangiitis (GPA) and eosinophilic granulomatosis with polyangiitis (EGPA), formerly known as Wegener's granulomatosis and Churg-Strauss Syndrome respectively, are systemic granulomatous vasculitides affecting small- and medium-sized blood vessels. Both GPA and EGPA are included within the group of antineutrophilic cytoplasmic antibodies (ANCA)-associated vasculitides, on the basis of the detection of such autoantibodies in a significant proportion of affected patients. Two main settings of GPA, possibly overlapping each other, are recognized: a localized form, which is limited to the upper airways but is highly relapsing and refractory, and a diffuse form, which is initially more severe but then less commonly recurrent. In EGPA, a prodromic phase characterized by asthma and rhino-sinusitis is followed by an eosinophilic phase, marked by peripheral eosinophilia, and then by a vasculitic phase, in which skin lesions are a prominent feature together with peripheral neuropathy and renal involvement. Polymorphic cutaneous manifestations can occur during the course of both GPA and EGPA, and include palpable purpura, livedo reticularis, papules, nodules, vesiculo-bullae and necrotic-ulcerative lesions most commonly involving the lower extremities; pyoderma gangrenosum-like ulcers and lesions resembling erythema multiforme have been described in GPA and EGPA, respectively. Oral involvement is not uncommon in GPA and may manifest as nonspecific erosive lesions or as a hyperplastic gingivitis named strawberry gingivitis. Considering that skin involvement is common in ANCA-associated vasculitides and may also be their presenting sign, the role of dermatologist is crucial in the early diagnosis of these forms as well as of vasculitis in general.
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Affiliation(s)
- A V Marzano
- Operative Unit of Dermatology, Department of Transplantation, Medico-Surgical Physiopathology,University of Milan, Ca' Granda IRCCS Foundation, Ospedale Maggiore Policlinico, Milan, Italy -
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Berriche O, Younes S, Ammari W, Alaya W, Kessomtini W, Hammami S. Présentation atypique d’une granulomatose avec polyangeite: à propos d’une observation pédiatrique. Pan Afr Med J 2015; 21:141. [PMID: 26327978 PMCID: PMC4546791 DOI: 10.11604/pamj.2015.21.141.7086] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2015] [Accepted: 06/07/2015] [Indexed: 11/14/2022] Open
Abstract
La granulomatose avec polyangéite (GPA) est une vascularite nécrosante systémique, caractérisée par une inflammation granulomateuse, une nécrose tissulaire et une vascularite touchant les vaisseaux de moyen et, surtout, de petit calibre, elle touche rarement l'enfant.
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Affiliation(s)
- Olfa Berriche
- Service de Médecine Interne, Hopital Taher Sfar, Mahdia, Tunisie
| | - Samia Younes
- Service de Médecine Interne, Hopital Taher Sfar, Mahdia, Tunisie
| | - Wafa Ammari
- Service d'Ophtalmologie, Hopital, Taher Sfar, Mahdia, Tunisie
| | - Wafa Alaya
- Service de Médecine Interne, Hopital Taher Sfar, Mahdia, Tunisie
| | | | - Sonia Hammami
- Service de Médecine Interne, Hopital Fattouma Bourguiba, Monastir, Tunisie
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Berriche O, Alaya W. Infarctus splénique au cours d’une forme grave de la granulomatose avec polyangéite: à propos d’un cas. Pan Afr Med J 2015; 21:68. [PMID: 26491511 PMCID: PMC4594989 DOI: 10.11604/pamj.2015.21.68.7039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Accepted: 05/21/2015] [Indexed: 11/24/2022] Open
Affiliation(s)
- Olfa Berriche
- Service de Médecine Interne, Hopital Taher Sfar, Mahdia, Tunisie
| | - Wafa Alaya
- Service de Médecine Interne, Hopital Taher Sfar, Mahdia, Tunisie
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Kapoor E, Cartin-Ceba R, Specks U, Leavitt J, Erickson B, Erickson D. Pituitary dysfunction in granulomatosis with polyangiitis: the Mayo Clinic experience. J Clin Endocrinol Metab 2014; 99:3988-94. [PMID: 25077899 DOI: 10.1210/jc.2014-1962] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [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: 02/04/2023]
Abstract
CONTEXT Pituitary involvement in granulomatosis with polyangiitis (GPA) has been described in case reports. The aim of this study was to describe the clinical presentation and outcomes of pituitary disease in patients with GPA evaluated at a tertiary referral center. SETTING A retrospective review of patients with GPA-related pituitary disease seen at the Mayo Clinic in Rochester, Minnesota. PATIENTS A total of 637 patients with antineutrophil cytoplasmic antibodies-associated vasculitis were followed at our institution from 1996 through 2011. Eight patients (1.3%) with clinically confirmed pituitary involvement formed the basis of this study. INTERVENTIONS None. MEASUREMENTS Pituitary function was assessed with hormonal testing, including TSH, free T4, cortisol, ACTH, prolactin, FSH, LH, estradiol, T, IGF-1, and simultaneous serum and urine osmolalities. RESULTS Secondary hypogonadism and diabetes insipidus were the predominant manifestations of pituitary disease (87.5 and 75% of patients, respectively). All patients had abnormal pituitary imaging. A sellar mass with central cystic change and peripheral enhancement was the commonest imaging finding. Pituitary disease was managed with glucocorticoids in combination with cyclophosphamide or rituximab, achieving disease remission in all but one patient. However, permanent anterior pituitary dysfunction was noted in 63% of the patients. Diabetes insipidus was more often reversible, with resolution in 66.7% of the patients. CONCLUSIONS Pituitary involvement in GPA is rare, but it needs to be recognized to avoid unnecessary biopsies of sellar lesions encountered in the context of GPA, and to minimize the risk of irreversible pituitary function loss by prompt implementation of definitive medical therapy for the vasculitis.
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Affiliation(s)
- Ekta Kapoor
- Divisions of General Internal Medicine (E.K.), Pulmonary and Critical Care Medicine (R.C.-C., U.S.) Ophthalmology (J.L.), Radiology (B.E.), and Endocrinology (D.E.), Mayo Clinic, Rochester, Minnesota 55905
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Morović-Vergles J, Culo MI, Sutić A. [Clinical manifestations of antineutrophil cytoplasmic antibodies associated vasculitis]. Lijec Vjesn 2014; 136:228-231. [PMID: 25327013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitides are rare diseases, with the average of 30 new cases per million inhabitants per year. Their main characteristic is systemic involvement with necrosis of the vessel walls (histological changes showing necrosis of the media and inflammation of adventitia and intima). In some forms granulomas may be found surrounding the vessels. ANCA-associated vasculitides include granulomatosis with polyangiitis (GPA, previously called Wegener's), microscopic polyangiitis (MPA) and eosinophilic granulomatosis with polyangiitis (EGPA, previously called Churg-Straus). Honorific eponyms are now changing to a disease-descriptive or etiology-based nomenclature. ANCA-associated vasculitides are a distinctive group of vasculitides because they dominantly involve small sized vessels, sometimes even medium sized vessels, are associated with antineutrophil cytoplasmic antibodies with high risk of developing glomerulonephritis and respond well to immunosuppresion with cyclophosphamide.
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Pisoni CN, Ibañez S, Guevara M, Castro D, Romero Vidomlansky S. Granulomatosis with polyangiitis: recurrence presenting as ependimoplexitis. Clin Exp Rheumatol 2014; 32:S70-S72. [PMID: 24642347] [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] [Received: 08/14/2013] [Accepted: 11/20/2013] [Indexed: 06/03/2023]
Abstract
A 55-year-old man with granulomatosis with polyangiitis (GPA) developed continuous parietal headache, malaise, nasal crusting and dry cough. Neurological exam revealed only left hand hypoesthesia in 4th and 5th finger. Brain MRI showed enlarged right choroid plexus, hyperintense periventricular white matter, thalami and right side of corpus callosum. The suspected diagnosis was ependimoplexitis due to GPA, the patient received three 500 mg methylprednisolone pulses followed by 1 mg/kg of meprednisone with gradual tapering and was switched to oral cyclophosphamide. He had complete resolution of headache. An MRI following this treatment for relapse revealed only minimal ependimal changes.
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Affiliation(s)
- Cecilia N Pisoni
- Section of Rheumatology and Immunology, Centro de Educación Médica e Investigaciones Clínicas (CEMIC), Buenos Aires, Argentina.
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21
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Jethava A, Ali S. Ischemic stroke as a presenting feature of Wegener's granulomatosis. Conn Med 2013; 77:533-535. [PMID: 24266130] [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: 06/02/2023]
Abstract
Wegener's granulomatosis (WG) is an autoimmune disease of unknown origin characterized by necrotizing granuloma of both upper and lower respiratory tracts and glomerulonephritis. Neurological manifestations in the central nervous system (CNS) and peripheral nervous system (PNS) are a rare but well-documented feature of WG in the literature. We describe a 51-old-male who presented with complaints of slurred speech and left-sided weakness, along with bilateral pulmonary nodules on initial chest x-ray, which were associated with pulmonary symptoms in the past. A repeated computed tomography (CT) scan showed ischemia in the distribution of the right-middle cerebral artery. An open lung biopsy showed vasculitis with necrosis of a vessel wall, with a multinucleated giant cell, confirming the diagnosis of WG. The patient was successfully treated with cyclophosphamide and oral prednisone and he has continued in remission for one year.
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Affiliation(s)
- Ashif Jethava
- Department of Hospital Medicine, Saint Francis Hospital and Medical Center, Hartford, USA.
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Nahlieli O. Wegener's granulomatosis and the salivary glands. Isr Med Assoc J 2013; 15:178-179. [PMID: 23662384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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23
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Polachek A, Caspi D, Elkayam O. Granulomatosis and polyangiitis: the rituximab option. Isr Med Assoc J 2013; 15:193-194. [PMID: 23662388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- Ari Polachek
- Department of Rheumatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
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24
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Kenis I, Zahavi T, Korzets Z. Parotid gland involvement as initial presentation of Wegener's granulomatosis: a diagnostic pitfall. Isr Med Assoc J 2013; 15:186-187. [PMID: 23662386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- Irina Kenis
- Department of Nephrology, Meir Medical Center, Kfar Saba, Israel
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25
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Green I, Szyper-Kravitz M, Shoenfeld Y. Parotitis as the presenting symptom of Wegener's granulomatosis: case report and meta-analysis. Isr Med Assoc J 2013; 15:188-192. [PMID: 23662387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- Ilan Green
- Zabludowicz Center for Autoimmune Diseases, Department of Internal Medicine B, Sheba Medical Center, Tel Hashomer, Israel.
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26
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Sugiyama K, Sada KE, Kurosawa M, Wada J, Makino H. Current status of the treatment of microscopic polyangiitis and granulomatosis with polyangiitis in Japan. Clin Exp Nephrol 2013; 17:51-8. [PMID: 22760432 PMCID: PMC3572371 DOI: 10.1007/s10157-012-0651-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2011] [Accepted: 05/28/2012] [Indexed: 01/09/2023]
Abstract
BACKGROUND This study aimed to describe the epidemiologic characteristics of microscopic polyangiitis (MPA) and granulomatosis with polyangiitis (GPA) in Japan. METHODS We used the database of the Ministry of Health, Labour and Welfare (MHLW) from 2006 to 2008, and analyzed data from 938 patients (MPA = 697, GPA = 241) who fulfilled the MHLW diagnostic criteria and had registered within a year after onset. RESULTS The mean ages of the MPA and GPA patients were 69.4 ± 0.4 and 58.4 ± 1.1 years, respectively. Renal (86.9 %), chest (73.7 %), and nervous system (45.2 %) symptoms were common in MPA patients. Ear, nose, and throat (86.7 %), chest (78.0 %), and renal (60.6 %) symptoms were frequently observed in GPA patients. The concomitant use of cyclophosphamide (CY) with corticosteroids was observed in 22.2 % of the MPA patients and 58.5 % of the GPA patients. In multivariate analysis, the concomitant use of CY was associated with a younger age and pulmonary hemorrhage in MPA patients, and the avoidance of CY was associated with nervous system symptoms and rapidly progressive glomerulonephritis in GPA patients. Plasma exchanges were inducted in 5.2 % of the MPA patients and 4.1 % of the GPA patients. The addition of plasma exchange was associated with elevation of the serum creatinine level in patients with both MPA and GPA. CONCLUSION A dominance of MPA and a reduced frequency of renal involvement in GPA patients may be significant features of the Japanese population. Clinical practice relating to MPA and GPA in Japan can be characterized as follows: CY is used less commonly, and plasma exchange is employed for patients with deteriorated renal function.
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Affiliation(s)
- Koichi Sugiyama
- Department of Medicine and Clinical Science, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558 Japan
| | - Ken-ei Sada
- Department of Medicine and Clinical Science, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558 Japan
| | - Michiko Kurosawa
- Department of Epidemiology and Environmental Health, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo Japan
| | - Jun Wada
- Department of Medicine and Clinical Science, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558 Japan
| | - Hirofumi Makino
- Department of Medicine and Clinical Science, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558 Japan
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Kara O, Demirel F, Acar BC, Cakar N. Wegener granulomatosis as an uncommon cause of panhypopituitarism in childhood. J Pediatr Endocrinol Metab 2013; 26:959-62. [PMID: 23729544 DOI: 10.1515/jpem-2013-0033] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2013] [Accepted: 04/18/2013] [Indexed: 11/15/2022]
Abstract
Wegener granulomatosis (WG) is a cytoplasmic antineutrophil cytoplasmic antibody (c-ANCA)-associated, multi-system, necrotizing granulomatous vasculitis. Inflammation of the nasal or oral mucosa, and lung and kidney involvements are typical in the course of the disease. In rare cases, pituitary involvement may occur and cause panhypopituitarism. Pituitary involvement is very rare, and only two pediatric case reports have been published to date out of a total of 24 cases. This is a case report of an adolescent patient who presented with panhypopituitarism symptoms and was later diagnosed with WG. A 16-year-old female patient complained of fever, headache, purulent nasal discharge and severe muscle and joint pain. Additionally, she had polyuria and polydipsia. Investigations revealed a pituitary mass and panhypopituitarism. Positivity of c-ANCA and renal biopsy result compatible with WG confirmed the diagnosis.
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Park JK, Askin F, Giles JT, Halushka MK, Rosen A, Levine SM. Increased generation of TRAP expressing multinucleated giant cells in patients with granulomatosis with polyangiitis. PLoS One 2012; 7:e42659. [PMID: 22905158 PMCID: PMC3414441 DOI: 10.1371/journal.pone.0042659] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2012] [Accepted: 07/10/2012] [Indexed: 11/19/2022] Open
Abstract
Background Tissue-infiltrating multinucleated giant cells (MNGs) within geographic necrosis are pathologic hallmarks of granulomatosis with polyangiitis (GPA). However, the origin, phenotype, and function of these cells in GPA remain undefined. Methodology/Principal Findings MNG phenotype in GPA lung tissue was examined by immunohistochemistry using antibody directed against cathepsin K and calcitonin-receptor. Tartrate-resistant-acid-phosphatase (TRAP) expression was assessed using enzymatic color reaction. Peripheral blood mononuclear cells (PBMCs) from 13 GPA patients (5 with localized and 8 with systemic disease) and 11 healthy controls were cultured in the presence of RANKL and M-CSF for 9 days, and TRAP+ MNGs containing 3 or more nuclei were identified. GPA lung granulomata contained numerous MNGs that expressed osteoclastic TRAP and cathepsin K but not calcitonin receptors. In the presence of RANKL and M-CSF, PBMCs of GPA patients formed significantly more MNGs than healthy controls (114±29 MNG/well vs. 22±9 MNG/well, P = 0.02). In a subgroup analysis, patients with systemic disease generated significantly more MNGs than patients with localized disease (161±35 MNG/well vs. 39±27 MNG/well, P<0.01) or healthy controls (P<0.01). MNG production did not differ between localized GPA and control subjects (P = 0.96). Conclusions/Significance MNGs in granulomata in the GPA lung express osteoclastic enzymes TRAP and cathepsin K. GPA patients have a higher propensity to form TRAP+ MNGs from peripheral blood than healthy controls. These data suggest that (i) the tendency to form MNGs is a component of the GPA phenotype itself, and (ii) that lesional MNGs might participate in the destructive process through their proteolytic enzymes.
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Affiliation(s)
- Jin Kyun Park
- Division of Rheumatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America.
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Baslund B, Wiencke AK, Rasmussen N, Faurschou M, Toft PB. Treatment of orbital inflammation with rituximab in Wegener's granulomatosis. Clin Exp Rheumatol 2012; 30:S7-S10. [PMID: 22272561] [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] [Received: 03/22/2011] [Accepted: 06/21/2011] [Indexed: 05/31/2023]
Abstract
OBJECTIVES To study the efficacy of rituximab therapy for the treatment of orbital inflammation in patients with Wegener's granulomatosis (WG). METHODS Ten WG patients with orbital inflammation were included in this case-series. None had symptoms suggestive of extra-orbital disease activity. Immunosuppressive medication (mycophenolate and prednisolone) was administered to 3 patients at the time of rituximab therapy. Three patients had previously been treated with anti-tumour-necrosis-factor-alpha antibodies, and one of these patients had also received cyclophosphamide as treatment for orbital inflammation. All patients were treated with 1000 mg of rituximab administered twice with an interval of 14 days between the infusions. Six months after therapy, a physical examination and a control computerised tomography (CT) scan was performed. RESULTS All patients had orbital inflammation demonstrated by CT-scan before treatment (3 had bilateral and 7 unilateral orbital involvement). Orbital symptoms at study baseline included pain, pressure sensation behind the eyes, epiphora, diplopia, and affection of the visual acuity. Nine out of ten patients experienced subjective improvement. Four patients (seven eyes) with visual impairment responded to therapy, and the improvement in visual acuity was sustained throughout follow-up (median duration of follow-up: 17 months; range: 6-18 months). At the time of the control CT-scan, size-reduction of the orbital mass was observed in two patients, while the size of the orbital mass was unchanged in eight patients. CONCLUSIONS Rituximab therapy has positive effects on symptoms, visual acuity and/or granuloma size in some WG patients with orbital inflammation. Treatment with rituximab should be considered in WG patients with this serious manifestation of the disease.
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Affiliation(s)
- Bo Baslund
- Department of Rheumatology, Rigshospitalet, Copenahgen, Denmark.
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Abstract
The May COM. A 32-year-old woman with a history of previous mastoid surgery presented with bilateral extremity weakness and ambulatory instability. MRI revealed a dural-based mass completely encircling the upper cervical spinal cord. Workup was significant for an abnormally elevated c-ANCA, positive at a dilution of 1:128. A portion of the lesion was removed by a posterior surgical approach to decompress the cervical cord. Histologic examination of the dura showed a dense granulomatous infiltrate with vasculitis and giant cells; coupled with the positive c-ANCA, the process was felt to be most consistent with Wegener's granulomatosis. Wegener's granulomatosis infrequently involves the dura or meninges and has not previously been reported to affect dura of the cervical cord. Symptomatic improvement followed surgical decompression and high-dose corticosteroid therapy, with resultant resolution of an elevated c-ANCA titer.
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Affiliation(s)
- P J McCarthy
- Department of Pathology, University of Colorado Health Sciences Center, Denver, USA
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Novikov PI, Krivosheev OG, Semenkova EN. [Experience with rituximab treatment (monoclonal antibodies to B-lymphocyte CD20 receptors) of Wegener's granulomatosis patients with renal impairment]. TERAPEVT ARKH 2011; 83:70-76. [PMID: 22312891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
AIM To assess efficacy of rituximab in patients suffering from Wegener's granulematosis (WG) with renal disease. MATERIAL AND METHODS We analysed clinical laboratory data from 9 WG patients with renal disease treated with rituximab in E.M. Tareev clinic. RESULTS The treatment led to a complete remission in 7 (77.8%) patients, a partial remission--in 2 (22.2%) patients. Vasculitis activity regressed including renal damage (a decrease of 24 h proteinurea, enhanced glomerular filtration rate). A prednisolone dose decreased from 38.3 to 10 mg/day (to month 6) and to 7.5 mg/day (to month 12). Non-selective cytostatic drugs were discontinued in all the patients. Recurrences occurred in 3 (33.3%) patients, one with lethal outcome after 6 months of rituximab administration, in two cases one more course of rituximab produced another complete remission. Serious side effects were absent. CONCLUSION Rituximab demonstrated high efficacy in the treatment of WG with renal affection resistant to standard therapy, in multiple side effects of standard immunosuppressive therapy and recurrent course. Rituximab help overcome steroid dependence even at late stages of the disease.
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Koldingsnes W, Jacobsen EA, Sildnes T, Hjalmarsen A, Nossent HC. Pulmonary function and high‐resolution CT findings five years after disease onset in patients with Wegener's granulomatosis. Scand J Rheumatol 2009; 34:220-8. [PMID: 16134729 DOI: 10.1080/03009740410011271] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Although pulmonary involvement is common in Wegener's granulomatosis (WG), little is known about the pulmonary outcome. We evaluated the relationship between clinical disease characteristics and pulmonary function and high-resolution computed tomography (HRCT) findings after disease duration of 5 years. METHODS A pulmonary function test (PFT) and pulmonary HRCT were performed in 41 patients from a population-based register of WG. Clinical predictors for abnormal PFT and HRCT were tested by logistic regression. RESULTS Previous WG-related lung involvement (PLI) had occurred in 80% of patients, but only 24% of patients still reported pulmonary symptoms at the research visit. One-third of patients had abnormal PFT findings, with reduced alveolar diffusion by KCO (transfer coefficient) being most common (24%). The number of PLI episodes was associated with reduced KCO and reduced FEV1% (forced expiratory volume in 1 s as a percentage of forced vital capacity) (overall presence 10%). Reduced KCO was also associated with disease duration. Reduced total lung capacity (TLC) (overall presence 8%) was only related to prior WG-related lung nodules. Pulmonary HRCT was abnormal in 80%, but with more severe abnormalities in only 30%. Pleural thickening and parenchymal bands were associated with PLI. None of the treatment variables was associated with the PFT or HRCT findings. CONCLUSION Five years after disease onset a quarter of the WG patients reported pulmonary symptoms, had severe abnormalities on HRCT, and abnormal PFT. The correlation between these abnormalities was poor, but the number of pulmonary involvements was a risk factor for reduced gas diffusion, obstructive lung disease, parenchymal bands, and pleural thickening. Treatment variables had no discernible negative pulmonary effects.
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Affiliation(s)
- W Koldingsnes
- Department of Rheumatology, University Hospital Northern Norway, Tromsø, Norway.
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Zielonka TM, Demkow U, Zycinska K, Filewska M, Korzeniewska M, Radzikowska E, Bialas-Chromiec B, Kus J, Wardyn KA, Skopinska-Rozewska E. Angiogenic activity of sera from patients with systemic autoimmune diseases in relation to clinical, radiological, and functional pulmonary status. J Physiol Pharmacol 2008; 59 Suppl 6:791-800. [PMID: 19218706] [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] [Received: 06/10/2008] [Accepted: 08/22/2008] [Indexed: 05/27/2023]
Abstract
Systemic autoimmune diseases, such as vasculitis and collagen diseases, are characterized by chronic inflammation. Mutual interrelationship between angiogenesis and chronic inflammation has already been demonstrated. The aim of the study was to examine the effect of sera from patients with systemic autoimmune diseases on angiogenesis induced by human mononuclear cells. The study population consisted of 43 patients with a systemic autoimmune disease associated with pulmonary manifestations, divided into three groups: 14 with Wegener's granulomatosis (WG), 13 with systemic sclerosis (SS), and 16 with collagen vascular diseases (CVD) such as rheumatoid arthritis, systemic lupus erythematosus, and dermatomyositis. The control group consisted of 15 healthy volunteers. Clinical status was evaluated using a questionnaire. Standard chest radiographs were performed in all patients. Pulmonary function tests were performed according to the ERS standards. An animal model of a leukocyte-induced angiogenesis assay was used as an angiogenic test. Sera from WG and CVD patients significantly stimulated angiogenesis compared with healthy subjects (P<0.001). On the other hand, sera from healthy donors exerted a proangiogenic effect compared with PBS. In contrast, sera from SS patients significantly (P<0.001) inhibited angiogenesis compared with sera from healthy subjects and PBS. Proangiogenic effect of sera from systemic diseases patients depended on radiological changes. No significant correlation between a degree of dyspnea or functional pulmonary tests and the number of new vessels or angiogenesis index was found. Sera from patients with systemic autoimmune diseases and healthy people constitute the source of mediators modulating angiogenesis. These modulatory effects differ depending on the disease entity.
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Affiliation(s)
- T M Zielonka
- Department of Family Medicine, Warsaw Medical University, Warsaw, Poland.
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Abstract
PURPOSE To report three cases of sclerosing Wegener's granulomatosis in the orbit and to compare the histopathological morphology with those of other types of sclerosing orbital inflammation. METHODS We analysed the clinical data along with histopathological specimens from orbital biopsies and from two enucleated eyes. RESULTS All three patients had longstanding inflammation in the orbit and involvement of the paranasal sinuses. Proptosis, impaired ocular motility and reduced visual acuity dominated the clinical picture. All histopathological specimens featured granulomatous inflammation, tissue necrosis, vasculitis and widespread dense fibrosis. In certain areas of all specimens the fibrous tissue was arranged in characteristic concentric, onionskin-like whorls of collagen around obliterated small blood vessels. CONCLUSIONS Wegener's granulomatosis may lead to orbital fibrosis and sclerosis. The stromal changes and cellular infiltrate resemble the non-specific orbital inflammation previously termed orbital pseudotumour. We present the first 'onionskin' lesions in association with Wegener's granulomatosis in the orbit. This latter morphology may represent an abnormal fibrotic reaction in inflammatory tissue.
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Affiliation(s)
- Christoffer Ostri
- Department of Neuroscience and Pharmacology, Eye Pathology Section, University of Copenhagen, Copenhagen, Denmark
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Abstract
Infections are associated with secondary forms of vasculitis. However, there is increasing evidence that microbial agents play a role also in primary systemic vasculitides. For a long time it has been noted that Hepatitis B virus (HBV) is involved in polyarteritis nodosa (PAN) although the incidence of HBV-associated PAN seems to decline. Cryoglobulinemic vasculitis has been shown to be strongly associated with Hepatitis C Virus (HCV) infection, but this is most striking in Southern Europe and less in Northern Europe. Different microbial agents have been suggested to influence disease expression in other primary vasculitides but no specific association has been established. In Wegener’s Granulomatosis (WG) chronic carriage of Staphylococcus aureus (S. aureus) is associated with a strongly increased risk for relapsing disease. Various pathogenic pathways for this association have been suggested by clinical and experimental observations. Recent studies even suggest that S. aureus derived peptides, amongst others, may induce proteinase 3-ANCA via idiotypic–anti-idiotypic interactions. Treatment with co-trimoxazole in WG localized to the upper airways may result in (temporary) remission of the disease.
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Affiliation(s)
- Cees G M Kallenberg
- Department of Rheumatology and Clinical Immunology, University Medical Center Groningen, University of Groningen, The Netherlands.
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Pagnoux C. [Wegener's granulomatosis and microscopic polyangiitis]. Rev Prat 2008; 58:522-532. [PMID: 18524109] [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: 05/26/2023]
Abstract
Wegener's granulomatosis and microscopic polyangiitis are among the main systemic necrotizing vasculitides predominantly affecting small vessels. Their prevalences range from 24 to 157 cases per million inhabitants. Mean age at onset is usually 40 to 60 years old. Most common and suggestive features of Wegener's granulomatosis are upper (sinusitis, crusting rhinitis, saddle nose deformity, otitis media) and lower (excavated lung nodules, alveolar hemorrhage) respiratory tract, and kidney involvements. Alveolar hemorrhage and crescentic necrotizing glomerulonephritis are also characteristic manifestations of microscopic polyangiitis. Mononeuritis multiplex and necrotic purpura are frequent symptoms in both diseases. Antineutrophil cytoplasm autoantibodies (ANCA) directed against proteinase 3 can be found in the serum of 90% of the patients with diffuse forms of Wegener's granulomatosis, whereas ANCA with anti-myeloperoxidase specificity, whose pathogenic role is now well documented, can be detected in more than 60% of those with microscopic polyangiitis. Histologically, Wegener's granulomatosis can be differentiated from its counterpart when the inflammatory infiltrates have a granulomatous pattern. Therapy relies on the combination of corticosteroids and pulse intravenous cyclophosphamide, which can be switched, as soon as remission is achieved, to azathioprine or methotrexate, for a total duration of treatment of at least 18 months. Ten-year survival rate now exceeds 80%, but relapses are frequent. The precise place of new biologics, such as rituximab, needs to be further defined.
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Affiliation(s)
- Christian Pagnoux
- Centre de référence maladies auto-immunes et maladies systémiques rares, vascularites nécrosantes et sclérodermie systémique, pôle de médecine, hôpital Cochin, Université Paris-5, Paris.
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Chen M, Yu F, Zhao MH. Relapses in patients with antineutrophil cytoplasmic autoantibody-associated vasculitis: likely to begin with the same organ as initial onset. J Rheumatol 2008; 35:448-450. [PMID: 18085730] [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: 05/25/2023]
Abstract
OBJECTIVE In antineutrophil cytoplasmic antibody-associated vasculitis (AAV), relapses constitute a challenge despite initial good control. Our objective was to investigate whether patients with relapses shared the same initial organ involvement. METHODS One hundred sixty patients with AAV in our center were investigated. Of these 160, 38 experienced relapse during followup. Clinical and laboratory data were analyzed. RESULTS Among the 38 patients, there was a total of 55 relapse events, 39 (70.9%) of which had the same initial organ as in the initial onset. CONCLUSION Relapses in AAV were likely to begin with the same organ as in the initial onset; this facilitates early recognition of relapses.
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Affiliation(s)
- Min Chen
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China
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Kim SY, Linton JM, Kolasinski SL. Successful treatment of new onset Wegener's granulomatosis with IVIG (intravenous immunoglobulin) during pregnancy: a case report. Mod Rheumatol 2008; 18:177-80. [PMID: 18299958 DOI: 10.1007/s10165-008-0020-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2007] [Accepted: 10/05/2007] [Indexed: 01/31/2023]
Abstract
We describe a patient with limited Wegener's granulomatosis (WG) presenting during pregnancy with aggressive cutaneous involvement. She was treated with a combination of high-dose corticosteroids and intravenous immunoglobulin (IVIG) during her third trimester. The patient had otherwise uneventful pregnancy and a satisfactory outcome for both herself and her newborn. In the English literature, prior to this report, there have been de novo cases of WG in pregnant women that were diagnosed and treated during pregnancy and three cases of WG treated successfully with IVIG during pregnancy.
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Affiliation(s)
- Seo Young Kim
- Division of Rheumatology, Department of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA.
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Bogaczewicz J, Sysa-Jedrzejowska A, Woźniacka A. [Role of matrix metalloproteinases in primary systemic vasculitis]. Pol Merkur Lekarski 2008; 24:85-89. [PMID: 18634260] [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: 05/26/2023]
Abstract
Primary systemic vasculitis comprise a group of diseases such as Wegener's granulomatosis, Kawasaki disease, Takayasu arteritis, giant cell arteritis with various clinical manifestations, and an etiology not fully understood. The pathogenesis involves an inflammatory infiltration of the vessel wall, which results in its damage. Matrix metalloproteinases seem to participate not only in the degradation of structural components of a vessel wall which leads to bleeding and/or aneurysmal dilatation. In addition, they play a significant role in the in inflammatory cells migration and development of inflammatory infiltration. This process, and the proliferation and migration of smooth muscle cells may result in the narrowing of the affected vessels. This article outlines the role of matrix metalloproteinases in primary systemic vasculitis.
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Affiliation(s)
- Avnesh S Thakor
- Department of Renal Medicine, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK.
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Yildiz M, Soy M, Kürüm T, Yildiz BS. Arterial distensibility in Wegener's granulomatosis: a carotid-femoral pulse wave velocity study. Anadolu Kardiyol Derg 2007; 7:281-5. [PMID: 17785217] [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: 05/17/2023]
Abstract
OBJECTIVE The purpose of this study was to test the hypothesis; that chronic inflammation may impair vascular function and lead to an increase of arterial pulse wave velocity (PWV) in patients with Wegener's granulomatosis (WG). METHODS We recruited 5 patients with WG and 5 healthy age and sex matched controls in this cross-sectional case-controlled study. Aortic PWV was determined by using an automatic device (Complior Colson, France), which allowed on-line pulse wave recording and automatic calculation of PWV. RESULTS The carotid-femoral (aortic) PWV was increased in patients with WG as compared with control group (p=0.04). Although we found positive correlation between PWV and heart rate (r=0.75, p=0.01), we did not find any significant correlation between PWV and anthropometric and other hemodynamic parameters (p>0.05). In addition, we found positive correlation between PWV and erythrocyte sedimentation rate in patients with WG (r=0.90, p=0.03). CONCLUSION Pulse wave velocity is increased and arterial distensibility decreased in patients with WG. Measurements of carotid-femoral (aortic) PWV may provide an easy and noninvasive technique to identify patients at increased risk of arterial disease.
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Affiliation(s)
- Mustafa Yildiz
- Sakarya University School of Health, Sakarya, and Department of Internal Medicine, Dr Lütfi Kirdar Kartal Educational and Research Hospital, Istanbul, Turkey.
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Vardar SA. Carotid-femoral pulse wave velocity in patients with Wegener's granulomatosis. Anadolu Kardiyol Derg 2007; 7:286. [PMID: 17785218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
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Abstract
Systemic inflammatory diseases represent a large group of rare diseases that may involve all organs and also the heart. The three layers of the heart can be affected and some manifestations such as pericarditis in systemic lupus erythematosus are rather well known, yet others are not known even for cardiologists. Modern sophisticated imaging techniques reveal cardiac abnormalities in most of these diseases and the reported frequency of cardiac involvement ranges widely depending upon the applied diagnostic methods and selection of patients. The clinical significance of these findings is not always established. However, better knowledge and awareness of cardiac involvement is necessary because it conveys a major risk for mortality in several of these rare diseases.
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Affiliation(s)
- Daniel C Knockaert
- Department of General Internal Medicine, University Hospital Gasthuisberg, Herestraat 49, 3000 Leuven, Belgium.
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Abstract
PURPOSE To provide nurse practitioners with a basic understanding of the clinical presentation, diagnosis, diagnostic testing, pharmacological treatment, and prevalence of Wegener's granulomatosis (WG). DATA SOURCES Published research and clinical articles, and a case report. CONCLUSIONS WG is a systemic disease characterized by vasculitis, necrosis, and granulomas. The diagnosis of WG is difficult, particularly early in the disease process. In order to confirm the diagnosis, the patient should undergo specific tests such as antineutrophil cytoplasm antibodies, erythrocyte sedimentation rate, C-reactive protein, and biopsy of the tissue involved. IMPLICATIONS FOR PRACTICE The diagnosis of WG is often delayed because of the vague symptoms on presentation. Initial symptoms, such as chronic fatigue, upper respiratory infection, sinusitis, and otitis media are common and may not be alarming. Recognizing symptoms, ordering diagnostic tests, and providing appropriate pharmacological therapy is key to diagnosing and treating WG.
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Sebastian JK, Mahr AD, Ahmed SS, Stone JH, Romay-Penabad Z, Davis JC, Hoffman GS, McCune WJ, St Clair EW, Specks U, Spiera R, Pierangeli S, Merkel PA. Antiendothelial cell antibodies in patients with Wegener's granulomatosis: prevalence and correlation with disease activity and manifestations. J Rheumatol 2007; 34:1027-31. [PMID: 17444585] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
OBJECTIVE Previous studies in small cohorts of patients with Wegener's granulomatosis (WG) or antineutrophil cytoplasmic antibody (ANCA) associated vasculitis have yielded conflicting data regarding the prevalence of antiendothelial cell antibodies (AECA), ranging from 8% to 100%, and the use of AECA as a measure of disease activity. We examined a large, well-characterized cohort of patients with WG and active disease for the presence of AECA. METHODS Serum from subjects with WG who participated in a clinical therapeutic trial was collected at baseline, when all subjects had active disease. Clinical manifestations and disease activity were documented using the Birmingham Vasculitis Activity Score for WG (BVAS/WG). Serum AECA (IgG) was measured by cyto-ELISA using unfixed human umbilical vein endothelial cells (HUVEC). The AECA positivity cutoff was determined using 71 healthy control samples. Statistical analyses utilized Student's t test, chi-square and Fisher's exact tests, and linear regression. RESULTS AECA were detected in 34 of 173 (20%) evaluated serum samples. Mean BVAS/WG did not differ between patients with (7.3 +/- 3.2) or without AECA (7.0 +/- 3.3) (p = 0.58). Among the 34 patients positive for AECA, the antibody titer did not correlate with disease activity (BVAS/WG; r = 0.09, p = 0.60). There were no statistically significant differences in the frequency of major clinical manifestations between patients with or without AECA. CONCLUSION AECA, as measured using HUVEC, are not highly prevalent among patients with active WG, are not associated with specific clinical manifestations, and do not correlate with level of disease activity.
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Abstract
Biological therapies enable us to apply highly selective targeting components to modulate the immune response. Until now, a few controlled studies investigated the efficacy of TNF-alpha blocking agents in systemic vasculitis have been carried out, but, in general, they were falling short of expectations. However, there is conducive evidence that TNF-alpha blockers are advantageous in antineutrophil cytoplasmic antibodies (ANCA)-associated vasculitis, at least in selected disease stages. Likewise, although the efficacy of the monoclonal CD20 antibody rituximab in ANCA-associated vasculitis is obvious, the effect on predominantly granulomatous disease activity in Wegener's granulomatosis is less clear. In addition, interferon-alpha is used for induction treatment particularly in Churg-Strauss syndrome. Even though the effectiveness and safety of short-term administration was confirmed by case series, severe side effects after long-term treatment relativized the initial results. This review presents the recent data on the use of biologicals in vasculitis and appraises the knowledge in the clinical context.
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MESH Headings
- Antibodies, Antineutrophil Cytoplasmic/adverse effects
- Antibodies, Antineutrophil Cytoplasmic/immunology
- Antibodies, Antineutrophil Cytoplasmic/physiology
- Antibodies, Monoclonal/adverse effects
- Antibodies, Monoclonal/blood
- Antibodies, Monoclonal/therapeutic use
- Antibodies, Monoclonal, Murine-Derived
- Antirheumatic Agents/adverse effects
- Antirheumatic Agents/therapeutic use
- Biological Therapy/methods
- Churg-Strauss Syndrome/drug therapy
- Etanercept
- Granulomatosis with Polyangiitis/drug therapy
- Granulomatosis with Polyangiitis/etiology
- Granulomatosis with Polyangiitis/physiopathology
- Humans
- Immunoglobulin G/adverse effects
- Immunoglobulin G/blood
- Immunoglobulin G/therapeutic use
- Immunologic Factors/therapeutic use
- Infliximab
- Interferon-alpha/therapeutic use
- Randomized Controlled Trials as Topic
- Receptors, Tumor Necrosis Factor/blood
- Receptors, Tumor Necrosis Factor/therapeutic use
- Rituximab
- Tumor Necrosis Factor-alpha/antagonists & inhibitors
- Tumor Necrosis Factor-alpha/blood
- Tumor Necrosis Factor-alpha/immunology
- Vasculitis/drug therapy
- Vasculitis/etiology
- Vasculitis/immunology
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Affiliation(s)
- Peer M Aries
- University Hospital Schleswig-Holstein, Campus Luebeck, Department of Rheumatology and Rheumaklinik Bad Bramstedt, Ratzeburger Allee 160, 23538 Lübeck, Germany.
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Abstract
AIMS Anemia is commonly observed among patients with chronic kidney disease (CKD). No such information is available for patients with a history of systemic vasculitis. METHODS We examined the prevalence of anemia, the response to therapy with erythropoiesis-stimulating agents (ESA), and the association of anemia with the kidney function in clinically stable patients with Wegener's granulomatosis in a retrospective, single-center study. RESULTS The mean hemoglobin concentration of 36 patients (mean age: 58 years; 15 female, 21 male; mean duration of disease: 4.6 years) was 13.0+/-2.1 g/dl, and the mean estimated glomerular filtration rate (eGFR) was 41+/-21 ml/min/1.73 m(2). 14 of 36 patients (38.8%) presented with anemia (hemoglobin concentration < 12 g/dl in women, < 13 g/dl in men, or ESA therapy). In patients with a CKD Stage 3 or 4, anemia was present about twice as much as compared to the Third National Health and Nutrition Examination Survey (NHANES III) population. The hemoglobin concentration, however, was not associated with a change of kidney function (p = 0.1578). CONCLUSIONS We found a higher prevalence of anemia in patients with Wegener's granulomatosis, as compared to the NHANES III population. The hemoglobin concentrations showed no association with changes of kidney function.
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Affiliation(s)
- M Riegersperger
- Division of Nephrology and Dialysis, Department of Medicine Ill, Medical University Vienna, Währinger Gürtel 18 - 20, 1090 Vienna, Austria.
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