POS0834 COMPARISON OF NOVEL INFLAMMATORY MARKERS IN IDIOPATHIC AND SECONDARY LEUKOCYTOCLASTIC VASCULITIS

Background

Positive diagnosis of Leukocytoclastic vasculitis (LV) is easy to establish via cutaneous biopsy, while etiologic diagnosis can be quiet challenging which leads to a still concerning high rate of idiopathic LV (ILV). Novel inflammatory Ratios such as platelet to lymphocyte ratio (PLR), neutrophil to lymphocyte ratio (NLR), C-reactive protein (CRP) to albumin ratio (CAR) and Fibrinogen to albumin ratio (FAR) have been recently described in multiple inflammatory pathologies, but their description and role in distinguishing idiopathic and secondary LV (SLV) is yet to be explored.

Objectives

We conducted a study aiming to compare new inflammatory markers and their potential role in distinguishing both LV subtypes.

Methods

Cross sectional study in which LV diagnosis was retained on cutaneous biopsy examination from January 2001 to November 2020. Patient’s clinical assessment and laboratory data measured for each patient included age and sex, aspect and extent of the LV cutaneous lesions, neutrophil (N) count, lymphocyte (L) count, platelet (PLT) count, CRP, albumin (ALB), gammaglobulin (GG). PLR, NLR, CAR and FAR were calculated according to the results of individual items. We have also defined the number of positive aetiological examination (NPE) as the sum in a unique patient of the positive para clinical examinations involved in the etiological assessment of LV.

Categorical variables were compared with the χ2 -test. Comparisons of the differences of continuous variables were performed by the Mann–Whitney U test or Student’s t-test. Pearson correlation ratio was used for linear correlation analysis.

Results

A total of 77 patients were included in this study with 52 patients in the SLV group and 25 patients in the ILV group, demographic and clinical characteristics of both groups were distributed respectively as followed: mean age at diagnosis was 44+/-18 vs 49+/-21, gender ratio was at 29/23 vs 11/14, petechial aspect (89% vs 92%), ecchymotic aspect (64% vs 52%), necrotic aspect (46% vs 28%), extent to the trunk (31% vs 46%) and extend to upper limbs (50% vs 55%), none of these differences were statistically significant (p>0.05).

Aetiologies of SLV were distributed as followed: IGA vasculitis 16 cases, Sjogren’s syndrome 6 cases, Systemic lupus erythematous and cryoglobulinemia 5 cases each, Viral hepatitis and infectious endocarditis 3 cases each, rheumatoid arthritis, granulomotosis with polyangeitis, post streptococcal and chlamydia infection 2 cases each, Castleman’s disease, tuberculosis, lymphoma, primary APS, periarteritis nodosa and parvovirus B19 infection 1 case each.

Comparison of PLR, NLR, CAR and FAR showed statistically significant difference in means between SLV and ILV groups with 199 (177-309) vs 127 (79-193) (p=0.01) for PLR, 3.6 (1.9-5.1) vs 2.3 (1.7-3.4) (p=0.048) for NLR, 1.9mg.g-1 (0.4-3.6) vs 0.6mg.g-1 (0.2-1.9) (p=0.043) for CAR, 156mg.g-1 (91-192) vs 108mg.g-1 (82-148) (p=0.034) for FAR.

PLR, CAR and FAR were significantly positively correlated to NPE (r=0.463, P<0.001; r=0.434, P<0.001 and r=0.411, P<0.001 respectively), there was no significant correlation between NLR and NPE (r=0.165, P=0.151).

Conclusion

In conclusion, this is the first study to explore the role of PLR, NLR, CAR and FAR in LV, it demonstrates that elevation of these ratios is a good predictor of SLV and that PLR, CAR and FAR were correlated with NPE in LV, which leads us to suggest to exhaustively explore patients with elevated ratios in order to make sure not to miss any underlying aetiology and provide more specific management for LV patients.

Disclosure of Interests

None declared

AB1362 LOCATION AND NUMBER OF SARCOIDOSIS GRANULOMA, A POSSIBLE DIAGNOSTIC ARGUMENT?

Background

Sarcoidosis is a non-necrotizing granulomatous disease which diagnosis is often challenging and requires elimination of other causes of granulomatous lesions. Location and number of granulomatous lesions in patients are not yet established as arguments in diagnosing this disease.

Objectives

We therefor conducted a study aiming to compare locations and number of granulomas between patients with sarcoidosis and patients with other granulomatous diseases (OGD).

Methods

Cross sectional study in which were included patients in whom non-necrotizing granulomatous lesions have been identified via biopsy over a period of 11 years (2010 to 2021) then were stratified into two groups: sarcoidosis group and OGD group. Categorical variables were compared with the χ2 –test or Fisher’s test. Comparisons of the differences of continuous variables were performed by the Mann–Whitney U test or Student’s t-test. Pearson correlation ratio was used for linear correlation analysis.

Results

30 patients were included in the sarcoidosis group and 32 in the OGD group.

Aetiologies in the OGD group were: 10 tuberculosis cases, 5 lymphoma cases, 4 Primary biliary cholangitis cases, 1 Castleman’s disease and 12 idiopathic granulomas.

Mean age was respectively in both groups 51+/-13 versus 57+/-17 years old (p=0.128), sex ratio (F/M) was 29/1 versus 27/5 (p=0.197).

Associated signs were distributed in both groups as followed: 11(37%) versus 5(16%) general signs (p=0.085), 15(50%) versus 20(63%) lymphadenopathy (p=0.442), 4(13%) versus 6(19%) inflammatory arthralgias (p=0.733), 13(43%) versus 2(6%) cutaneous lesions (p=0.001), 4 versus no ocular manifestations (p=0.049), 20 (66%) versus 3(9%) pulmonary manifestations (p<0.001), 5 (17%) versus 10 (31%) abdominal manifestations (p=0.239).

Cutaneous, salivary gland and ENT granulomas were significantly more frequent in patients with sarcoidosis with respectively 11(37%) versus 1 (3%) (12.3 risk ratio 95%CI 10.4 to 14.4)(p=0.001), 8 (27%) versus 0% (p=0.002), 8(27%) versus 2(6%) (4.5 risk ratio 95% CI 3.1 to 5.9)(p=0.025).

Lymph node, hepatic and pulmonary granulomas prevalence was not significantly higher in sarcoidosis patients, 17 (57%) versus 24 (75%) (p=0.180), 2 (7%) versus 5 (16%)(p=0.427), 3(10%) versus 0%(p=0.308).

Mean number of granulomas found in one patient was significantly higher in sarcoidosis patients with 1.7 (95% CI 1.5 to 2) versus 1.1 (95%CI 1 to 1.2) (p=0.001).

There was also a significant correlation between the number of granulomas in one patient and the angiotensin converting enzyme titres (r=0.566, 95% CI 0.360 to 0.771); (p=004).

Conclusion

This study shows that sarcoidosis patients have more often granulomas in the skin, salivary gland and ENT regions, and that the number of granulomas is on average superior in sarcoidosis than in OGD, these findings could be considered when establishing future diagnostic algorithms, as taking into account these elements could ease this diagnostic challenge in clinical practice.

Disclosure of Interests

None declared

[Refractory Sweet syndrome complicated by monoclonal gammopathy of undetermined significance]

The association between Sweet syndrome and monoclonal gammopathy of undetermined significance (MGUS) is exceptional. We report the case of a 44 years-old woman in whom recurrent Sweet syndrome was complicated by monoclonal gammopathy of undetermined significance (MGUS) after 3 years of evolution.