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Vitale A, Caggiano V, Martin-Nares E, Frassi M, Dagna L, Hissaria P, Sfriso P, Hernández-Rodríguez J, Ruiz-Irastorza G, Monti S, Tufan A, Piga M, Giardini HAM, Lopalco G, Viapiana O, De Paulis A, Triggianese P, Vitetta R, de-la-Torre A, Fonollosa A, Caroni F, Sota J, Conticini E, Sbalchiero J, Renieri A, Casamassima G, Wiesik-Szewczyk E, Yildirim D, Hinojosa-Azaola A, Crisafulli F, Franceschini F, Campochiaro C, Tomelleri A, Callisto A, Beecher M, Bindoli S, Baggio C, Gómez-Caverzaschi V, Pelegrín L, Soto-Peleteiro A, Milanesi A, Vasi I, Cauli A, Antonelli IPDB, Iannone F, Bixio R, Casa FD, Mormile I, Gurnari C, Fiorenza A, Mejia-Salgado G, Kawakami-Campos PA, Ragab G, Ciccia F, Ruscitti P, Bocchia M, Balistreri A, Tosi GM, Frediani B, Cantarini L, Fabiani C. Orbital/ocular inflammatory involvement in VEXAS syndrome: Data from the international AIDA network VEXAS registry. Semin Arthritis Rheum 2024; 66:152430. [PMID: 38554594 DOI: 10.1016/j.semarthrit.2024.152430] [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] [Received: 11/28/2023] [Revised: 01/24/2024] [Accepted: 03/07/2024] [Indexed: 04/01/2024]
Abstract
VEXAS syndrome is a recently described monogenic autoinflammatory disease capable of manifesting itself with a wide array of organs and tissues involvement. Orbital/ocular inflammatory manifestations are frequently described in VEXAS patients. The objective of this study is to further describe orbital/ocular conditions in VEXAS syndrome while investigating potential associations with other disease manifestations. In the present study, twenty-seven out of 59 (45.8 %) VEXAS patients showed an inflammatory orbital/ocular involvement during their clinical history. The most frequent orbital/ocular affections were represented by periorbital edema in 8 (13.6 %) cases, episcleritis in 5 (8.5 %) patients, scleritis in 5 (8.5 %) cases, uveitis in 4 (6.8 %) cases, conjunctivitis in 4 (6.8 %) cases, blepharitis in 3 (5.1 %) cases, orbital myositis in 2 (3.4 %) cases. A diagnosis of systemic immune-mediated disease was observed in 15 (55.6 %) cases, with relapsing polychondritis diagnosed in 12 patients. A significant association was observed between relapsing polychondritis and orbital/ocular involvement in VEXAS syndrome (Relative Risk: 2.37, 95 % C.I. 1.03-5.46, p = 0.048). Six deaths were observed in the whole cohort of patients after a median disease duration of 1.2 (IQR=5.35) years, 5 (83.3 %) of which showed orbital/ocular inflammatory involvement. In conclusion, this study confirms that orbital/ocular inflammatory involvement is a common finding in VEXAS patients, especially when relapsing polychondritis is diagnosed. This makes ophthalmologists a key figure in the diagnostic process of VEXAS syndrome. The high frequency of deaths observed in this study seems to suggest that patients with orbital/ocular involvement may require increased attention and more careful follow-up.
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Affiliation(s)
- Antonio Vitale
- Department of Medical Sciences, Surgery and Neurosciences, Research Center of Systemic Autoinflammatory Diseases and Behçet's Disease Clinic, University of Siena, Siena, Italy; Rheumatology Unit, Policlinico "Le Scotte", Azienda Ospedaliero-Universitaria Senese [European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory and Autoimmune Diseases (RITA) Center] Siena, viale Bracci 16, Siena 53100, Italy
| | - Valeria Caggiano
- Department of Medical Sciences, Surgery and Neurosciences, Research Center of Systemic Autoinflammatory Diseases and Behçet's Disease Clinic, University of Siena, Siena, Italy; Rheumatology Unit, Policlinico "Le Scotte", Azienda Ospedaliero-Universitaria Senese [European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory and Autoimmune Diseases (RITA) Center] Siena, viale Bracci 16, Siena 53100, Italy
| | - Eduardo Martin-Nares
- Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Micol Frassi
- Rheumatology and Clinical Immunology, Spedali Civili and Department of Clinical and Experimental Sciences, University of Brescia, [European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory and Autoimmune Diseases (RITA) Center], Brescia, Italy
| | - Lorenzo Dagna
- Division of Immunology, Transplants and Infectious Diseases, Università Vita-Salute San Raffaele, Milan, Italy; Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS Ospedale San Raffaele, [European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory and Autoimmune Diseases (RITA) Center], Milan, Italy
| | - Pravin Hissaria
- Department of Clinical Immunology and Allergy, Royal Adelaide Hospital, Adelaide, Australia; Department of Immunopathology, SA Pathology, Adelaide, Australia
| | - Paolo Sfriso
- Rheumatology Unit, Department of Medicine, University of Padua, [European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory and Autoimmune Diseases (RITA) Center], Padua, Italy
| | - José Hernández-Rodríguez
- Clinical Unit of Autoinflammatory Diseases, Department of Autoimmune Diseases, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Hospital Clínic of Barcelona [European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory and Autoimmune Diseases (RITA) Center], University of Barcelona, Barcelona, Spain
| | - Guillermo Ruiz-Irastorza
- Faculty of Medicine and Nursery, University of the Basque Country, UPV/EHU, Leioa, Biscay, Spain; Autoimmune Diseases Unit, Biocruces Bizkaia Health Research Institute, Barakaldo, Biscay, Spain
| | - Sara Monti
- Division of Rheumatology, Fondazione IRCCS Policlinico San Matteo, [European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory and Autoimmune Diseases (RITA) Center], Pavia, Italy; Department of Internal Medicine and Therapeutics, Università di Pavia, Italy
| | - Abdurrahman Tufan
- Department of Internal Medicine, Division of Rheumatology, Gazi University Hospital, Ankara, Turkiye
| | - Matteo Piga
- Rheumatology Unit, Department of Medical Sciences, University and AOU of Cagliari, Cagliari, Italy
| | - Henrique A Mayrink Giardini
- Rheumatology Division, Faculdade de Medicina, Hospital das Clínicas, Universidade de São Paulo, São Paulo, Brazil
| | - Giuseppe Lopalco
- Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J) Policlinic Hospital, University of Bari, Bari, Italy
| | - Ombretta Viapiana
- Rheumatology Unit, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Italy
| | - Amato De Paulis
- Department of Translational Medical Sciences, Section of Clinical Immunology, University of Naples Federico II, Naples, Italy; Center for Basic and Clinical Immunology Research (CISI), WAO Center of Excellence, University of Naples Federico II, Naples, Italy
| | - Paola Triggianese
- Rheumatology, Allergology and Clinical Immunology, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy; Molecular Medicine and Applied Biotechnology, University of Rome Tor Vergata, Rome, Italy
| | - Rosetta Vitetta
- Unit of Rheumatology, ASL VC Sant' Andrea Hospital, Vercelli 13100, Italy
| | - Alejandra de-la-Torre
- Neuroscience Research Group (NEUROS), NeuroVitae Center, Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia
| | - Alex Fonollosa
- Department of Ophthalmology, Biocruces Bizkaia Health Research Institute, Cruces University Hospital, University of the Basque Country, Barakaldo, Spain
| | - Federico Caroni
- Rheumatology Unit, Policlinico "Le Scotte", Azienda Ospedaliero-Universitaria Senese [European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory and Autoimmune Diseases (RITA) Center] Siena, viale Bracci 16, Siena 53100, Italy; Hematology Unit, Azienda Ospedaliera Universitaria Senese, University of Siena, Siena 53100, Italy
| | - Jurgen Sota
- Department of Medical Sciences, Surgery and Neurosciences, Research Center of Systemic Autoinflammatory Diseases and Behçet's Disease Clinic, University of Siena, Siena, Italy; Rheumatology Unit, Policlinico "Le Scotte", Azienda Ospedaliero-Universitaria Senese [European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory and Autoimmune Diseases (RITA) Center] Siena, viale Bracci 16, Siena 53100, Italy
| | - Edoardo Conticini
- Department of Medical Sciences, Surgery and Neurosciences, Research Center of Systemic Autoinflammatory Diseases and Behçet's Disease Clinic, University of Siena, Siena, Italy; Rheumatology Unit, Policlinico "Le Scotte", Azienda Ospedaliero-Universitaria Senese [European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory and Autoimmune Diseases (RITA) Center] Siena, viale Bracci 16, Siena 53100, Italy
| | - Jessica Sbalchiero
- Department of Medical Sciences, Surgery and Neurosciences, Research Center of Systemic Autoinflammatory Diseases and Behçet's Disease Clinic, University of Siena, Siena, Italy; Rheumatology Unit, Policlinico "Le Scotte", Azienda Ospedaliero-Universitaria Senese [European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory and Autoimmune Diseases (RITA) Center] Siena, viale Bracci 16, Siena 53100, Italy
| | - Alessandra Renieri
- Rheumatology Unit, Policlinico "Le Scotte", Azienda Ospedaliero-Universitaria Senese [European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory and Autoimmune Diseases (RITA) Center] Siena, viale Bracci 16, Siena 53100, Italy; Medical Genetics, Department of Medical Biotechnologies, University of Siena, Siena, Italy; Department of Medical Biotechnologies, Med Biotech Hub and Competence Center, University of Siena, Siena, Italy; Genetica Medica, Azienda Ospedaliero-Universitaria Senese, Siena, Italy
| | - Giulia Casamassima
- Rheumatology Unit, Policlinico "Le Scotte", Azienda Ospedaliero-Universitaria Senese [European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory and Autoimmune Diseases (RITA) Center] Siena, viale Bracci 16, Siena 53100, Italy; Medical Genetics, Department of Medical Biotechnologies, University of Siena, Siena, Italy; Department of Medical Biotechnologies, Med Biotech Hub and Competence Center, University of Siena, Siena, Italy; Genetica Medica, Azienda Ospedaliero-Universitaria Senese, Siena, Italy
| | - Ewa Wiesik-Szewczyk
- Department of Internal Medicine, Pneumonology, Allergology and Clinical Immunology, Central Clinical Hospital of the Ministry of National Defense, Military Institute of Medicine, National Research Institute, Warsaw, Poland
| | - Derya Yildirim
- Department of Internal Medicine, Division of Rheumatology, Gazi University Hospital, Ankara, Turkiye
| | - Andrea Hinojosa-Azaola
- Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Francesca Crisafulli
- Rheumatology and Clinical Immunology, Spedali Civili and Department of Clinical and Experimental Sciences, University of Brescia, [European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory and Autoimmune Diseases (RITA) Center], Brescia, Italy
| | - Franco Franceschini
- Rheumatology and Clinical Immunology, Spedali Civili and Department of Clinical and Experimental Sciences, University of Brescia, [European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory and Autoimmune Diseases (RITA) Center], Brescia, Italy
| | - Corrado Campochiaro
- Division of Immunology, Transplants and Infectious Diseases, Università Vita-Salute San Raffaele, Milan, Italy; Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS Ospedale San Raffaele, [European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory and Autoimmune Diseases (RITA) Center], Milan, Italy
| | - Alessandro Tomelleri
- Division of Immunology, Transplants and Infectious Diseases, Università Vita-Salute San Raffaele, Milan, Italy; Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS Ospedale San Raffaele, [European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory and Autoimmune Diseases (RITA) Center], Milan, Italy
| | - Alicia Callisto
- Department of Clinical Immunology and Allergy, Royal Adelaide Hospital, Adelaide, Australia
| | - Mark Beecher
- Department of Clinical Immunology and Allergy, Royal Adelaide Hospital, Adelaide, Australia
| | - Sara Bindoli
- Rheumatology Unit, Department of Medicine, University of Padua, [European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory and Autoimmune Diseases (RITA) Center], Padua, Italy
| | - Chiara Baggio
- Rheumatology Unit, Department of Medicine, University of Padua, [European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory and Autoimmune Diseases (RITA) Center], Padua, Italy
| | - Verónica Gómez-Caverzaschi
- Clinical Unit of Autoinflammatory Diseases, Department of Autoimmune Diseases, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Hospital Clínic of Barcelona [European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory and Autoimmune Diseases (RITA) Center], University of Barcelona, Barcelona, Spain
| | - Laura Pelegrín
- Department of Ophthalmology, Institut Clínic d'Oftalmologia (ICOF), Hospital Clinic de Barcelona, University of Barcelona, Institut de Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Adriana Soto-Peleteiro
- Faculty of Medicine and Nursery, University of the Basque Country, UPV/EHU, Leioa, Biscay, Spain; Autoimmune Diseases Unit, Biocruces Bizkaia Health Research Institute, Barakaldo, Biscay, Spain
| | - Alessandra Milanesi
- Division of Rheumatology, Fondazione IRCCS Policlinico San Matteo, [European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory and Autoimmune Diseases (RITA) Center], Pavia, Italy; Department of Internal Medicine and Therapeutics, Università di Pavia, Italy
| | - Ibrahim Vasi
- Department of Internal Medicine, Division of Rheumatology, Gazi University Hospital, Ankara, Turkiye
| | - Alberto Cauli
- Rheumatology Unit, Department of Medical Sciences, University and AOU of Cagliari, Cagliari, Italy
| | | | - Florenzo Iannone
- Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J) Policlinic Hospital, University of Bari, Bari, Italy
| | - Riccardo Bixio
- Rheumatology Unit, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Italy
| | - Francesca Della Casa
- Department of Translational Medical Sciences, Section of Clinical Immunology, University of Naples Federico II, Naples, Italy
| | - Ilaria Mormile
- Department of Translational Medical Sciences, Section of Clinical Immunology, University of Naples Federico II, Naples, Italy
| | - Carmelo Gurnari
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy; Department of Translational Hematology and Oncology Research, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Alessia Fiorenza
- Unit of Rheumatology, ASL VC Sant' Andrea Hospital, Vercelli 13100, Italy
| | - Germán Mejia-Salgado
- Neuroscience Research Group (NEUROS), NeuroVitae Center, Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia
| | - Perla Ayumi Kawakami-Campos
- Department of Ophthalmology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Gaafar Ragab
- Internal Medicine Department, Rheumatology and Clinical Immunology Unit, Faculty of Medicine, Cairo University, Giza, Egypt; Faculty of Medicine, Newgiza University, 6th of October City, Egypt
| | - Francesco Ciccia
- Department of Precision Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Piero Ruscitti
- Rheumatology Unit, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Monica Bocchia
- Rheumatology Unit, Policlinico "Le Scotte", Azienda Ospedaliero-Universitaria Senese [European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory and Autoimmune Diseases (RITA) Center] Siena, viale Bracci 16, Siena 53100, Italy; Hematology Unit, Azienda Ospedaliera Universitaria Senese, University of Siena, Siena 53100, Italy
| | - Alberto Balistreri
- Rheumatology Unit, Policlinico "Le Scotte", Azienda Ospedaliero-Universitaria Senese [European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory and Autoimmune Diseases (RITA) Center] Siena, viale Bracci 16, Siena 53100, Italy; Bioengineering and Biomedical Data Science Lab, Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Gian Marco Tosi
- Rheumatology Unit, Policlinico "Le Scotte", Azienda Ospedaliero-Universitaria Senese [European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory and Autoimmune Diseases (RITA) Center] Siena, viale Bracci 16, Siena 53100, Italy; Ophthalmology Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Bruno Frediani
- Department of Medical Sciences, Surgery and Neurosciences, Research Center of Systemic Autoinflammatory Diseases and Behçet's Disease Clinic, University of Siena, Siena, Italy; Rheumatology Unit, Policlinico "Le Scotte", Azienda Ospedaliero-Universitaria Senese [European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory and Autoimmune Diseases (RITA) Center] Siena, viale Bracci 16, Siena 53100, Italy
| | - Luca Cantarini
- Department of Medical Sciences, Surgery and Neurosciences, Research Center of Systemic Autoinflammatory Diseases and Behçet's Disease Clinic, University of Siena, Siena, Italy; Rheumatology Unit, Policlinico "Le Scotte", Azienda Ospedaliero-Universitaria Senese [European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory and Autoimmune Diseases (RITA) Center] Siena, viale Bracci 16, Siena 53100, Italy.
| | - Claudia Fabiani
- Rheumatology Unit, Policlinico "Le Scotte", Azienda Ospedaliero-Universitaria Senese [European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory and Autoimmune Diseases (RITA) Center] Siena, viale Bracci 16, Siena 53100, Italy; Bioengineering and Biomedical Data Science Lab, Department of Medical Biotechnologies, University of Siena, Siena, Italy.
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Yavaşoğlu İ, Turgutkaya A, Bolaman AZ. Hydroxyurea-Associated Relapsing Polychondritis in a Patient With Myeloproliferative Neoplasm. Ann Pharmacother 2024; 58:557-558. [PMID: 37415323 DOI: 10.1177/10600280231180197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/08/2023] Open
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Couselo-Rodríguez C, Viejo-Rodríguez MÁ, Carballeira-Seoane L, Álvarez-Álvarez C, Cervates-Pérez E, García-González MÁ, Flórez Á. [Translated article] Patient With Relapsing Polychondritis and Cutaneous Nodules Being Followed by the Hematology Department for a Myelodysplastic Syndrome. Actas Dermosifiliogr 2024; 115:T301-T302. [PMID: 38219906 DOI: 10.1016/j.ad.2024.01.006] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 07/07/2022] [Indexed: 01/16/2024] Open
Affiliation(s)
- C Couselo-Rodríguez
- Servicio de Dermatología, Complejo Hospitalario Universitario de Pontevedra, Pontevedra, Spain; Grupo de Investigación DIPO, Instituto de Investigación Sanitaria Galicia Sur (IIS Galicia Sur), SERGAS-UVIGO, Spain.
| | - M Á Viejo-Rodríguez
- Servicio de Medicina Interna, Complejo Hospitalario Universitario de Pontevedra, Pontevedra, Spain
| | - L Carballeira-Seoane
- Servicio de Hematología, Complejo Hospitalario Universitario de Pontevedra, Pontevedra, Spain
| | - C Álvarez-Álvarez
- Servicio de Anatomía Patológica, Complejo Hospitalario Universitario de Pontevedra, Pontevedra, Spain
| | - E Cervates-Pérez
- Servicio de Reumatología, Complejo Hospitalario Universitario de Pontevedra, Pontevedra, Spain
| | - M Á García-González
- Fundación Pública Galega de Medicina Xenómica, Santiago de Compostela, Spain
| | - Á Flórez
- Servicio de Dermatología, Complejo Hospitalario Universitario de Pontevedra, Pontevedra, Spain; Grupo de Investigación DIPO, Instituto de Investigación Sanitaria Galicia Sur (IIS Galicia Sur), SERGAS-UVIGO, Spain
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Didier T, Laure B. Bilateral medial rectus muscle infiltration secondary to relapsing polychondritis. J Fr Ophtalmol 2024; 47:104050. [PMID: 38364732 DOI: 10.1016/j.jfo.2023.104050] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 10/24/2023] [Accepted: 11/03/2023] [Indexed: 02/18/2024]
Affiliation(s)
- T Didier
- Service de chirurgie maxillo-faciale plastique et brûlés, CHRU de Tours, hôpital Trousseau, avenue de la République, 37170 Chambray-lès-Tours, France.
| | - B Laure
- Service de chirurgie maxillo-faciale plastique et brûlés, CHRU de Tours, hôpital Trousseau, avenue de la République, 37170 Chambray-lès-Tours, France
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Couselo-Rodríguez C, Viejo-Rodríguez MÁ, Carballeira-Seoane L, Álvarez-Álvarez C, Cervates-Pérez E, García-González MÁ, Flórez Á. Patient With Relapsing Polychondritis and Cutaneous Nodules Being Followed by the Hematology Department for a Myelodysplastic Syndrome. Actas Dermosifiliogr 2024; 115:301-302. [PMID: 36511287 DOI: 10.1016/j.ad.2022.07.023] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 06/22/2022] [Accepted: 07/07/2022] [Indexed: 11/06/2022] Open
Affiliation(s)
- C Couselo-Rodríguez
- Servicio de Dermatología, Complejo Hospitalario Universitario de Pontevedra, Pontevedra, España; Grupo de Investigación DIPO, Instituto de Investigación Sanitaria Galicia Sur (IIS Galicia Sur), SERGAS-UVIGO, Pontevedra, España.
| | - M Á Viejo-Rodríguez
- Servicio de Medicina Interna, Complejo Hospitalario Universitario de Pontevedra, Pontevedra, España
| | - L Carballeira-Seoane
- Servicio de Hematología, Complejo Hospitalario Universitario de Pontevedra, Pontevedra, España
| | - C Álvarez-Álvarez
- Servicio de Anatomía Patológica, Complejo Hospitalario Universitario de Pontevedra, Pontevedra, España
| | - E Cervates-Pérez
- Servicio de Reumatología, Complejo Hospitalario Universitario de Pontevedra, Pontevedra, España
| | - M Á García-González
- Fundación Pública Galega de Medicina Xenómica, Santiago de Compostela, La Coruña, España
| | - Á Flórez
- Servicio de Dermatología, Complejo Hospitalario Universitario de Pontevedra, Pontevedra, España; Grupo de Investigación DIPO, Instituto de Investigación Sanitaria Galicia Sur (IIS Galicia Sur), SERGAS-UVIGO, Pontevedra, España
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Hirata R, Nakamura M, Yamada S, Tago M. Relapsing polychondritis presenting with chronic cough and costal cartilage tenderness. BMJ Case Rep 2024; 17:e259645. [PMID: 38378589 PMCID: PMC10882328 DOI: 10.1136/bcr-2024-259645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2024] Open
Affiliation(s)
- Risa Hirata
- Department of General Medicine, Saga University Hospital, Saga, Japan
| | - Masahiko Nakamura
- Department of General Medicine, Saga University Hospital, Saga, Japan
| | - Shuto Yamada
- Department of General Medicine, Saga University Hospital, Saga, Japan
| | - Masaki Tago
- Department of General Medicine, Saga University Hospital, Saga, Japan
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Wang ST, Wang J, Gao X, Chen K, Xu KF, Tian X. Risk factors associated with severe adverse events in patients with relapsing polychondritis undergoing flexible bronchoscopy. Orphanet J Rare Dis 2024; 19:54. [PMID: 38336719 PMCID: PMC10858597 DOI: 10.1186/s13023-024-03061-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 02/03/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Patients with relapsing polychondritis (RP) sometimes experience upper airway collapse or lower airway stenosis, and bronchoscopy may provide a valuable typical image to confirm the diagnosis. This study aimed to identify potential risk factors associated with severe adverse effects during bronchoscopy. METHODS We performed a retrospective cohort study of 82 consecutive patients with RP hospitalized at Peking Union Medical College Hospital between January 1, 2012 and December 31, 2022. Clinical features and disease patterns were compared among patients with RP undergoing bronchoscopy with or without severe adverse effects. Binary logistic regression analysis was performed to identify the associated risk factors. RESULTS For patients with RP undergoing bronchoscopy with severe adverse effects, the forced vital capacity (FVC), forced vital capacity percent predicted values (FVC%), and peak expiratory flow were significantly lower (P = 0.001, P = 0.001, and P = 0.021, respectively) than those in the non-severe adverse effect subgroup. Binary logistic regression analysis revealed that low FVC% (odds ratio, 0.930; 95% confidence interval, 0.880-0.982; P = 0.009) was an independent risk factor for severe adverse events in patients undergoing bronchoscopy. CONCLUSIONS Low FVC or FVC% suggests a high risk of severe adverse effects in patients with RP undergoing bronchoscopy. Patients with such risk factors should be carefully evaluated before bronchoscopy and adequately prepared for emergency tracheal intubation or tracheostomy.
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Affiliation(s)
- Shao-Ting Wang
- Department of Pulmonary and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, #1 Shuaifuyuan Hutong, Beijing, 100730, China
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Beijing, 100730, China
| | - Jinglan Wang
- Department of Pulmonary and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, #1 Shuaifuyuan Hutong, Beijing, 100730, China
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Beijing, 100730, China
| | - Xiaoxing Gao
- Department of Pulmonary and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, #1 Shuaifuyuan Hutong, Beijing, 100730, China
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Beijing, 100730, China
| | - Keqi Chen
- Department of Pulmonary and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, #1 Shuaifuyuan Hutong, Beijing, 100730, China
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Beijing, 100730, China
| | - Kai-Feng Xu
- Department of Pulmonary and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, #1 Shuaifuyuan Hutong, Beijing, 100730, China
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Beijing, 100730, China
| | - Xinlun Tian
- Department of Pulmonary and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, #1 Shuaifuyuan Hutong, Beijing, 100730, China.
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Beijing, 100730, China.
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8
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Villa-Piñeros J, Ramos-Santodomingo M, Rojas-Carabali W, de-la-Torre A. Ocular Inflammation as the First Sign of Relapsing Polychondritis in Hispanic Patients: Report of Three Cases. Ocul Immunol Inflamm 2024; 32:244-249. [PMID: 36638347 DOI: 10.1080/09273948.2023.2165112] [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] [Received: 07/29/2022] [Accepted: 12/31/2022] [Indexed: 01/15/2023]
Abstract
BACKGROUND Relapsing polychondritis (RP) is a rare inflammatory systemic disease characterized by recurrent inflammatory episodes of cartilaginous and proteoglycan-rich tissues, particularly ears, nose, respiratory tract, eyes, and joints. PURPOSE To present the clinical features, management, and prognosis of three Hispanic patients presenting with RP and ocular involvement as the first manifestation of the disease. CONCLUSION This study extends the knowledge regarding ocular disease characteristics in patients with RP. Furthermore, it increases ophthalmologists' awareness of the findings, leading to earlier diagnoses and adequate treatment for improved patients' prognoses.
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Affiliation(s)
- Jerónimo Villa-Piñeros
- Neurosciences Research Group (NEUROS), NeuroVitae Center for Neuroscience, Translational Medicine Institute, School of Medicine and Health Sciences, Universidad Del Rosario, Bogotá, Colombia
| | - Mario Ramos-Santodomingo
- Neurosciences Research Group (NEUROS), NeuroVitae Center for Neuroscience, Translational Medicine Institute, School of Medicine and Health Sciences, Universidad Del Rosario, Bogotá, Colombia
| | - William Rojas-Carabali
- Neurosciences Research Group (NEUROS), NeuroVitae Center for Neuroscience, Translational Medicine Institute, School of Medicine and Health Sciences, Universidad Del Rosario, Bogotá, Colombia
| | - Alejandra de-la-Torre
- Neurosciences Research Group (NEUROS), NeuroVitae Center for Neuroscience, Translational Medicine Institute, School of Medicine and Health Sciences, Universidad Del Rosario, Bogotá, Colombia
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9
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Winter G, Löffelmann T, Chaya S, Kaiser H, Prenzler NK, Warnecke A, Wetzke M, Derlin T, Renz D, Stueber T, Länger F, Schütz K, Schwerk N. Relapsing Polychondritis with Tracheobronchial Involvement: A Detailed Description of Two Pediatric Cases and Review of the Literature. Klin Padiatr 2024; 236:97-105. [PMID: 38224687 PMCID: PMC10883755 DOI: 10.1055/a-2230-1521] [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: 01/17/2024]
Abstract
Relapsing polychondritis (RP) is a rare immune-mediated disease that primarily affects the cartilaginous structures of the ears, nose and airways. The clinical spectrum ranges from mild to severe disease characterized by progressive destruction of cartilage in the tracheobronchial tree leading to airway obstruction and acute respiratory failure. Early diagnosis is crucial to prevent irreversible airway damage and life-threatening complications. Due to its rarity and variability of symptoms, the diagnosis of RP is often delayed particularly in childhood. To address this and increase awareness of this rare disease, we present a detailed case report of two adolescent females affected by RP. We aim to describe the clinical findings, consequences of a delayed diagnosis and provide a review of the current literature.
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Affiliation(s)
- Greta Winter
- Department of Paediatric Pneumology, Allergy and Neonatology, Hannover
Medical School Centre for Paediatrics and Adolescent Medicine, Hannover,
Germany
| | - Tara Löffelmann
- Department of Paediatric Pneumology, Allergy and Neonatology, Hannover
Medical School Centre for Paediatrics and Adolescent Medicine, Hannover,
Germany
| | - Shaakira Chaya
- Division of Paediatric Pulmonology, Department of Paediatrics and Child
Health, University of Cape Town, Red Cross War Memorial Children’s
Hospital, Cape Town, South Africa
| | - Hannah Kaiser
- Department of Paediatric Pneumology, Allergy and Neonatology, Hannover
Medical School Centre for Paediatrics and Adolescent Medicine, Hannover,
Germany
| | - Nils Kristian Prenzler
- Department of Otorhinolaryngology, Head and Neck Surgery, Hannover
Medical School, Hannover, Germany
| | - Athanasia Warnecke
- Department of Otorhinolaryngology, Head and Neck Surgery, Hannover
Medical School, Hannover, Germany
| | - Martin Wetzke
- Department of Paediatric Pneumology, Allergy and Neonatology, Hannover
Medical School Centre for Paediatrics and Adolescent Medicine, Hannover,
Germany
- German Centre for Lung Research (DZL), Hannover Medical School,
Hannover, Germany
| | - Thorsten Derlin
- Department of Nuclear Medicine, Hannover Medical School, Hannover,
Germany
| | - Diane Renz
- Institute of Diagnostic and Interventional Radiology, Department of
Paediatric Radiology, Hannover Medical School, Hannover, Germany
| | - Thomas Stueber
- Department of Anaesthesiology and Intensive Care Medicine, Hannover
Medical School, Hannover, Germany
| | - Florian Länger
- German Centre for Lung Research (DZL), Hannover Medical School,
Hannover, Germany
- Institute of Pathology, Hannover Medical School, Hannover,
Germany
| | - Katharina Schütz
- Department of Paediatric Pneumology, Allergy and Neonatology, Hannover
Medical School Centre for Paediatrics and Adolescent Medicine, Hannover,
Germany
| | - Nicolaus Schwerk
- German Centre for Lung Research (DZL), Hannover Medical School,
Hannover, Germany
- Pediatric Pulmonology and Neonatology, Hannover Medical School Centre
for Paediatrics and Adolescent Medicine, Hannover, Germany
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10
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Funakoshi K, Kato Y, Narazaki M, Kumanogoh A. Paradoxical improvement of dyspnoea in relapsing polychondritis by glucocorticoid tapering. BMJ Case Rep 2024; 17:e257861. [PMID: 38272524 PMCID: PMC10826481 DOI: 10.1136/bcr-2023-257861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2024] Open
Affiliation(s)
- Kenji Funakoshi
- Graduate School of Medicine, Department of Respiratory Medicine and Clinical Immunology, Osaka University, Suita, Osaka, Japan
| | - Yasuhiro Kato
- Graduate School of Medicine, Department of Respiratory Medicine and Clinical Immunology, Osaka University, Suita, Osaka, Japan
| | - Masashi Narazaki
- Graduate School of Medicine, Department of Respiratory Medicine and Clinical Immunology, Osaka University, Suita, Osaka, Japan
- Graduate School of Medicine, Department of Advanced Clinical and Translational Immunology, Osaka University, Suita, Osaka, Japan
| | - Atsushi Kumanogoh
- Graduate School of Medicine, Department of Respiratory Medicine and Clinical Immunology, Osaka University, Suita, Osaka, Japan
- Department of Immunopathology, WPI, Immunology Frontier Research Center (IFReC), Osaka University, Suita, Osaka, Japan
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11
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Yamato M, Shirai T, Sato H, Ishii T, Fujii H. First reported case of pulmonary arteritis in patients with relapsing polychondritis. Rheumatology (Oxford) 2024; 63:e9-e11. [PMID: 37326857 DOI: 10.1093/rheumatology/kead300] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 06/09/2023] [Indexed: 06/17/2023] Open
Affiliation(s)
- Maya Yamato
- Department of Rheumatology, Tohoku University Hospital, Sendai, Japan
| | - Tsuyoshi Shirai
- Department of Rheumatology, Tohoku University Hospital, Sendai, Japan
| | - Hiroko Sato
- Department of Rheumatology, Tohoku University Hospital, Sendai, Japan
| | - Tomonori Ishii
- Department of Rheumatology, Tohoku University Hospital, Sendai, Japan
| | - Hiroshi Fujii
- Department of Rheumatology, Tohoku University Hospital, Sendai, Japan
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12
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Peng Y, Ni N, Jiang Z. Collapse crisis of tracheomalacia caused by undiagnosed relapsing polychondritis during general anesthesia : A case report. Anaesthesiologie 2023; 72:36-38. [PMID: 36912989 DOI: 10.1007/s00101-023-01265-5] [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] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 05/26/2022] [Accepted: 06/01/2022] [Indexed: 03/14/2023]
Affiliation(s)
- Yunan Peng
- Department of Anesthesiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing University, No. 321, Zhongshan Road, 210008, Nanjing, Jiangsu Province, China
| | - Na Ni
- Department of Anesthesiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing University, No. 321, Zhongshan Road, 210008, Nanjing, Jiangsu Province, China
| | - Zhong Jiang
- Department of Anesthesiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing University, No. 321, Zhongshan Road, 210008, Nanjing, Jiangsu Province, China.
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13
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Husein S, Murayama Y, Koo A, Wakefield M, Buccoliero R. Relapsing polychondritis presenting with sero-negative limbic encephalitis. Clin Med (Lond) 2023; 23:618-620. [PMID: 38065590 PMCID: PMC11046591 DOI: 10.7861/clinmed.2023-0430] [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] [Indexed: 12/18/2023]
Abstract
The presented case highlights a rare instance of relapsing polychondritis (RP) manifesting as seronegative limbic encephalitis, an uncommon neurological complication. A 70-year-old female patient with a history of RP-related inflammation, along with neuropsychiatric symptoms, was diagnosed through multidisciplinary collaboration. Swift administration of steroid therapy, followed by azathioprine, led to remarkable physical and cognitive recovery. This case emphasises the importance of a multidisciplinary approach in diagnosing and treating complex autoimmune disorders with neurological manifestations.
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Affiliation(s)
- Salman Husein
- Harrogate and District NHS Foundation Trust, Harrogate, UK
- equal contributions
| | - Yuna Murayama
- Harrogate and District NHS Foundation Trust, Harrogate, UK
- equal contributions
| | - Andrew Koo
- Harrogate and District NHS Foundation Trust, Harrogate, UK
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14
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Cao F, Hou X, Kang T, Shi X, Ma W, Zhang Y, Li C. SAPHO syndrome complicated with relapsing polychondritis: A case report. Int J Rheum Dis 2023; 26:2060-2063. [PMID: 37021927 DOI: 10.1111/1756-185x.14693] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 03/14/2023] [Accepted: 03/23/2023] [Indexed: 04/07/2023]
Abstract
Synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome is a rare chronic inflammatory disease. The main clinical manifestation of SAPHO syndrome is an osteoarthropathy with cutaneous involvement. Relapsing polychondritis (RP) characterized by chronic inflammation and cartilage degeneration is a rare systematic autoimmune disease. Here we report a RP case in a SAPHO syndrome patient, in which auricularitis happened 10 years after the diagnosed as SAPHO syndrome. Tofacitinib treatment can alleviate the symptoms.
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Affiliation(s)
- Fengjiao Cao
- Department of Rheumatology, Dongfang Hospital Beijing University of Chinese Medicine, Beijing, China
| | - Xiujuan Hou
- Department of Rheumatology, Dongfang Hospital Beijing University of Chinese Medicine, Beijing, China
| | - Tianlun Kang
- Department of Rheumatology, Dongfang Hospital Beijing University of Chinese Medicine, Beijing, China
| | - Xiaojun Shi
- Department of Rheumatology, Dongfang Hospital Beijing University of Chinese Medicine, Beijing, China
| | - Weiguo Ma
- Department of Rheumatology, Dongfang Hospital Beijing University of Chinese Medicine, Beijing, China
| | - Yuan Zhang
- Department of Rheumatology, Fangshan Hospital Beijing University of Chinese Medicine, Beijing, China
| | - Chen Li
- Department of Rheumatology, Fangshan Hospital Beijing University of Chinese Medicine, Beijing, China
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15
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Al-Janabi A, Wang A, Gallagher K. Bilateral, sequential orbital inflammation secondary to relapsing polychondritis. BMJ Case Rep 2023; 16:e253513. [PMID: 37770235 PMCID: PMC10546150 DOI: 10.1136/bcr-2022-253513] [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] [Indexed: 09/30/2023] Open
Abstract
This report describes a case of a Caucasian man in his 60s with bilateral sequential orbital inflammatory disease associated with relapsing polychondritis (RPC).He first presented with a subclavian vein periphlebitis/thrombosis and swollen left knee. Two weeks later, he developed right orbital inflammation with restricted eye movements. He was treated initially for possible orbital cellulitis. His inflammation failed to respond to antibiotics but rapidly resolved with oral prednisolone. One year later, he presented with left auricular inflammation, a maculopapular rash on his arms and torso and left orbital inflammation. Again, he failed to respond to antibiotics but had rapid resolution of his inflammatory signs following oral prednisolone.Based on his previous inflammatory arthropathy, auricular inflammation, orbital inflammation and response to oral steroids, he was diagnosed with RPC based on the McAdam diagnostic criteria. His steroids were tapered and he was commenced on methotrexate as maintenance therapy.
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Affiliation(s)
- Ahmed Al-Janabi
- Department of Ophthalmology, Cwm Taf Morgannwg University Health Board, Llantrisant, UK
| | - Aijing Wang
- Department of Ophthalmology, Cwm Taf Morgannwg University Health Board, Llantrisant, UK
| | - Kevin Gallagher
- Department of Ophthalmology, Cwm Taf Morgannwg University Health Board, Llantrisant, UK
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16
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Yin R, Zhao M, Xu D, Wang Q, Li M, Zhang W, Zhang F, Zeng X, Huo Y, Hou Y. Relapsing polychondritis: focus on cardiac involvement. Front Immunol 2023; 14:1218475. [PMID: 37771578 PMCID: PMC10523381 DOI: 10.3389/fimmu.2023.1218475] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Accepted: 08/24/2023] [Indexed: 09/30/2023] Open
Abstract
Background Relapsing polychondritis (RP) with cardiac involvement may present with acute cardiovascular events, and may be associated with a negative prognosis. Herein, we analyzed the clinical characteristics of RP patients with cardiac involvement. Method RP patients, hospitalized from December 2005 to December 2021 at Peking Union Medical College Hospital (PUMCH), were screened. Univariate and multivariate logistic regression analyses were used to statistically analyze the clinical characteristics of these patients. Results The incidence of cardiac involvement in inpatients with RP was 24.1%. Univariate logistic regression analysis revealed age, central nervous system (CNS) involvement, neutrophil-to-lymphocyte ratio (NLR) > 6.41, and disease duration > 4 years as risk factors for cardiac involvement in RP. Conversely, the incidence of tracheobronchial and chest wall involvement was significantly lower in the group with cardiac involvement. Multivariate logistic regression confirmed that age, CNS involvement, NLR > 6.41, and disease duration > 4 years were independent factors for cardiac involvement. Subsequently, we identified five well-defined clinical patterns of RP, based on the involvement of different organs in our patients, and found that the heart-brain model was significantly mutually exclusive with the airway model. Conclusion Occurrence of cardiac involvement in RP is associated with age, CNS involvement, NLR, and disease duration. It is mutually exclusive with airway-related involvement. Regular echocardiography and electrocardiography are necessary for patients with RP.
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Affiliation(s)
- Ruxue Yin
- Key Laboratory of Rheumatology and Clinical Immunology, Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Ministry of Education, National Clinical Research Center for Dermatologic and Immunologic Diseases, Ministry of Science & Technology, Beijing, China
| | - Mengzhu Zhao
- Key Laboratory of Rheumatology and Clinical Immunology, Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Ministry of Education, National Clinical Research Center for Dermatologic and Immunologic Diseases, Ministry of Science & Technology, Beijing, China
| | - Dong Xu
- Key Laboratory of Rheumatology and Clinical Immunology, Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Ministry of Education, National Clinical Research Center for Dermatologic and Immunologic Diseases, Ministry of Science & Technology, Beijing, China
| | - Qian Wang
- Key Laboratory of Rheumatology and Clinical Immunology, Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Ministry of Education, National Clinical Research Center for Dermatologic and Immunologic Diseases, Ministry of Science & Technology, Beijing, China
| | - Mengtao Li
- Key Laboratory of Rheumatology and Clinical Immunology, Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Ministry of Education, National Clinical Research Center for Dermatologic and Immunologic Diseases, Ministry of Science & Technology, Beijing, China
| | - Wen Zhang
- Key Laboratory of Rheumatology and Clinical Immunology, Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Ministry of Education, National Clinical Research Center for Dermatologic and Immunologic Diseases, Ministry of Science & Technology, Beijing, China
| | - Fengchun Zhang
- Key Laboratory of Rheumatology and Clinical Immunology, Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Ministry of Education, National Clinical Research Center for Dermatologic and Immunologic Diseases, Ministry of Science & Technology, Beijing, China
| | - Xiaofeng Zeng
- Key Laboratory of Rheumatology and Clinical Immunology, Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Ministry of Education, National Clinical Research Center for Dermatologic and Immunologic Diseases, Ministry of Science & Technology, Beijing, China
| | - Yuping Huo
- Department of Rheumatology, Jin Cheng People’s Hospital, Jincheng, Shanxi, China
| | - Yong Hou
- Key Laboratory of Rheumatology and Clinical Immunology, Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Ministry of Education, National Clinical Research Center for Dermatologic and Immunologic Diseases, Ministry of Science & Technology, Beijing, China
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17
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Venetsanopoulou AI, Voulgari PV, Drosos AA. TNFα inhibitor biosimilar associated with polychondritis. A case-based review. Rheumatol Int 2023; 43:1751-1754. [PMID: 37316633 DOI: 10.1007/s00296-023-05364-9] [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] [Received: 04/07/2023] [Accepted: 06/05/2023] [Indexed: 06/16/2023]
Abstract
Relapsing polychondritis (RP) is a rare autoimmune disease characterized by inflammation of the cartilage structures of the body with typical features of auricular chondritis, nasal and ocular inflammation, audio-vestibular damage, as well as respiratory tract manifestations. It is associated with several autoimmune diseases and many other disorders. Tumor necrosis factor alpha (TNFα) inhibitors treat many chronic inflammatory disorders. They have proven effective and relatively safe in many clinical trials and observational studies. However, several autoimmune phenomena and paradoxical inflammation have been described with TNFα inhibitors, among them RP. This report presents a 43-year-old man with psoriatic arthritis treated with ABP-501 (Amgevita), an adalimumab (ADA) biosimilar and who developed RP, 8 months after the initiation of the treatment. This, is the first report of RP development during TNFα inhibitors biosimilar. We concluded that rheumatologists dealing with patients treated with TNFα inhibitors (originators or biosimilars), should be aware of several paradoxical reactions which may emerge and RP, is one of them.
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Affiliation(s)
- Aliki I Venetsanopoulou
- Department of Rheumatology, School of Health Sciences, Faculty of Medicine, University of Ioannina, Ioannina, Greece
| | - Paraskevi V Voulgari
- Department of Rheumatology, School of Health Sciences, Faculty of Medicine, University of Ioannina, Ioannina, Greece
| | - Alexandros A Drosos
- Department of Rheumatology, School of Health Sciences, Faculty of Medicine, University of Ioannina, Ioannina, Greece.
- Rheumatology Clinic, Department of Internal Medicine, Medical School, University of Ioannina, 45110, Ioannina, Greece.
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18
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Mesolella M, Allosso S, Petruzzi G, Motta G. Subglottic Mass as Isolated Manifestation of Relapsing Polychondritis at Presentation. Ear Nose Throat J 2023; 102:NP440-NP445. [PMID: 34082611 DOI: 10.1177/01455613211016718] [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] [Indexed: 11/17/2022] Open
Abstract
Relapsing polychondritis (RP) is a rare systemic disease that is characterized by recurrent episodic inflammation of the cartilaginous structures of the body, resulting in their progressive destruction and subsequent replacement with fibrotic scar. We present a case of RP that initially manifested with subglottic involvement and we propose an innovative strategy for the treatment for laryngeal RP in phase of active inflammation. A multidisciplinary approach (rheumatologist, otolaryngologist, immunologist, internist, cardiologist, etc) and adequate follow-up are essential. The timeliness of the diagnosis is fundamental to contain the destructive effects on the cartilages involved.
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Affiliation(s)
- Massimo Mesolella
- Unit of Otorhinolaryngology, Department of Neuroscience, Reproductive Sciences and Dentistry, Federico II University of Naples, Naples, Italy
| | - Salvatore Allosso
- Unit of Otorhinolaryngology, Department of Neuroscience, Reproductive Sciences and Dentistry, Federico II University of Naples, Naples, Italy
| | - Gerardo Petruzzi
- Department of Otolaryngology-Head and Neck Surgery, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Gaetano Motta
- Unit of Otorhinolaryngology, University Luigi Vanvitelli, Napoli, Italy
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19
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Wang G, Zhuo N, Tian F, Li J, Wen Z. Relapsing polychondritis with ANCA-associated vasculitis: is it a coincidence or an overlapping condition? Clin Exp Rheumatol 2023; 41 Suppl 135:13-16. [PMID: 36441655 DOI: 10.55563/clinexprheumatol/m9ardb] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Accepted: 03/03/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Gang Wang
- Department of Rheumatology and Immunology, Zhuzhou Hospital Affiliated to Xiangya Medical College, Central South University, Zhuzhou, Hunan, China
| | - Ning Zhuo
- Department of Nephrology, Xiangya Second Hospital, Central South University, Changsha, Hunan, China
| | - Feng Tian
- Department of Rheumatology and Immunology, Zhuzhou Hospital Affiliated to Xiangya Medical College, Central South University, Zhuzhou, Hunan, China
| | - Jingyang Li
- Department of Rheumatology and Immunology, Zhuzhou Hospital Affiliated to Xiangya Medical College, Central South University, Zhuzhou, Hunan, China
| | - Zhenhua Wen
- Department of Rheumatology and Immunology, Zhuzhou Hospital Affiliated to Xiangya Medical College, Central South University, Zhuzhou, Hunan, China.
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20
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Gallagher K, Al-Janabi A, Wang A. The ocular manifestations of relapsing polychondritis. Int Ophthalmol 2023; 43:2633-2641. [PMID: 36856986 DOI: 10.1007/s10792-023-02662-w] [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] [Received: 10/11/2022] [Accepted: 02/19/2023] [Indexed: 03/02/2023]
Abstract
PURPOSE Relapsing polychondritis (RPC) is a rare, multi-system, inflammatory disorder. Ocular disease is estimated to occur in 14-67% of patients with RPC, and any ocular structure can be affected. Published case reports and series of RPC were analysed to determine the frequency and nature of the ocular manifestations of RPC, including the age and gender distribution. METHODS A literature search of the MEDLINE database for case reports and series on RPC was conducted in October 2021 using search terms [relapsing polychondritis (MeSH Major Topic)] OR [relapsing polychondritis (Title/Abstract)]. Articles were included if the diagnosis of RPC was confirmed using established diagnostic criteria and if the paper described the clinical features of patients with RPC. RESULTS 546 articles (454 case reports and 92 case series) described the clinical features in a total of 2414 patients with RPC. 49% of patients with RPC had ocular involvement, and this was a presenting feature in 21%. The most common ocular manifestations were scleritis (32%), episcleritis (31%) and uveitis (23%). CONCLUSION Many patients with RPC will be seen by an ophthalmologist during the course of their disease. Knowledge and awareness of RPC and its ocular manifestations is therefore essential to enable the ophthalmologist to make the diagnosis.
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Affiliation(s)
- Kevin Gallagher
- Ysbyty Cwm Rhondda Hospital, Cwm Taf Morgannwg University Health Board, Tonypandy, CF40 2LX, Wales, UK.
| | - Ahmed Al-Janabi
- Ysbyty Cwm Rhondda Hospital, Cwm Taf Morgannwg University Health Board, Tonypandy, CF40 2LX, Wales, UK
| | - Aijing Wang
- Ysbyty Cwm Rhondda Hospital, Cwm Taf Morgannwg University Health Board, Tonypandy, CF40 2LX, Wales, UK
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21
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Terao-Hirayama K, Hasegawa A, Takei S, Katsumi T, Yuki A, Hama N, Hasegawa E, Sato H, Kobayashi D, Abe R. Histiocytoid Sweet syndrome as a rare skin manifestation of relapsing polychondritis. J Dermatol 2023; 50:e220-e222. [PMID: 36786162 DOI: 10.1111/1346-8138.16745] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 01/17/2023] [Accepted: 01/27/2023] [Indexed: 02/15/2023]
Affiliation(s)
- Kana Terao-Hirayama
- Division of Dermatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Akito Hasegawa
- Division of Dermatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Shingo Takei
- Division of Dermatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Tatsuya Katsumi
- Division of Dermatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Akihiko Yuki
- Division of Dermatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Natsumi Hama
- Division of Dermatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Eriko Hasegawa
- Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Hiroe Sato
- Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Daisuke Kobayashi
- Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Riichiro Abe
- Division of Dermatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
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22
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Ahmad AB, Giebner M. [Not Available]. Ugeskr Laeger 2023; 185:V12220793. [PMID: 37114572] [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: 06/19/2023]
Abstract
This is a case report of a 67-year-old man with the rare autoimmune disease relapsing polychondritis. The patient was initially diagnosed by general practitioners with erysipelas around his left ear, which was found red, swollen, and painful. Due to the lack of effect from antibiotics, the patient was referred to an emergency department. A rheumatologist recognised the patterns of the rare disease, diagnosed the patient and initiated proper treatment. The case clarifies the difficulty in diagnosing relapsing polychondritis, mainly due to the rarity and lack of knowledge of the disease.
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23
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Arakawa S, Nakao M, Sone K, Hayashi S, Sugihara M, Hirata Y, Kuriyama M, Takeda N, Ohtakara K, Horikawa Y, Muramatsu H. Lung Cancer Complicated by Relapsing Polychondritis. Intern Med 2023; 62:1049-1054. [PMID: 36070940 PMCID: PMC10125820 DOI: 10.2169/internalmedicine.0203-22] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 77-year-old man presented with a 1-month history of cough, pharyngeal discomfort, and weight loss. Chest radiography revealed a mass shadow in the right upper lung field. Bronchoscopy showed multiple white nodules along the tracheal cartilage ring. Although adenocarcinoma cells were detected in the mass, several biopsy specimens of the tracheal lesions exhibited no malignancy. 18F-fluorodeoxyglucose positron emission tomography revealed an intense accumulation in the mass, nasal septum, and tracheal cartilage. Furthermore, anti-type II collagen antibody levels were elevated. We finally diagnosed him with lung cancer complicated by relapsing polychondritis. Treatment with oral prednisolone was initiated, followed by sequential chemoradiotherapy for lung cancer.
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Affiliation(s)
- Sosuke Arakawa
- Department of Respiratory Medicine, Kainan Hospital Aichi Prefectural Welfare Federation of Agricultural Cooperatives, Japan
| | - Makoto Nakao
- Department of Respiratory Medicine, Kainan Hospital Aichi Prefectural Welfare Federation of Agricultural Cooperatives, Japan
| | - Kazuki Sone
- Department of Respiratory Medicine, Kainan Hospital Aichi Prefectural Welfare Federation of Agricultural Cooperatives, Japan
| | - Shuntaro Hayashi
- Department of Respiratory Medicine, Kainan Hospital Aichi Prefectural Welfare Federation of Agricultural Cooperatives, Japan
| | - Masahiro Sugihara
- Department of Respiratory Medicine, Kainan Hospital Aichi Prefectural Welfare Federation of Agricultural Cooperatives, Japan
| | - Yuya Hirata
- Department of Respiratory Medicine, Kainan Hospital Aichi Prefectural Welfare Federation of Agricultural Cooperatives, Japan
| | - Mamiko Kuriyama
- Department of Respiratory Medicine, Kainan Hospital Aichi Prefectural Welfare Federation of Agricultural Cooperatives, Japan
| | - Norihisa Takeda
- Department of Respiratory Medicine, Kainan Hospital Aichi Prefectural Welfare Federation of Agricultural Cooperatives, Japan
| | - Kazuhiro Ohtakara
- Department of Radiation Oncology, Kainan Hospital Aichi Prefectural Welfare Federation of Agricultural Cooperatives, Japan
| | - Yoshimi Horikawa
- Department of Radiation Oncology, Kainan Hospital Aichi Prefectural Welfare Federation of Agricultural Cooperatives, Japan
| | - Hideki Muramatsu
- Department of Respiratory Medicine, Kainan Hospital Aichi Prefectural Welfare Federation of Agricultural Cooperatives, Japan
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Mertz P, Sparks J, Kobrin D, Ogbonnaya SA, Sevim E, Michet C, Arnaud L, Ferrada M. Relapsing polychondritis: Best Practice & Clinical Rheumatology. Best Pract Res Clin Rheumatol 2023; 37:101867. [PMID: 37839908 DOI: 10.1016/j.berh.2023.101867] [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] [Received: 05/18/2023] [Revised: 08/08/2023] [Accepted: 08/12/2023] [Indexed: 10/17/2023]
Abstract
Relapsing polychondritis (RP) is an uncommon inflammatory disorder that predominantly targets cartilaginous structures. The disease frequently affects the nose, ears, airways, and joints, but it can also impact organs that aren't primarily cartilage-based, such as blood vessels, skin, inner ear, and eyes. Given its infrequent occurrence and recurrent symptoms, patients often experience delays in proper diagnosis. Lately, based on the organs involved, the disease's diverse manifestations have been categorized into specific clinical groups, based on the most likely organ involvement including auricular, nasal, pulmonary, and musculoskeletal. More recently the discovery of a new disease, called (Vacuoles, E1 enzyme, X-linked, Autoinflammatory, Somatic) VEXAS syndrome, due to mutations in UBA1 gene, identified the cause of 8 % of the patients with a clinical diagnosis of RP. VEXAS is likely the cause of a previously described "hematologic subgroup" in RP. This discovery is proof of concept that RP is likely more than one disease (Beck et al., Dec 31 2020; Ferrada et al., 2021). People diagnosed with RP face numerous hurdles, with the quality of their lives and overall prognosis being affected. Diagnosing the condition is particularly challenging due to its fluctuating symptoms, the absence of specific markers, and the lack of universally recognized classification criteria. For a correct diagnosis, it's imperative for healthcare professionals to identify its unique clinical patterns. Moreover, there are no approved metrics to gauge the disease's severity, complicating patient management. This review seeks to equip clinicians with pertinent insights to better diagnose and attend to these complex patients.
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Affiliation(s)
- Phillip Mertz
- Hôpitaux Universitaires de Strasbourg, Centre National de Référence RESO-Lupus, 67000 Strasbourg, France
| | - Joshua Sparks
- Department of Pediatrics, University of Louisville, Louisville, KY, USA
| | - Dale Kobrin
- National Institutes of Arthritis and Musculoskeletal and Skin Diseases, Bethesda, MD, USA
| | - Sandra Amara Ogbonnaya
- National Institutes of Arthritis and Musculoskeletal and Skin Diseases, Bethesda, MD, USA
| | - Ecem Sevim
- National Institutes of Arthritis and Musculoskeletal and Skin Diseases, Bethesda, MD, USA
| | - Clement Michet
- Mayo Clinic School of Medicine, Division of Rheumatology, USA
| | - Laurent Arnaud
- Hôpitaux Universitaires de Strasbourg, Centre National de Référence RESO-Lupus, 67000 Strasbourg, France
| | - Marcela Ferrada
- National Institutes of Arthritis and Musculoskeletal and Skin Diseases, Bethesda, MD, USA.
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Abstract
We herein report a 49-year-old Japanese man with relapsing polychondritis (RP) and aseptic meningoencephalitis. Four years ago, the patient was diagnosed with RP. Prednisolone (PSL) was started at 30 mg/day, and the symptoms promptly disappeared. However, cognitive impairment gradually appeared from six months before hospitalization. Methylprednisolone pulse therapy was immediately initiated, followed by administration of PSL at 1 mg/kg/day. Intravenous cyclophosphamide was combined with PSL. After treatment, the patient's cognitive impairment clearly improved. In conclusion, RP rarely causes aseptic meningoencephalitis, highlighting the need for prompt and aggressive immunosuppressive therapy.
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Affiliation(s)
- Kazuhiro Yokota
- Department of Rheumatology and Applied Immunology, Faculty of Medicine, Saitama Medical University, Japan
| | | | - Akifumi Miyake
- Department of General Medicine, Saku Central Hospital, Japan
| | - Toshimasa Yamamoto
- Department of Neurology, Faculty of Medicine, Saitama Medical University, Japan
| | - Toshihide Mimura
- Department of Rheumatology and Applied Immunology, Faculty of Medicine, Saitama Medical University, Japan
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26
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Maekawa M, Yoshimura M, Kadowaki M, Nakano M, Moriwaki A, Ueda H, Yoshizawa S. Successful treatment of relapsing polychondritis with circumferential bronchial wall thickening including the tracheomembranous area with tumor necrosis factor-α inhibitor. Mod Rheumatol Case Rep 2023; 7:197-201. [PMID: 35078245 DOI: 10.1093/mrcr/rxac005] [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] [Received: 08/03/2021] [Revised: 11/01/2021] [Accepted: 01/18/2022] [Indexed: 06/14/2023]
Abstract
This is a case of a 55-year-old man who presented with cough and anterior chest pain. Tracheal biopsy confirmed the diagnosis of relapsing polychondritis (RP). Although the patient had circumferential bronchial wall thickening extending to the tracheomembranous area and was positive foRPR3-ANCA, he did not meet the diagnostic criteria for granulomatosis with polyangiitis. The patient was refractory to prednisolone + methotrexate + azathioprine and responded to adalimumab, a biologic tumor necrosis factor-α inhibitor effective in RP refractory cases. Herein, we report a rare case of RP with circumferential bronchial wall thickening extending to the tracheomembranous area.
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Affiliation(s)
- Makiko Maekawa
- Department of Rheumatology, National Hospital Organization Fukuoka Hospital, Fukuoka, Japan
| | - Motoki Yoshimura
- Department of Rheumatology, National Hospital Organization Fukuoka Hospital, Fukuoka, Japan
| | - Masako Kadowaki
- Department of Internal Medicine, National Hospital Organization Fukuoka Hospital, Fukuoka, Japan
| | - Miki Nakano
- Department of Rheumatology, National Hospital Organization Fukuoka Hospital, Fukuoka, Japan
| | - Atsushi Moriwaki
- Department of Respiratory Medicine, National Hospital Organization Fukuoka Hospital, Fukuoka, Japan
| | - Hitoshi Ueda
- Department of Respiratory Surgery, National Hospital Organization Fukuoka Hospital, Fukuoka, Japan
| | - Shigeru Yoshizawa
- Department of Rheumatology, National Hospital Organization Fukuoka Hospital, Fukuoka, Japan
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27
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Özgür DS, Akkuzu G, Yildirim F, Yalçin Mutlu M, Karaali Oğlu B, Erdoğan M, Bes C. Coexistence of relapsing polychondritis and eosinophilic granulomatous with polyangiitis: A rare entity. Clin Ter 2022; 173:500-502. [PMID: 36373442 DOI: 10.7417/ct.2022.2469] [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] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Relapsing polychondritis (RP) is a a rare multisystemic disease and it affects cartilaginous tissue and proteoglycan rich organs. The spectrum of clinical features are intermittent inflammation involving especially the auricular and nasal regions. In some patients with RP, systemic vasculitis, autoimmune diseases or malignancy may accompany. Although rare, any of the ANCA-associated vasculitis have been reported in patients with RP. Eosinophilic granulomatous with polyangiitis (EGPA) is a multisystem small vessel vasculitis associated with asthma and eosinophilia. Here we present a case of coexistence of RP and EGPA.
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Affiliation(s)
- D S Özgür
- University of Health Sciences, Başakşehir Çam and Sakura City Hospital, Department of Rheumatology, Istanbul, Turkey
| | - G Akkuzu
- University of Health Sciences, Başakşehir Çam and Sakura City Hospital, Department of Rheumatology, Istanbul, Turkey
| | - F Yildirim
- University of Health Sciences, Başakşehir Çam and Sakura City Hospital, Department of Rheumatology, Istanbul, Turkey
| | - M Yalçin Mutlu
- University of Health Sciences, Başakşehir Çam and Sakura City Hospital, Department of Rheumatology, Istanbul, Turkey
| | - B Karaali Oğlu
- University of Health Sciences, Başakşehir Çam and Sakura City Hospital, Department of Rheumatology, Istanbul, Turkey
| | - M Erdoğan
- University of Health Sciences, Başakşehir Çam and Sakura City Hospital, Department of Rheumatology, Istanbul, Turkey
| | - C Bes
- University of Health Sciences, Başakşehir Çam and Sakura City Hospital, Department of Rheumatology, Istanbul, Turkey
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28
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Yoshida T, Nishimura K, Murabe H, Yokota T. Dapsone-induced methaemoglobinaemia in relapsing polychondritis. BMJ Case Rep 2022; 15:e252431. [PMID: 36109093 PMCID: PMC9478832 DOI: 10.1136/bcr-2022-252431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Tomohiro Yoshida
- Department of Endocrinology and Rheumatology, Kurashiki Central Hospital, Kurashiki, Japan
| | - Keisuke Nishimura
- Department of Endocrinology and Rheumatology, Kurashiki Central Hospital, Kurashiki, Japan
- Department of Rheumatology and Clinical Immunology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hiroyuki Murabe
- Department of Endocrinology and Rheumatology, Kurashiki Central Hospital, Kurashiki, Japan
| | - Toshihiko Yokota
- Department of Endocrinology and Rheumatology, Kurashiki Central Hospital, Kurashiki, Japan
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29
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Lokken A, Wang A. Relapsing Polychondritis as a Cause of Sudden and Unexpected Death With Central Nervous System Involvement. Am J Forensic Med Pathol 2022; 43:263-268. [PMID: 35642781 DOI: 10.1097/paf.0000000000000771] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT Relapsing polychondritis (RP) is a rare inflammatory disease process that affects cartilaginous tissues throughout the body. Although the pathogenesis remains unknown, RP is thought to be an autoimmune disorder in which host immune cells are conditioned to attack the body's cartilage, such as the ears, nose, eyes, joints, and airways, resulting in inflammation and destruction of otherwise healthy tissues. In rare and unusual cases, neurological involvement has been described.We report a case of a 36-year-old man with a medical history of asthma and suspected seronegative rheumatoid arthritis/RP and panuveitis who was found deceased in his residence. Postmortem examination revealed cartilaginous destruction of the external ear and large airways and meningoencephalitis involving the left medial temporal lobe without an underlying infectious cause.Progressive destruction of airway tissue and increased susceptibility to pulmonary infection is the most common cause of death in RP. Central nervous system involvement is exceedingly rare, presenting with highly variable clinical and pathological manifestations. A review of RP and systemic manifestations will follow. Accurate recognition of this multisystem autoimmune disease as a cause of sudden and unexpected death is critical for proper death certification and to broaden our understanding of this disease.
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Affiliation(s)
- Alexander Lokken
- From the Rosalind Franklin University of Medicine and Science, North Chicago, IL
| | - Amber Wang
- Maricopa County Medical Examiner's Office, Phoenix, AZ
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30
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Park H, Gon Kim J, Kim WU. A Rare Case of Ankylosing Spondylitis Coexisting with Relapsing Polychondritis, Antiphospholipid Syndrome, and Myelodysplastic Syndrome. Intern Med 2022; 61:2367-2371. [PMID: 35022354 PMCID: PMC9424073 DOI: 10.2169/internalmedicine.8784-21] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Ankylosing spondylitis (AS) is rarely accompanied by other autoimmune diseases and/or hematologic disorders. We herein report a 46-year-old man with AS coexisting with relapsing polychondritis (RP), antiphospholipid syndrome (APS) and myelodysplastic syndrome (MDS). While receiving anti-TNF therapy for AS, the patient developed anemia and was diagnosed with MDS. After six months, he developed swelling and redness of the nose and both auricles. RP was diagnosed by an ear biopsy. Afterward, during the evaluation of a repeated fever, APS was diagnosed. This case of AS with multiple autoimmune diseases and hematologic malignancy successfully responded to a Janus kinase inhibitor (baricitinib).
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Affiliation(s)
- Hanna Park
- Division of Rheumatology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, the Catholic University of Korea, Republic of Korea
| | - Jung Gon Kim
- Division of Rheumatology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, the Catholic University of Korea, Republic of Korea
| | - Wan-Uk Kim
- Division of Rheumatology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, the Catholic University of Korea, Republic of Korea
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31
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Kunishita Y, Kirino Y, Tsuchida N, Maeda A, Sato Y, Takase-Minegishi K, Yoshimi R, Nakajima H. Case Report: Tocilizumab Treatment for VEXAS Syndrome With Relapsing Polychondritis: A Single-Center, 1-Year Longitudinal Observational Study In Japan. Front Immunol 2022; 13:901063. [PMID: 35769485 PMCID: PMC9234115 DOI: 10.3389/fimmu.2022.901063] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [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: 03/21/2022] [Accepted: 05/18/2022] [Indexed: 11/15/2022] Open
Abstract
Vacuoles, E1 enzyme, X-linked, autoinflammatory, somatic (VEXAS) syndrome is an autoinflammatory disease caused by somatic variants in the UBA1 gene that lead to severe systemic inflammation and myelodysplastic syndrome. Although no standard therapy has been established yet, azacitidine and bone marrow transplantation have been reported to be promising possibilities; however, the indications for these treatments are problematic and not necessarily applicable to all patients. We previously reported the results of short-term treatment with tocilizumab (TCZ) and glucocorticoids in three patients with VEXAS syndrome. In this paper, we report that the combination of TCZ and glucocorticoids allowed the patients to continue treatment for at least one year without significant disease progression. Glucocorticoids were able to be reduced from the start of TCZ. Adverse events were herpes zoster, skin ulceration after cellulitis, and decreased blood counts. The results suggest the significance of this treatment as a bridge therapy for the development of future therapies.
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Affiliation(s)
- Yosuke Kunishita
- Department of Stem Cell and Immune Regulation, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Yohei Kirino
- Department of Stem Cell and Immune Regulation, Yokohama City University Graduate School of Medicine, Yokohama, Japan
- *Correspondence: Yohei Kirino,
| | - Naomi Tsuchida
- Department of Stem Cell and Immune Regulation, Yokohama City University Graduate School of Medicine, Yokohama, Japan
- Department of Human Genetics, Yokohama City University Graduate School of Medicine, Yokohama, Japan
- Department of Rare Disease Genomics, Yokohama City University Hospital, Yokohama, Japan
| | - Ayaka Maeda
- Department of Stem Cell and Immune Regulation, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Yuichiro Sato
- Department of Stem Cell and Immune Regulation, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Kaoru Takase-Minegishi
- Department of Stem Cell and Immune Regulation, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Ryusuke Yoshimi
- Department of Stem Cell and Immune Regulation, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Hideaki Nakajima
- Department of Stem Cell and Immune Regulation, Yokohama City University Graduate School of Medicine, Yokohama, Japan
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İçaçan OC, Yalçın Mutlu M, Yıldırım F, Bes C. Relapsing Polychondritis in a Patient with Ankylosing Spondylitis under Two Different Tumor Necrosis Factor Alpha Inhibitors Treatment. Clin Ter 2022; 173:97-98. [PMID: 35385029 DOI: 10.7417/ct.2022.2400] [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] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Relapsing polychondritis (RP) is a rare autoimmune disease char-acterized by multi-systemic involvement characterized by recurrent and progressive inflammation of the cartilaginous tissue. Auricular inflammation is a characteristic finding of RP. Anti-tumor necrosis fac-tor alpha (anti-TNF) is a highly effective drug used in the treatment of inflammatory arthritis. There are several case reports showing potential relationship between the RP development and anti-TNF treatment. Here, we present a case of RP in a patient with ankylosing spondylitis under the two different tumor necrosis factor alpha inhibitors therapy.
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Affiliation(s)
- O C İçaçan
- Department of Rheumatology, Basaksehir Cam and Sakura City Hospital, University of Health Sciences, Istanbul, Turkey
| | - M Yalçın Mutlu
- Department of Rheumatology, Basaksehir Cam and Sakura City Hospital, University of Health Sciences, Istanbul, Turkey
| | - F Yıldırım
- Department of Rheumatology, Basaksehir Cam and Sakura City Hospital, University of Health Sciences, Istanbul, Turkey
| | - C Bes
- Department of Rheumatology, Basaksehir Cam and Sakura City Hospital, University of Health Sciences, Istanbul, Turkey
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33
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Zhang Y, Zhang L, Wu Z, Tang J, Wang X. Relapsing Polychondritis Associated with Miscellaneous Ocular Symptoms and Increased IgA: a Case Report. Iran J Immunol 2022; 19:10. [PMID: 35293351 DOI: 10.22034/iji.2022.91845.2110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
A male patient had suffered miscellaneous ocular symptoms for 20 years with auricular dysmorphosis and was diagnosed with Relapsing Polychondritis (RP) in the ear, nose, joints, and costal cartilage. The patient lost his vision owing to recurrent ocular symptoms for decades. He presented an increased IgA and was diagnosed with monoclonal gammopathy of undetermined significance (MGUS) and treated by prednisone and cyclophosphamide. His ocular symptoms relieved and serum IgA decreased after six months. In conclusion, RP is a systemic disease with a wide range of clinical symptoms and may lead to serious complications.
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Affiliation(s)
- Yu Zhang
- Department of Rheumatology and Immunology, Tongji Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China
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Midtvedt Ø, Stray-Pedersen A, Andersson H, Gunnarsson R, Tveten K, Ali MM, Tjønnfjord GE. A man in his sixties with chondritis and bone marrow failure. Tidsskr Nor Laegeforen 2022; 142:21-0370. [PMID: 35239266 DOI: 10.4045/tidsskr.21.0370] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND VEXAS syndrome (Vacuoles, E1 enzyme, X-linked, Autoinflammatory, Somatic syndrome) first described in 2020, is caused by a limited repertoire of somatic mutations in UBA1, a gene involved in the initiation of ubiquitination. Ubiquitination, adding an ubiquitin protein to a substrate protein, can have various effects on the substrate. Disruption of UBA1 function results in diverse clinical manifestations, mimicking a variety of disorders. CASE PRESENTATION A man in his sixties presented with fever, chest pain, fatigue, pulmonary infiltrates and elevated acute phase reactants. Initially he was thought to have extra-cranial giant cell arteritis. When he developed ear and nose chondritis, a revised diagnosis of relapsing polychondritis was made. Subsequently he developed macrocytic anaemia and thrombocytopenia. His condition remained resistant to medical therapy and he died eight years after disease onset. Analysis of stored DNA revealed a somatic mutation in UBA1 confirming the diagnosis of VEXAS syndrome. INTERPRETATION VEXAS syndrome is a newly identified inflammatory disorder due to an acquired mutation in haematopoietic bone marrow cells in older men. The syndrome may be misdiagnosed as treatment-refractory relapsing polychondritis, polyarteritis nodosa, Sweet syndrome or giant cell arteritis. We describe the first individual with molecularly confirmed VEXAS syndrome in Norway.
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Kothari T, Valsamakis T, Sridhar AV, Ahmed MI. Case of paediatric relapsing polychondritis with severe airway involvement: the challenges of long-term airway and respiratory management. BMJ Case Rep 2021; 14:e239774. [PMID: 34380670 PMCID: PMC8359488 DOI: 10.1136/bcr-2020-239774] [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: 08/01/2021] [Indexed: 11/04/2022] Open
Abstract
We describe a case of a 15-year-old girl diagnosed with relapsing polychondritis (RP) with involvement of the tracheobronchial tree, resulting in an increased difficulty in breathing, hoarseness of voice and stridor.Her case required the input of multiple specialities including ear, nose and throat, rheumatology, respiratory team and intensive care. Airway assessment and imaging showed glottic and subglottic stenosis and left bronchomalacia. Despite the use of steroids, cyclophosphamide and rituximab, her symptoms progressed and she was started on overnight non-invasive ventilation.She had further relapses of her airway RP-she was started on adalimumab and methotrexate and underwent monthly balloon dilatations which helped with her symptoms and facilitated a safe discharge home. However, she had further relapses and intensive care admissions and following further discussions, a tracheostomy was inserted. She is now stable on her tracheostomy and is off any respiratory support.
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36
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Yamamoto T, Adachi K, Hori D, Fujimori T, Shiraishi M, Kimura N, Yamaguchi A. [Rapid Growing Thoracic Aortic Aneurysm in a Patient with Relapsing Polychondritis]. Kyobu Geka 2021; 74:583-586. [PMID: 34334598] [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
A 26-year-old man with relapsing polychondritis was admitted for the treatment of multiple thoracic aortic aneurysms in the ascending and descending aorta. Descending thoracic aortic aneurysm showed rapid expansion, therefore, the patient underwent an extended thoracic aortic repair from the ascending aorta to the descending aorta via anterolateral thoracotomy and partial sternotomy. Although postoperative course was uneventful, aortic root enlargement and severe aortic insufficiency progressed over the next two years. He and his family refused redo surgical intervention and the patient died of heart failure. Careful perioperative follow-up may be mandatory in a patient with relapsing polychondritis complicated by cardiovascular disease.
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Affiliation(s)
- Takahiro Yamamoto
- Department of Cardiovascular Surgery, Jichi Medical University Saitama Medical Center, Saitama, Japan
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Matsumoto H, Tokimura R, Fujita Y, Matsuoka N, Asano T, Sato S, Temmoku J, Yashiro-Furuya M, Yoshida K, Takahashi R, Tanaka S, Itagaki Y, Honma M, Matsuda N, Watanabe H, Migita K, Kanai K. Meningoencephalitis in relapsing polychondritis: A case report. Medicine (Baltimore) 2021; 100:e26315. [PMID: 34128872 PMCID: PMC8213297 DOI: 10.1097/md.0000000000026315] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 05/25/2021] [Indexed: 01/04/2023] Open
Abstract
RATIONALE Aseptic meningoencephalitis is a rare central nervous system complication of relapsing polychondritis (RP). PATIENT We report a 61-year-old Japanese male patient with spiking fever and impaired consciousness. Neurological examination revealed meningealirritation, and cerebrospinal fluid (CSF) examination showed lymphocytic pleocytosis with elevated protein (199 mg/dL) and interleukin-6 (3810 pg/mL). Serological analysis showed high levels of anti-type II collagen antibodies, and the result of auricular biopsy was consistent with the diagnosis of RP showing cartilage degeneration surrounded by inflammatory cell infiltrations. DIAGNOSIS A clinical diagnosis of RP was made according to the diagnostic criteria established by MacAdams et al. INTERVENTION Steroid pulse therapy (methylprednisolone 1000 mg, consecutive 3 days) followed by oral prednisolone (60 mg/day) resolved the patient's high fever and disturbance of consciousness. OUTCOMES The patient rapidly improved after steroid treatments and has a normal quality of life under the maintenance dose of steroid plus methotrexate (4 mg/week). LESSONS RP-associated meningoencephalitis is a rare complication with significant morbidity and mortality. It should be considered and differentiated in patients with RP with unexplained spiking fever and impaired consciousness. In addition, the assessment of cerebrospinal fluid interleukin-6 levels may be useful to investigate the disease activity of RP-related meningoencephalitis. Further prospective studies are required to confirm this result.
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Affiliation(s)
| | - Ryo Tokimura
- Department of Neurology, Fukushima Medical University School of Medicine, Fukushima
| | | | | | | | | | | | | | - Kenji Yoshida
- Department of Neurology, Fukushima Medical University School of Medicine, Fukushima
| | - Ryoma Takahashi
- Department of Neurology, Fukushima Medical University School of Medicine, Fukushima
| | - Shoko Tanaka
- Department of Neurology, Fukushima Medical University School of Medicine, Fukushima
| | - Yuya Itagaki
- Department of Neurology, Fukushima Medical University School of Medicine, Fukushima
| | - Mari Honma
- Department of Neurology, Masu Memorial Hospital, Nihonmatsu, Fukushima, Japan
| | - Nozomu Matsuda
- Department of Neurology, Fukushima Medical University School of Medicine, Fukushima
| | | | | | - Kazuaki Kanai
- Department of Neurology, Fukushima Medical University School of Medicine, Fukushima
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Pitsigavdaki S, Evangelou G, Kefalogianni T, Kougkas N. Relapsing polychondritis with sterile purulent perichondrial effusions responding to Infliximab in a patient with erythrodermic and pustular psoriasis. Acta Reumatol Port 2021; 46:189-190. [PMID: 34243186] [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: 06/13/2023]
Affiliation(s)
- Sofia Pitsigavdaki
- Department of Rheumatology, Clinical Immunology and Allergy, University Hospital of Heraklion, Greece
| | - George Evangelou
- Department of Dermatology, University Hospital of Heraklion, Greece
| | | | - Nikolaos Kougkas
- Department of Rheumatology, Clinical Immunology and Allergy, University Hospital of Heraklion, Greece
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Sato R, Takahashi H, Terasaki M, Okamoto S, Terasaki T, Toko H, Yagishita M, Hagiawara S, Kondo Y, Tsuboi H, Matsumoto I, Sumida T. Advantage of Magnetic Resonance Imaging in Detecting Tracheal Involvement and Evaluation of the Therapeutic Response in Relapsing Polychondritis With Asthma-Like Symptoms. J Clin Rheumatol 2021; 27:e90-e91. [PMID: 31985719 DOI: 10.1097/rhu.0000000000001264] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Ryota Sato
- From the Department of Internal Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
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Cao XY, Zhao JL, Xu D, Hou Y, Zhang X, Zhao Y, Zeng XF, Zhang FC. [Clinical Features of Relapsing Polychondritis Patients Presented with Arthropathy]. Zhongguo Yi Xue Ke Xue Yuan Xue Bao 2020; 42:717-722. [PMID: 33423717 DOI: 10.3881/j.issn.1000-503x.11914] [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] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Objective To explore the clinical characteristics of relapsing polychondritis(RP)patients presented with arthropathy. Methods We retrospectively analyzed the clinical data of 201 RP patients who were hospitalized in our center between December 2005 and February 2019.After 16 patients with co-existing other autoimmune diseases and malignancies were ruled out,185 RP patients entered the final analysis,among whom 16 RP patients were presented with arthropathy and 169 without arthropathy.The demographic data,clinical manifestations,laboratory findings,and prognosis were compared between these two groups. Results Five of the 16 RP patients with arthropathy at presentation were misdiagnosed as rheumatoid arthritis.Compared with RP patients without arthropathy at presentation,RP patients with arthropathy at presentation had a longer disease course[(37.50±66.50)months vs.(9.00±11.00)months,z=-3.186,P =0.001],longer time of diagnostic delay[(24.00±41.25)months vs.(7.00±9.00)months,z=-2.890,P=0.004],and higher incidence of eye(62.50% vs. 36.09%,χ2=4.309,P=0.038)and nervous system involvements(43.75% vs. 15.38%,χ2=6.205,P=0.013). Conclusions RP patients with arthropathy at presentation are most likely to be misdiagnosed as rheumatoid arthritis.These patients are characterized by longer disease course and diagnostic delay and more frequrent eye and nervous system involvements.
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Affiliation(s)
- Xiao Yu Cao
- Department of Rheumatology and Clinical Immunology,PUMC Hospital,CAMS and PUMC,Beijing 100730,China
- Department of Rheumatology and Clinical Immunology,Beijing Tiantan Hospital,Capital Medical University,Beijing 100070,China
| | - Jiu Liang Zhao
- Department of Rheumatology and Clinical Immunology,PUMC Hospital,CAMS and PUMC,Beijing 100730,China
| | - Dong Xu
- Department of Rheumatology and Clinical Immunology,PUMC Hospital,CAMS and PUMC,Beijing 100730,China
| | - Yong Hou
- Department of Rheumatology and Clinical Immunology,PUMC Hospital,CAMS and PUMC,Beijing 100730,China
| | - Xuan Zhang
- Department of Rheumatology and Clinical Immunology,PUMC Hospital,CAMS and PUMC,Beijing 100730,China
| | - Yan Zhao
- Department of Rheumatology and Clinical Immunology,PUMC Hospital,CAMS and PUMC,Beijing 100730,China
| | - Xiao Feng Zeng
- Department of Rheumatology and Clinical Immunology,PUMC Hospital,CAMS and PUMC,Beijing 100730,China
| | - Feng Chun Zhang
- Department of Rheumatology and Clinical Immunology,PUMC Hospital,CAMS and PUMC,Beijing 100730,China
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Udomkarnjananun S, Puapatanakul P, Praditpornsilpa K. Relapsing polychondritis associated with pauci-immune crescentic glomerulonephritis. Lancet 2020; 396:e63. [PMID: 33543713 DOI: 10.1016/s0140-6736(20)32135-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 07/14/2020] [Accepted: 09/15/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Suwasin Udomkarnjananun
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand.
| | - Pongpratch Puapatanakul
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Kearkiat Praditpornsilpa
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
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Stiller RH, Gadzhiev M, Schachtel AK, Chang OH, Bastawrous S, Hermes Shantz H, Matute-Bello G, Albert TJ. A 68-Year-Old Man With Skin Rash and a Pleural Effusion. Chest 2020; 158:e33-e36. [PMID: 32654736 DOI: 10.1016/j.chest.2019.12.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 11/29/2019] [Accepted: 12/13/2019] [Indexed: 12/24/2022] Open
Abstract
CASE PRESENTATION A 68-year-old man developed an erythematous, papular, pruritic rash on his right thigh 1 month prior to presentation. It subsequently spread to his other extremities and trunk. He also endorsed fevers of > 38.3°C, night sweats, fatigue, shortness of breath, and a dry cough. He was prescribed triamcinolone 0.1% cream for his rash and azithromycin for presumed community-acquired pneumonia, with no improvement in symptoms. He had a history of relapsing polychondritis for which he was prescribed infliximab and low-dose prednisone. He had never smoked tobacco, did not use alcohol or illicit substances, and had no significant travel history.
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Affiliation(s)
- Robin H Stiller
- Division of General Internal Medicine, Department of Medicine, University of Washington
| | - Marat Gadzhiev
- Division of Rheumatology, Department of Medicine, University of Washington; VA Puget Sound Health Care System, Seattle, WA
| | - April K Schachtel
- Division of Dermatology, Department of Medicine, University of Washington; VA Puget Sound Health Care System, Seattle, WA
| | - Oliver H Chang
- Department of Pathology, University of Washington; VA Puget Sound Health Care System, Seattle, WA
| | - Sarah Bastawrous
- Department of Radiology, Department of Medicine, University of Washington; VA Puget Sound Health Care System, Seattle, WA
| | | | - Gustavo Matute-Bello
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Washington, Seattle, WA; VA Puget Sound Health Care System, Seattle, WA
| | - Tyler J Albert
- Division of General Internal Medicine, Department of Medicine, University of Washington; VA Puget Sound Health Care System, Seattle, WA.
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Abstract
Relapsing polychondritis (RP) is a rare immune-mediated disease affecting cartilaginous structures. Respiratory tract manifestations are frequent and constitute a major cause of morbidity and mortality. The present review of the literature was designed to assess the efficacy of tumor necrosis factor alpha (TNF-α) inhibitors in respiratory tract involvement of RP.A MEDLINE literature search was performed from January 2000 to December 2016 to identify all studies and case reports of anti-TNF-α therapy in RP. Articles published in English or French concerning patients with respiratory tract involvement were eligible. Two authors (JB, FL) independently reviewed and extracted data concerning each patient and 2 personal cases were added. Treatment efficacy was assessed according to systemic and/or respiratory criteria.A total of 28 patients (mean age: 41.6 years; 16 females/12 males) were included in the final analysis. Anti-TNF-α therapy was associated with improved health status and respiratory symptoms in 67.8% and 60.1% of cases, respectively.These results suggest that TNF-α inhibitors could be considered for the treatment of respiratory tract involvement of RP.
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Affiliation(s)
- Josette Biya
- Department of Respiratory Diseases, Reims University Hospital
| | - Sandra Dury
- Department of Respiratory Diseases, Reims University Hospital
- EA 4683 Medical and Pharmacological Sciences
| | - Jeanne-Marie Perotin
- Department of Respiratory Diseases, Reims University Hospital
- UMRS 903, Reims University Hospital, Reims, France
| | - Claire Launois
- Department of Respiratory Diseases, Reims University Hospital
| | - Maxime Dewolf
- Department of Respiratory Diseases, Reims University Hospital
| | - Gaëtan Deslée
- Department of Respiratory Diseases, Reims University Hospital
- UMRS 903, Reims University Hospital, Reims, France
| | - François Lebargy
- Department of Respiratory Diseases, Reims University Hospital
- EA 4683 Medical and Pharmacological Sciences
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Le Goueff A, Vandergheynst F, Jayne D. Coincident relapsing polychondritis and IgG4-related disease: a diagnostic challenge. Pol Arch Intern Med 2019; 129:539-541. [PMID: 31469124 DOI: 10.20452/pamw.14954] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Zhu Z, Tian D, Ren N, Zhao Z, Wang X, Chen L. Limbic encephalitis with relapsing polychondritis: persistent white matter lesions and brain atrophy. J Int Med Res 2018; 46:5297-5302. [PMID: 30426814 PMCID: PMC6300954 DOI: 10.1177/0300060518805593] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 05/18/2018] [Accepted: 09/17/2018] [Indexed: 11/16/2022] Open
Abstract
Relapsing polychondritis (RP) is a rare autoimmune disorder affecting cartilage. Limbic encephalitis is a rare central nervous system manifestation of RP. This current case report describes a 66-year-old Chinese male patient who complained of developing myoclonus in the left leg, ataxia and speech difficulties 3 weeks prior to hospital admission. The patient presented with cognitive impairment, sleep disorder and extrapyramidal symptoms. The patient was diagnosed with RP that affected auricular cartilage, which also manifested as limbic encephalitis. Magnetic resonance imaging showed bilateral temporal lobe lesions involving the hippocampi and basal ganglia. Signal abnormalities in the white matter persisted during the 15-month follow-up period after treatment with corticosteroids and intravenous immunoglobulin. Over the same period, the bilateral hippocampi showed significant atrophy.
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Affiliation(s)
- Zilong Zhu
- Department of Neurology, Tianjin HuanHu Hospital, Tianjin, China
| | - Decai Tian
- Centre for Neuroinflammation, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Ning Ren
- Department of Neurology, Tianjin HuanHu Hospital, Tianjin, China
| | - Zhihong Zhao
- Department of Neurology, Tianjin HuanHu Hospital, Tianjin, China
| | - Xin Wang
- Department of Neurology, Tianjin HuanHu Hospital, Tianjin, China
| | - Lei Chen
- Department of Neurology, Tianjin HuanHu Hospital, Tianjin, China
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Shimizu J, Yamano Y, Kawahata K, Suzuki N. Relapsing polychondritis patients were divided into three subgroups: patients with respiratory involvement (R subgroup), patients with auricular involvement (A subgroup), and overlapping patients with both involvements (O subgroup), and each group had distinctive clinical characteristics. Medicine (Baltimore) 2018; 97:e12837. [PMID: 30334986 PMCID: PMC6211876 DOI: 10.1097/md.0000000000012837] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Relapsing polychondritis (RP) is a multisystem disorder of cartilaginous tissues. Previously, we found that patients with respiratory involvement and patients with auricular involvement were mutually exclusive in the RP cohort, which suggests a strong inverse relationship between respiratory and auricular involvement. Here, we examined the clinical manifestation patterns in a subgroup of patients with respiratory involvement (R subgroup) and a subgroup of patients with auricular involvement (A subgroup) and investigated the clinical and laboratory characteristics of each subgroup.There were 47 patients (19.7%) and 118 patients (49.4%) allocated to the R and A subgroups, respectively. Saddle nose deformity and a progressive disease course were observed frequently in the R subgroup. Arthritis, conjunctivitis, and CNS involvement were observed frequently in the A subgroup.The remaining RP patients formed a third subgroup of patients that had both respiratory involvement and auricular involvement. We designated this subgroup as the O (overlap) subgroup, and 75 patients (31.4%) were allocated to the O subgroup. Disease duration in the O subgroup (5.70 ± 0.64 years) was significantly longer than that in the A subgroup (4.12 ± 0.45 years) and relatively longer than that in the R subgroup (4.80 ± 0.63 years).We found that cardiovascular involvement was more predominant in the O subgroup than in the R and A subgroups. Higher concentrations of serum matrix metalloproteinase (MMP)3 were observed in the O subgroup than in the R and A subgroups.We measured serum MMP3 concentrations in another patient cohort including 22 newly recruited RP patients. MMP3 concentrations were significantly higher in the O subgroup (n = 10) than those in the R subgroup (n = 6) and A subgroup (n = 10).RP patients in the R and A subgroups had different characteristics from each other, and the overlap of respiratory and auricular involvement was an important prognostic factor in patients with RP. Cardiovascular involvement was not observed in the R subgroup in RP patients. The current study may provide insights into the classification and treatment of RP.
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Oryoji D, Ono N, Himeji D, Yoshihiro K, Kai Y, Matsuda M, Tsukamoto H, Ueda A. Sudden Respiratory Failure due to Tracheobronchomalacia by Relapsing Polychondritis, Successfully Rescued by Multiple Metallic Stenting and Tracheostomy. Intern Med 2017; 56:3369-3372. [PMID: 29021454 PMCID: PMC5790730 DOI: 10.2169/internalmedicine.8778-16] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Relapsing polychondritis (RP) is a rare systemic autoimmune disease that affects cartilaginous structures. RP causes tracheobronchomalacia (TBM) by affecting the bronchial cartilage. TBM is a fatal condition characterized by excessive weakening of the walls of the trachea and bronchi. We herein report a case of a 73-year-old man who experienced sudden respiratory failure due to TBM caused by RP. Immunosuppressive treatment did not improve his respiratory failure. Multiple metallic stentings dramatically improved his severe airway symptoms. When the airway condition becomes lethal in RP patients, then metallic stenting can be a useful treatment option.
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Affiliation(s)
- Daisuke Oryoji
- Department of Medicine and Biosystemic Science, Kyushu University Graduate School of Medical Sciences, Japan
| | - Nobuyuki Ono
- Department of Internal Medicine, Miyazaki Prefectural Miyazaki Hospital, Japan
| | - Daisuke Himeji
- Department of Internal Medicine, Miyazaki Prefectural Miyazaki Hospital, Japan
| | - Kyoko Yoshihiro
- Department of Internal Medicine, Miyazaki Prefectural Miyazaki Hospital, Japan
| | - Yasufumi Kai
- Department of Internal Medicine, Miyazaki Prefectural Miyazaki Hospital, Japan
| | - Motohiro Matsuda
- Department of Internal Medicine, Miyazaki Prefectural Miyazaki Hospital, Japan
| | - Hiroshi Tsukamoto
- Department of Medicine and Biosystemic Science, Kyushu University Graduate School of Medical Sciences, Japan
| | - Akira Ueda
- Department of Internal Medicine, Miyazaki Prefectural Miyazaki Hospital, Japan
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Abstract
RATIOINALE Relapsing polychondritis (RP) is a rare and heterogeneous disease complex of unknown origin which basically affects cartilaginous structures, 40% of which accompanied by rheumatic, hematologic, and endocrine disease. Among them, vasculitis is the most common accompanying type and usually presented with positive antineutrophilic cytoplasmic antibody (ANCA). The presence of ANCA could be primary or drug-induced like propylthiouracil (PTU). Central involvement of RP is very rare, and there is almost no report of cerebral vasculopathy manifested as moyamoya. PATIENT CONCERNS A 26-year-old woman complained about recurrent fever, auricular chondritis, ocular inflammation, and arthritis. She had an 8-year drug intake of PTU for Graves disease. Myeloperoxidase antineutrophilc cytoplasmic antibodies (MPO-ANCA) were found positive. Magnetic resonance angiography (MRA) detected multiple intracranial vasculopathy which we highly suspected it as moyamoya disease. DIAGNOSES Relapsing polychondritis, Graves disease and suspected moyamoya disease were clinically diagnosed. INTERVENTIONS AND OUTCOMES In case of possible PTU-induced vasculitis and the aggravation of vasculopathy, PTU was replaced by Iodine-131 (I) therapy. Induction treatment included oral prednisone 30 mg daily and oral cyclophosphamide 100 mg daily. Symptoms rapidly relieved before discharge. Inflammation markers were normal and MPO-ANCA decreased in 3 weeks after admission. Prednisone was gradually tapered to 7.5 mg daily and at month 10 azathioprine was continued for maintenance. LESSONS RP can overlap with Graves disease and moyamoya disease; comprehensive tests should be performed when admission. When relapsing polychondritis is accompanied with Graves disease, especially when ANCA is positive, PTU should be avoided.
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Abstract
INTRODUCTION Fever of unknown origin (FUO) is a common initial presentation leading to a diagnostic challenge. PATIENT CONCERNS A 3-month history of moderate-to-high fever was reported in an otherwise healthy 54-year-old man. Enhanced computed tomography (CT) scans of his chest showed a remarkable progressive enlargement of bilateral cervical, supraclavicular, hilar, and mediastinal lymph nodes within 2 weeks. Bronchofibroscopy manifested obvious luminal stenosis with swelling, thick pale mucosa, and disappearing of structures of trachea cricoid cartilage, followed by a 18F-fluorodeoxyglucose positron-emission tomography-computed tomography (18F-FDG PET/CT) with intense symmetric FDG uptake in larynx, tracheobronchial tree, and hilar, mediastinal, and axillary lymph nodes being demonstrated. DIAGNOSIS A diagnosis of relapsing polychondritis (RP) was finally reached. INTERVENTIONS The patient received methylprednisolone 40 mg daily with a gradual tapering in a 4-month follow-up. OUTCOMES The patient experienced no relapse of fever and lymph nodes enlargement in the 4-month follow-up. LESSONS Even though long-term fever with multiple lymphadenectasis usually lead to a diagnosis of lymphoma, the bronchoscopic features and evidence from 18F-FDG PET/CT in this case were much more approximate to RP, indicating an importance of a sensible differential diagnosis of RP in patients who present with nonspecific features such as FUO and lymph nodes enlargement. Keeping a high index of clinical suspicion in these patients can help recognize uncommon of RP and promote diagnosis and treatment. Our case highlights the significance of 18F-FDG PET/CT in helping reaching the diagnosis of RP in this condition. This report provides new data regarding the diagnostic difficulties of this rare type of autoimmune disease, and further investigations are needed as cases accumulate.
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Motozawa N, Nakamura T, Takagi S, Fujihara M, Hirami Y, Ishida K, Sotozono C, Kurimoto Y. Unique circumferential peripheral keratitis in relapsing polychondritis: A case report. Medicine (Baltimore) 2017; 96:e7951. [PMID: 29019876 PMCID: PMC5662299 DOI: 10.1097/md.0000000000007951] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Relapsing polychondritis (RP) is a rare collagen disease characterized by inflammation and destruction of cartilage throughout the body. The paper details the clinical course of a case of RP with unique circumferential peripheral keratitis. PATIENT CONCERNS A 54-year-old Japanese woman was referred to the hospital presenting with auricular and ocular pain. DIAGNOSES Based on the auricle biopsy results and the three presenting symptoms (bilateral auricular chondritis, inflammatory arthritis and ocular inflammation), her condition was diagnosed as RP. INTERVENTIONS The three presenting symptoms gradually improved with prednisolone (PSL), methylprednisolone and cyclophosphamide combination therapy, followed by PSL, methotrexate and infliximab combination therapy. However, one month after the initial visit, despite ongoing treatment, a unique circumferential peripheral keratitis suddenly occurred, in which the corneal infiltration gradually clumped together and shrank at the peripheral area. The eye and ear pain showed exacerbations and remissions on reducing the dosage of steroid drugs. The general condition was improved on altering systemic therapy to PSL, methotrexate and tocilizumab. OUTCOMES Keratitis gradually disappeared within 10 months of the initial visit. LESSONS This is the first report of a case of RP causing unique circumferential peripheral keratitis. This keratitis occurred despite use of focal and systemic steroids and showed improvement with general recovery. This may indicate that stabilization of general condition is important for recovery from keratitis in RP.
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Affiliation(s)
- Naohiro Motozawa
- Department of Ophthalmology, Kobe City Medical Center General Hospital
- Department of Ophthalmology, Institute of Biomedical Research and Innovation Hospital, Kobe
| | - Takahiro Nakamura
- Department of Ophthalmology, Kobe City Medical Center General Hospital
- Department of Ophthalmology, Institute of Biomedical Research and Innovation Hospital, Kobe
- Department of Frontier Medical Science and Technology for Ophthalmology
| | - Seiji Takagi
- Department of Ophthalmology, Kobe City Medical Center General Hospital
- Department of Ophthalmology, Institute of Biomedical Research and Innovation Hospital, Kobe
| | - Masashi Fujihara
- Department of Ophthalmology, Kobe City Medical Center General Hospital
- Department of Ophthalmology, Institute of Biomedical Research and Innovation Hospital, Kobe
| | - Yasuhiko Hirami
- Department of Ophthalmology, Kobe City Medical Center General Hospital
- Department of Ophthalmology, Institute of Biomedical Research and Innovation Hospital, Kobe
| | - Kazuhiro Ishida
- Department of Ophthalmology, Kobe City Medical Center General Hospital
- Department of Ophthalmology, Institute of Biomedical Research and Innovation Hospital, Kobe
| | - Chie Sotozono
- Department of Ophthalmology, Kobe City Medical Center General Hospital
- Department of Ophthalmology, Institute of Biomedical Research and Innovation Hospital, Kobe
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yasuo Kurimoto
- Department of Ophthalmology, Kobe City Medical Center General Hospital
- Department of Ophthalmology, Institute of Biomedical Research and Innovation Hospital, Kobe
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