RESUMO
Eosinophils have widespread procoagulant effects. Eosinophilic cardiovascular toxicity mostly consists of endomyocardial damage or eosinophilic vasculitis, while reported cases of venous thrombosis (VT) are scarce. We aimed to report on the clinical features and treatment outcomes of patients with unexplained VT and eosinophilia, and to identify predictors of relapse. This retrospective, multicenter, observational study included patients aged over 15 years with VT, concomitant blood eosinophilia ≥ 1G/L and without any other moderate-to-strong contributing factors for VT. Fifty-four patients were included. VT was the initial manifestation of eosinophil-related disease in 29 (54%) patients and included pulmonary embolism (52%), deep venous thrombosis (37%), hepatic (11%) and portal vein (9%) thromboses. The median [IQR] absolute eosinophil count at VT onset was 3.3G/L [1.6-7.4]. Underlying eosinophil-related diseases included FIP1L1-PDGFRA-associated chronic myeloid neoplasm (n = 4), Eosinophilic Granulomatosis with Polyangiitis (n = 9), lymphocytic (n = 1) and idiopathic (n = 29) variants of hypereosinophilic syndrome. After a median [IQR] follow-up of 24 [10-62] months, 7 (13%) patients had a recurrence of VT. In multivariate analysis, persistent eosinophilia was the sole variable associated with a shorter time to VT relapse (HR 7.48; CI95% [1.94-29.47]; p = 0.015). Long-term normalization of eosinophil count could prevent the recurrence of VT in a subset of patients with unexplained VT and eosinophilia ≥ 1G/L.
Assuntos
Síndrome de Churg-Strauss/terapia , Eosinofilia/terapia , Síndrome Hipereosinofílica/terapia , Leucemia/terapia , Trombose Venosa/terapia , Adulto , Idoso , Síndrome de Churg-Strauss/epidemiologia , Síndrome de Churg-Strauss/patologia , Eosinofilia/complicações , Eosinofilia/epidemiologia , Eosinofilia/patologia , Eosinófilos/patologia , Feminino , Humanos , Síndrome Hipereosinofílica/epidemiologia , Síndrome Hipereosinofílica/genética , Síndrome Hipereosinofílica/patologia , Leucemia/epidemiologia , Leucemia/genética , Leucemia/patologia , Masculino , Pessoa de Meia-Idade , Veia Porta/patologia , Embolia Pulmonar/epidemiologia , Embolia Pulmonar/patologia , Embolia Pulmonar/terapia , Recidiva , Estudos Retrospectivos , Resultado do Tratamento , Trombose Venosa/epidemiologia , Trombose Venosa/genética , Trombose Venosa/patologia , Fatores de Poliadenilação e Clivagem de mRNA/genéticaRESUMO
BACKGROUND: Teledermoscopy (TDS) improves diagnostic accuracy and decreases the number of unnecessary consultations. OBJECTIVES: To determine the diagnostic concordance in tertiary (dermatologist-to-experts) TDS with histopathology/follow-up-based diagnosis. METHODS: A descriptive retrospective cohort study including 290 requests. RESULTS: Perfect diagnostic concordance was found in 202 (69.7%) cases and partial agreement in 29 (10%). Disagreement was found in 59 (20.3%) cases. Perfect concordance on the benign/malignant nature of the lesion was found in 227 (78.3%) cases and disagreement in 63 (21.7%). In onychology, diagnostic concordance was perfect in 43 (76.8%) cases, partial in 7 (12.5%), and there was disagreement in 6 (10.7%). Final concordance on the benign/malignant nature of the lesion was perfect in 48 (85.7%) and there was disagreement in 8 (14.3%) nail cases. For pediatric requests, diagnostic concordance was perfect in 29 (65.9%) cases, partial in 5 (11.4%), and there was disagreement in 10 (22.7%). Final concordance on the benign/malignant nature of the lesion was observed in 34 (77.3%) cases, disagreement in 10 (22.7%). CONCLUSIONS: This study confirms that tertiary TDS improves diagnostic accuracy of pigmented skin lesions. Moreover, it shows encouraging results in unusual conditions such as ungual and pediatric skin tumors. The main limitation was the retrospective nature and the "real-life" setting of our study that could have created a selection bias toward inclusion of the most difficult cases.