Coexistence of IgG4-related disease and ANCA-associated vasculitis: case report and review of the literature.

IgG4-related disease (IgG4-RD) is a fibroinflammatory condition that is characterized by storiform fibrosis, infiltration of IgG4-positive lymphocytes, obliterative phlebitis, and high IgG4 levels. Since IgG4-RD affects a wide variety of organs, a differential diagnosis must include multiple conditions. IgG4-RD is also believed to coexist with certain diseases. In recent years, case reports and case series describing the co-occurrence of IgG4-RD and ANCA-associated vasculitis (AAV) have been published. We intended to evaluate patients with IgG4-RD and AAV overlap in the literature using a case similar to one that was diagnosed and monitored in our department. We searched the databases of Web of Science, Scopus, and Google Scholar as well as PubMed with the keywords ANCA, IgG4, IgG4-RD, granulomatosis with polyangiitis, Wegener's granulomatosis, microscopic polyangiitis, Eosinophilic granulomatosis with polyangiitis, and Churg-Strauss syndrome. Cases and Case series addressing the coexistence of IgG4-RD and AAV have been selected. Comprehensive diagnostic criteria are used to diagnose IgG4-RD. The Chapel Hill Consensus Conference nomenclature criteria were used for the inclusion of AAV. Out of a total of 910 publications, 20 articles, including 65 cases, were found to be eligible. Forty-seven cases with IgG4-RD were evaluated as definitive (71.2%), 10 cases as probable (15.1%), and 9 cases as possible IgG4-RD (13.6%). 26 patients were diagnosed with GPA, 1 patient with localized GPA, 23 patients with MPA, and 4 patients with EGPA. The aorta, lacrimal tissue, pancreas, and retroperitoneum are the sites of IgG4-RD rather than AAV. AAV and IgG4-RD might coexist in the same patient. IgG4-RD is mainly associated with GPA.

Retrospective evaluation of 22 patients with Takayasu's arteritis.

Takayasu's arteritis (TA) is a rare, idiopathic, inflammatory, granulomatous vasculitis that affects the aorta and its primary branches. Clinical features and the pattern of arterial involvement show differences in different regions of the world according to ethnic influences. Our aim in this retrospective study was to evaluate the demographic, clinic, laboratory, and angiographic findings of 22 patients with TA followed by our clinic and also compare our results with series from the literature. The hospital files of the 22 patients followed by our clinic between 1998 and 2009 were retrospectively evaluated. We also compared our results with the series from the literature that we were able to reach by US National Library of Medicine, National Institute of Health. Gender distribution, age at diagnosis, and type of aortic involvement were similar with the study from Turkey. Different clinical manifestations of Takayasu's arteritis have been described in different ethnic groups. We also want to underline the coincidence of TA and other rheumatic diseases such as sarcoidosis, SLE, RA, and psoriatic arthritis, different from other published series.

The development of primary cutaneous adenoid cystic carcinoma in a patient with ankylosing spondylitis treated with etanercept.

The tumor necrosis factor-alpha (TNF-alpha) inhibitors are widely used in the treatment of some autoimmune disorders with promising results. However, their safety has been questioned with multiple postmarketing reports of increased risk for malignancies. The case of a patient with ankylosing spondylitis who developed cutaneous adenoid cystic carcinoma after three years of treatment with anti-TNF-alpha therapy is discussed.

Short-term course of chronic hepatitis B and C under treatment with etanercept associated with different disease modifying antirheumatic drugs without antiviral prophylaxis.

OBJECTIVE: To evaluate the short-term course of chronic hepatitis B and C under treatment with etanercept (ETN) associated with different disease modifying antirheumatic drugs (DMARD). METHODS: Patients with rheumatoid arthritis (RA) and ankylosing spondylitis (AS) receiving anti-tumor necrosis factor-a (TNF-a) were retrospectively reviewed for the presence of hepatitis B or C serology, liver function tests, liver biopsy findings, and the relevant outcomes in terms of viral load. RESULTS: We identified 5 relevant cases receiving ETN, 3 RA patients with chronic hepatitis C, another RA patient with dual infection by B and C, and one AS patient with hepatitis B. Four patients met the American College of Rheumatology criteria for RA. The patient with AS fulfilled the modified New York diagnostic criteria for AS. In Case 1, ETN was started after having discontinued a-interferon and ribavirin due to viral clearance of hepatitis C. These patients had not received prophylactic antiviral therapy while being treated with ETN. Viral replication increased in 2 patients to an insignificant level, remained negative in 2, and decreased in the remaining one. No significant rise in patients' liver transaminases could be determined during followup. CONCLUSION: We observed reactivation of hepatitis C virus infection in 2 of 4 patients while they were receiving ETN with DMARD without antiviral prophylaxis.