RESUMEN
BACKGROUND: Episodic angioedema with eosinophilia (EAE) (Gleich syndrome) is a rare disorder consisting of recurrent episodes of angioedema, hypereosinophilia, and frequent elevated serum IgM level. METHODS: We conducted a retrospective multicenter nationwide study regarding the clinical spectrum and therapeutic management of patients with EAE in France. RESULTS: A total of 30 patients with a median age at diagnosis of 41 years (range, 5-84) were included. The median duration of each crisis was 5.5 days (range, 1-90), with swelling affecting mainly the face and the upper limbs. Total serum IgM levels were increased in 20 patients (67%). Abnormal T-cell immunophenotypes were detected in 12 patients (40%), of whom 5 (17%) showed evidence of clonal T-cell receptor gamma locus gene (TRG) rearrangement. The median duration of follow-up was 53 months (range, 31-99). The presence of an abnormal T-cell population was the sole factor associated with a shorter time to flare (hazard ratio, 4.15; 95% confidence interval, 1.18-14.66; P = .02). At last follow-up, 3 patients (10%) were able to have all treatments withdrawn and 11 (37%) were in clinical and biologic remission with less than 10 mg of prednisone daily. CONCLUSION: EAE is a heterogeneous condition that encompasses several disease forms. Although patients usually respond well to glucocorticoids, those with evidence of abnormal T-cell phenotype have a shorter time to flare.
Asunto(s)
Angioedema , Eosinofilia , Humanos , Eosinofilia/complicaciones , Eosinofilia/diagnóstico , Angioedema/etiología , Angioedema/complicaciones , Síndrome , Pronóstico , Linfocitos T , Inmunoglobulina M , FenotipoAsunto(s)
Eosinofilia , Fascitis , Humanos , Estudios Retrospectivos , Pronóstico , Fascitis/diagnóstico , EdemaAsunto(s)
Infecciones por Coronavirus/tratamiento farmacológico , Proteína Antagonista del Receptor de Interleucina 1/uso terapéutico , Neumonía Viral/tratamiento farmacológico , Anciano de 80 o más Años , Antibacterianos/uso terapéutico , Azitromicina/uso terapéutico , Betacoronavirus , Proteína C-Reactiva/inmunología , COVID-19 , Infecciones por Coronavirus/diagnóstico por imagen , Infecciones por Coronavirus/inmunología , Infecciones por Coronavirus/fisiopatología , Progresión de la Enfermedad , Inhibidores Enzimáticos/uso terapéutico , Femenino , Hospitalización , Humanos , Hidroxicloroquina/uso terapéutico , Unidades de Cuidados Intensivos , Pulmón/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Pandemias , Neumonía Viral/diagnóstico por imagen , Neumonía Viral/inmunología , Neumonía Viral/fisiopatología , Síndrome de Dificultad Respiratoria/fisiopatología , SARS-CoV-2 , Índice de Severidad de la Enfermedad , Tomografía Computarizada por Rayos X , Resultado del Tratamiento , Tratamiento Farmacológico de COVID-19RESUMEN
OBJECTIVE: In a previous controlled trial, 1-year adjunction of AZA to glucocorticoids (GC) for patients with non-severe, newly diagnosed eosinophilic granulomatosis with polyangiitis (EGPA) failed to lower remission failure, vasculitis relapse and isolated asthma/rhinosinus exacerbation rates, or cumulative GC use at month (M) 24. The aim of this study was to analyse longer-term outcomes to determine whether subsequent vasculitis relapse or isolated asthma/rhinosinus exacerbation (IARE) rates differed. METHODS: After M24, patients were followed prospectively, being treated based on physicians' best judgment. Flares and reasons for increased GC dose or immunosuppressant use were recorded, and reviewed according to randomization group to distinguish vasculitis relapses from IAREs according to EGPA Task Force recommendations. RESULTS: Fifty EGPA trial participants were followed for a median (interquartile range) of 6.3 (5.4-7.6) years; two (4%) died 11 months post-inclusion. By M24, vasculitis had relapsed in 21/49 (43%) patients and 14/50 (28%) had IAREs. Another patient died 4.8 years post-inclusion (infection). Among nine patients with subsequent vasculitis relapses, three had a major relapse and three had their first relapse after M24; among 25 patients with later IAREs, 17 occurred after M24. At 5 years, respective vasculitis relapse and IARE rates were 48% (95% CI 34.0, 62.6) and 56% (95% CI 41.7, 70.8), with no between-arm differences (P = 0.32 and 0.13). No entry clinical or biological parameter was associated with these outcomes during follow-up. CONCLUSION: These results confirmed that 1-year AZA and GC induction obtained good overall survival but no long-term benefit for non-severe EGPA patients. Vasculitis relapses, occurring mostly during the first 2 years, and IAREs, occurring throughout follow-up, require other preventive treatments. TRIAL REGISTRATION: ClinicalTrials.gov, https://clinicaltrials.gov, NCT00647166.
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Azatioprina/uso terapéutico , Síndrome de Churg-Strauss/tratamiento farmacológico , Glucocorticoides/uso terapéutico , Inmunosupresores/uso terapéutico , Adulto , Anciano , Asma/epidemiología , Progresión de la Enfermedad , Supervivencia sin Enfermedad , Femenino , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Ensayos Clínicos Controlados Aleatorios como Asunto , Recurrencia , Inducción de Remisión , Rinitis/epidemiología , Índice de Severidad de la Enfermedad , Sinusitis/epidemiología , Resultado del TratamientoRESUMEN
Previous studies reported a 2- to 17-fold higher risk of aortic complications (dilation or dissection) in patients with giant-cell arteritis (GCA). We aimed to determine whether or not GCA patients with large-vessel involvement demonstrated by positron emission tomography with F-fluorodeoxyglucose combined with computed tomography (FDG-PET/CT) have a higher risk of aortic complications. We conducted a retrospective multicenter study between 1995 and 2014. Patients were included if they fulfilled at least 3 American College of Rheumatology criteria for GCA, or 2 criteria associated with extratemporal biopsy-proven giant-cell vasculitis; they underwent at least 1 FDG-PET/CT scan at diagnosis or during follow-up; and the morphology of the aorta was assessed by medical imaging at diagnosis. Patients with an aortic complication at the time of diagnosis were excluded. Of the 130 patients included [85 women (65%), median age 70 (50-86)], GCA was biopsy proven in 77 (59%). FDG-PET/CT was performed at diagnosis in 63 (48%) patients and during the follow-up period in the 67 (52%) remaining patients. FDG-PET/CT was positive in 38/63 (60%) patients at diagnosis and in 31/67 (46%) patients when performed during follow-up (P = NS). One hundred four patients (80%) underwent at least 1 morphological assessment of the aorta during follow-up. Nine (9%) patients developed aortic complications (dilation in all and dissection in 1) at a median time of 33 (6-129) months after diagnosis. All of them displayed large-vessel inflammation on previous FDG-PET/CT. A positive FDG-PET/CT was significantly associated with a higher risk of aortic complications (P = 0.004).In our study, a positive FDG-PET/CT was associated with an increased risk of aortic complications at 5 years.
Asunto(s)
Enfermedades de la Aorta/diagnóstico por imagen , Enfermedades de la Aorta/etiología , Fluorodesoxiglucosa F18 , Arteritis de Células Gigantes/complicaciones , Tomografía Computarizada por Tomografía de Emisión de Positrones , Radiofármacos , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios RetrospectivosAsunto(s)
Anticuerpos Monoclonales Humanizados/uso terapéutico , Displasia Fibrosa Poliostótica/tratamiento farmacológico , Displasia Fibrosa Poliostótica/genética , Adulto , Anticuerpos Monoclonales Humanizados/farmacología , Huesos/efectos de los fármacos , Huesos/patología , Cromograninas , Femenino , Subunidades alfa de la Proteína de Unión al GTP Gs/genética , Humanos , Mutación/genética , Resultado del TratamientoRESUMEN
BACKGROUND: Long-term anticoagulation is recommended in antiphospholipid syndrome with thrombosis in order to prevent recurrences. While the current mainstay relies on vitamin K antagonists, their long-term maintenance may remain challenging. OBJECTIVES: To report on the safety and the efficacy of oral direct inhibitors of thrombin and factor Xa (ODIs) in antiphospholipid syndrome (APS). METHODS: We performed a descriptive analysis of patients with APS enrolled in a French multicentre observational cohort between January 2012 and March 2014 and receiving ODIs. The main outcomes were the occurrence of a thrombotic recurrence or bleeding events. RESULTS: Twenty-six patients with APS (primary in 12) received ODIs. Twenty patients had been previously treated with VKA (n=19), or fondaparinux (n=1) for a median duration of 3years. ODIs were introduced as second-line therapy because of INR lability/therapeutic simplification (n=17), recurrent thrombosis (n=1), VKA's associated bleeding event (n=1), and atrial fibrillation (n=1). Six patients received ODIs as first-line therapy. After a median [IQR] follow-up of 19 [8-29] months, one relapse of arterial thrombosis, two bleeding events (hypermenorrhea and rectal bleeding under rivaroxaban) and one recurrent migraine were reported, leading to discontinuation of therapy in these 4 patients. CONCLUSION: ODIs might be an alternative therapeutic option in APS. Prospective studies are warranted to evaluate their safety in this condition.
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Síndrome Antifosfolípido/tratamiento farmacológico , Inhibidores del Factor Xa/uso terapéutico , Trombina/antagonistas & inhibidores , Administración Oral , Anticoagulantes/uso terapéutico , Factor Xa/metabolismo , Inhibidores del Factor Xa/administración & dosificación , Inhibidores del Factor Xa/efectos adversos , Hemorragia/inducido químicamente , HumanosAsunto(s)
Biopsia/métodos , Fluorodesoxiglucosa F18 , Granulomatosis Linfomatoide/diagnóstico , Neoplasias de los Músculos/diagnóstico , Músculo Esquelético/diagnóstico por imagen , Músculo Esquelético/patología , Tomografía de Emisión de Positrones/métodos , Diagnóstico Diferencial , Humanos , Masculino , Persona de Mediana Edad , RadiofármacosRESUMEN
OBJECTIVE: The association between vasculitis and large granular lymphocyte (LGL) leukemia has rarely been reported or investigated. Thus, we assessed the clinical and biological phenotypes of LGL leukemia associated with vasculitis. RESULTS: We studied a series of 11 patients displaying LGL leukemia associated with vasculitis (LAV). The mean age at diagnosis of LGL leukemia was 60.3 years; there were nine women and two men. The mean follow-up period was 45 months. The main LGL lineage was T-LGL (10 patients), and only one NK-LGL was identified. Clinical and biological features of T-LGL leukemia were compared with those from the 2009 French T-LGL registry. We did not find any relevant differences except that patients with LAV were predominantly female (p < 0.05). The most frequently observed vasculitis was cryoglobulinemia (n = 5). Three patients presented with cutaneous leukocytoclastic angiitis, two patients had ANCA-negative microscopic polyangiitis, and one patient had giant cell arteritis. The main clinical features involved the skin, e.g., purpura (91%), arthralgia (37%), peripheral neuritis (27%), and renal glomerulonephritis (18%). The most frequent histologic finding was leucocytoclastic vasculitis (54%). The rate of complete remission was high; i.e., 80%. A minority of patients had a vasculitis relapse (27%). Three patients (27%) died; one death was related to LGL leukemia (acute infection) and the two other deaths were related to vasculitis (both with heart failure). CONCLUSION: We conclude that vasculitis is overrepresented in the population of LGL patients, LAV predominantly affects women, vasculitis preferentially affects the small vessels, and LAV has high rate of complete response.
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Leucemia Linfocítica Granular Grande/complicaciones , Vasculitis/complicaciones , Adulto , Anciano , Femenino , Glucocorticoides/uso terapéutico , Humanos , Inmunosupresores/uso terapéutico , Leucemia Linfocítica Granular Grande/tratamiento farmacológico , Masculino , Persona de Mediana Edad , Resultado del Tratamiento , Vasculitis/tratamiento farmacológicoRESUMEN
We describe three cases of intravascular lymphoma B with different clinical presentation: one case of a cutaneous variant and two cases with surrenal and cutaneous localisation. All patients are in complete remission after chemotherapy alone or after chemotherapy and autologous stem cells transplantation. The review of the literature as well as our cases specify the interest of an aggressive chemotherapy with autologous of peripheral stem cells if it was possible.
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Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Linfoma de Células B Grandes Difuso/tratamiento farmacológico , Enfermedades Raras/tratamiento farmacológico , Neoplasias Cutáneas/tratamiento farmacológico , Neoplasias Vasculares/tratamiento farmacológico , Anciano , Anciano de 80 o más Años , Anticuerpos Monoclonales de Origen Murino/administración & dosificación , Bleomicina/administración & dosificación , Ciclofosfamida/administración & dosificación , Doxorrubicina/administración & dosificación , Femenino , Humanos , Quimioterapia de Inducción/métodos , Linfoma de Células B Grandes Difuso/patología , Masculino , Persona de Mediana Edad , Prednisona/administración & dosificación , Enfermedades Raras/patología , Rituximab , Neoplasias Cutáneas/patología , Neoplasias Vasculares/patología , Vindesina/administración & dosificaciónRESUMEN
This study aimed to review and analyze the effectiveness and safety of tocilizumab in the treatment of patients with adult-onset Still's disease (AOSD). We report on two patients with AOSD who were successfully treated with tocilizumab. All published information on the use of tocilizumab in this disease was also retrieved through a systematic review of the English-language literature. Including our cases, 35 patients were given tocilizumab for AOSD (8 mg/kg/month in 22 patients). The main clinical manifestations were arthritis in all 35 patients and systemic symptoms such as fever or skin rash in 28 (80 %). Thirty-three (94 %) patients had unsuccessfully tried other immunosuppressive agents such as methotrexate, tumor necrosis factor-α blockers, or anakinra. Most of the patients achieved a response with tocilizumab, such as a prompt articular improvement in 30/35 (86 %) patients and a disappearance of systemic symptoms in 27/28 (96 %). Twenty-eight (80 %) patients tapered their steroid intakes, including seven (20 %) who were able to discontinue them. Four (11 %) patients relapsed, and two were successfully retreated with tocilizumab. Regarding safety, tocilizumab is a well-tolerated treatment, but severe side effects such as macrophage activation syndrome or cytomegalovirus reactivation are possible and require ongoing vigilance. Our findings suggest that tocilizumab should probably be proposed in refractory AOSD, as it allows for remission to be induced and the dose of steroid intakes to be reduced. It is a well-tolerated treatment that can be administered according to the therapeutic sequence of rheumatoid arthritis. Further prospective studies are required to assess the better use of this treatment (dosage and duration) and its place among other conventional treatments.
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Anticuerpos Monoclonales Humanizados/uso terapéutico , Antirreumáticos/uso terapéutico , Enfermedad de Still del Adulto/tratamiento farmacológico , Resistencia a Medicamentos , Sustitución de Medicamentos , Femenino , Humanos , Persona de Mediana Edad , Inducción de Remisión , Enfermedad de Still del Adulto/patología , Enfermedad de Still del Adulto/fisiopatología , Resultado del Tratamiento , Adulto JovenRESUMEN
Eosinophilic fasciitis is a rare connective tissue disorder, which can be associated with hematological complications in 10% of cases, such as aplastic anemia or acquired amegakaryocytic thrombocytopenia. Paroxysmal nocturnal hemoglobinuria had never been described in a patient suffering from eosinophilic fasciitis. We report an original case of a 59-year-old patient who developed a moderate aplastic pancytopenia while he was treated for a biopsy-proven eosinophilic fasciitis. A complete set of investigations was carried out and was found to be negative, including a first research of paroxysmal nocturnal hemoglobinuria. Two years after disease onset, while pancytopenia remained stable, occurrence of morning dark urine led to found a paroxysmal nocturnal hemoglobinuria clone. We discuss a potential link between the two conditions and hypothesize that paroxysmal nocturnal hemoglobinuria blood cells may pre-exist for a long time and take a survival advantage in the setting of marrow injury, as observed in eosinophilic fasciitis with hematological complications. We finally suggest that paroxysmal nocturnal hemoglobinuria should be included as a hematological complication of eosinophilic fasciitis.
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Eosinofilia/complicaciones , Eosinofilia/patología , Fascitis/complicaciones , Fascitis/patología , Hemoglobinuria Paroxística/etiología , Leucemia Mieloide Aguda/complicaciones , Pancitopenia/complicaciones , Fascia/patología , Resultado Fatal , Humanos , Masculino , Persona de Mediana EdadRESUMEN
Late diagnosis of HIV infection is associated with a lower survival rate. Because of several consecutive cases of late diagnosis of AIDS occurring in truck drivers, a retrospective study was carried out in the northwest of France. Truck drivers were significantly associated with a late diagnosis of HIV infection (P = 0.009) and an increased risk of death (P = 0.03). Consequently, prevention and HIV-testing campaigns targeting this profession appear necessary.
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Infecciones por VIH/mortalidad , Vehículos a Motor , Adulto , Métodos Epidemiológicos , Francia/epidemiología , Infecciones por VIH/diagnóstico , Humanos , Masculino , Persona de Mediana EdadRESUMEN
We describe 2 adult patients (1 of whom was infected with human immunodeficiency virus) with osteomyelitis due to Bartonella henselae. Diagnosis was established on the basis of direct identification of the microorganism in one case and seroconversion in the other. Both patients recovered completely within 3 months.