Anti-NXP2-Positive Paraneoplastic Dermatomyositis With Histopathologic Changes Confined to the Acrosyringia.

BACKGROUND: Paraneoplastic syndromes consist of a group of disorders that are not related to the extension of the primary tumor or its metastases and that might be the first manifestation of a hidden neoplasm. It is a well-known association between dermatomyositis (DM) and cancer, especially gynecological tumors in women and lung cancer in men. METHODS: We describe the case of a 67-year-old male who developed muscular weakness and pruritic skin lesions. Skin biopsies were performed and histologic findings were consistent with DM. RESULTS: Skin biopsy showed interface dermatitis with vacuolar degeneration of the basal layer, dermal mucin deposits, and necrotic keratinocytes in the acrosyringia, a finding that has been previously reported in lupus erythematous but not in DM. Autoimmunity tests showed positivity for antinuclear antibodies and anti-NXP2, a recently described antibody associated with juvenile DM and, more rarely, with paraneoplastic DM. CONCLUSION: We present the first case in the literature with histopathologic changes of DM affecting the acrosyringia. Besides, our patient autoimmunity results support the utility of the new myositis-specific autoantibodies and its relation with a clinical phenotype.

Thrombin generation in subjects with lupus anticoagulant without prior thrombosis or gestational morbidities.

BACKGROUND: Lupus anticoagulant (LA) can be a cause of thrombosis and/or pregnancy morbidities, producing antiphospholipid syndrome (APS). An increase in thrombin generation (TG) is correlated with prothrombotic status. Several changes in TG-derived parameters have been reported in APS patients. OBJECTIVES: Evaluate whether the TG phenotype of APS can also be described in LA subjects without clinical manifestations of APS, and to investigate the possible influence of both LA potency and antiphospholipid (aPL) profile on it. RESULTS: TG was analyzed in 153 cases of LA and 41 healthy controls. We have observed prolongation of both lag time (3.7 min vs 2.32 min, p < 0.001) and time to peak (6.48 min vs 5.27 min, p < 0.001), increased peak height (221.7 nM vs 182.7 nM, p < 0.001), slightly higher ETP (221.7 nM·min vs 182.7 nM·min, p = 0.041), and higher velocity index (100.7 nM/min vs 74.53 nM/min, p = 0.001) in LA subjects compared to controls. After adding thrombomodulin (TM), ETP%inh was significantly lower in LA group (37.90% vs 59.90%, p < 0.001) showing resistance to TM/activated protein C (APC). Significant differences were found in lag time, time to peak and ETP%inh according to the potency and aPL profile. CONCLUSIONS: Previously described differences in TG-derived parameters in APS patients have been confirmed in incidental LA subjects: prolonged lag time and time to peak, slightly higher ETP, higher peak height, and less sensitivity to TM/APC. High LA potency and triple-positive aPL profile enhance differences in lag time, time to peak and, especially, increase APC resistance, but no effect in ETP was observed.

Valor predictivo y utilidad clínica del genotipado HLA-DQ en el diagnóstico de la enfermedad celiaca en mayores de 50 años / Predictive value and clinical utility of HLA-DQ typing in diagnosis of celiac disease in patients over 50

Introducción. Existe un alto número de casos no diagnosticados de enfermedad celiaca, especialmente en individuos de edad avanzada. El objetivo del presente trabajo es determinar el valor predictivo del genotipado de HLA-DQ en el diagnóstico de la enfermedad celiaca en mayores de 50 años y analizar una posible relación entre la gradación de riesgo atribuida a los alelos y el diagnóstico en edad avanzada. Materiales y métodos. Seiscientos treinta y cinco pacientes fueron estudiados durante 2013 con clínica sugestiva de enfermedad celiaca. El diagnóstico fue confirmado mediante estudios serológicos y biopsia intestinal. El genotipado del HLA-DQ se realizó mediante una técnica PCR-SSOP. Resultados. Un 10,7% de los pacientes estudiados eran mayores de 50 años con un ratio hombre mujer 1:3. La frecuencia de los alelos considerados de riesgo para la enfermedad celiaca (HLA-DQ2.5 y/o HLA-DQ8) fue del 87,5% (56 pacientes), siendo celiacos 13 de ellos. Veintiún pacientes portaban solo un alelo del DQ2.5 (DQA1*05 o DQB1*02) sin confirmarse el diagnóstico de celiaquía. Un paciente celiaco confirmado no expresaba ni DQ2 ni DQ8. El valor predictivo positivo del genotipado de HLA-DQ para el diagnóstico de EC en la población mayor de 50 años fue del 29,27% y el valor predictivo negativo del 93%. Conclusiones. Debido al alto valor predictivo negativo, la determinación del HLA-DQ es un marcador útil en el diagnóstico de la EC en individuos de edad avanzada con clínica asociada. No se encontró relación entre los alelos considerados de menor riesgo y la aparición tardía de la enfermedad (AU)

Introduction. Celiac disease is significantly undiagnosed, especially in older individuals. The aim of this study is to determine the predictive value of HLA-DQ typing in the diagnosis of celiac disease in patients over 50 and analyze the possible relationship between the gradation of risk attributed to the alleles and diagnosis in elderly. Materials and methods. 635 patients were studied during 2013 with suggestive symptoms of celiac disease. The diagnosis was confirmed by serologic studies and small bowel biopsy. The HLA-DQ genotyping was performed using a PCR-SSOP technique. Results. 68 of out 635 patients studied (10.7%) were older than 50 years with a male to female ratio of 1:3. The frequency of the alleles that has been associated with risk of CD (HLA DQ2.5 and/or HLA DQ8) was 87.5% (56 patients), being celiac 13 of them. 21 patients carry the half allele of HLA-DQ2.5 (DQA1*05 or DQB1*02) associated with low risk of celiac disease being none of them celiac. One patient with celiac disease did not carry DQ2.5 or DQ8 heterodimers but was positive for serological and histological analysis. The positive predictive value of the use of HLA testing in the population older than 50 years is 29.27% and the negative predictive value is 93%. Conclusions. Due to the high negative predictive value, the determination of HLA-DQ is a useful marker in the diagnosis of CD, in individuals over 50 with associated clinical. There was no relationship between low risk alleles and late onset of disease (AU)