ABSTRACT
OBJECTIVES: We aimed to characterize the clinical and radiological features, and outcomes, of a large cohort of hypertrophic pachymeningitis (HP) patients from a single center. METHODS: We conducted a retrospective study at a tertiary referral center, encompassing patients diagnosed with HP between 2003 and 2022. The diagnosis of HP relied on the identification of thickening of the dura mater via magnetic resonance imaging (MRI) of the brain or spine. RESULTS: We included 74 patients with a mean age of 43.6 ± 14.2 years, of whom 37 (50%) were male. Among them, 32 (43.2%) had an immune-mediated origin, including 21 with granulomatosis with polyangiitis (GPA) (predominantly PR3-ANCA positive), four with systemic lupus erythematosus, three with IgG4-related disease, three with idiopathic HP, and one with rheumatoid arthritis. Non-immune-mediated HP accounted for 45 cases (56.8%). Within this category, 21 (28.4%) were infectious cases, with 14 being Mycobacterium tuberculosis infection (TB-HP), and 21 (28.4%) were malignancy-associated HP. Clinical and MRI characteristics exhibited variations among the four etiological groups. Hypoglycorrhachia was primarily observed in infectious and malignancy-associated HP. Immune-mediated HP was associated with a peripheral pattern of contrast enhancement and the Eiffel-by-night sign. MRI features strongly indicative of TB-HP included leptomeningeal involvement, brain parenchymal lesions, and arterial stroke. MPO-ANCA GPA was associated with a higher prevalence of spinal HP. CONCLUSIONS: Within our cohort, GPA and Mycobacterium tuberculosis emerged as the predominant causes of HP. We identified significant disparities in clinical and radiological features among different etiologies, which could have implications for diagnosis.
ABSTRACT
Latin America is experiencing a demographic and epidemiological transition, with an increase in non-communicable diseases such as cancer. One of the greatest advances in the therapeutic approach to cancer has been the discovery of immunotherapy, and specifically of checkpoint inhibitors (CPIs). Since inhibition of CTLA-4 and PD-1/PD-L1 enhances the immune response, cancer immunotherapies are associated with a new class of toxicities of autoimmune and/or autoinflammatory origin. These immune-related adverse events (irAEs) result in a broad spectrum of clinical events including rheumatic clinical syndromes, which may resemble classic rheumatic diseases. The most common rheumatic manifestations include inflammatory arthritis, myositis, vasculitis, and sicca syndrome. Recognizing rheumatologic irAEs is challenging due to the wide spectrum of clinical presentations that often do not fulfill traditional classification criteria of rheumatic diseases. A delayed diagnosis and treatment can lead to long-term disability, and disorders may become chronic and require ongoing immunosuppressive therapy. The management of irAEs includes the prompt detection and appropriate grading since their management is dictated by their severity. The growing use of CPIs, and the ensuing increase in irAEs, warrants an increasing collaboration between rheumatologists and oncologists. Understanding the pathophysiology, diagnosis, grading, and therapeutic implications of irAEs in patients with cancer is thus a requirement for Latin American oncologists and rheumatologists alike.
Subject(s)
Myositis , Neoplasms , Rheumatic Diseases , Humans , Immune Checkpoint Inhibitors , Immunotherapy/adverse effects , Myositis/drug therapy , Myositis/therapy , Neoplasms/drug therapy , Rheumatic Diseases/diagnosis , Rheumatic Diseases/drug therapy , Rheumatic Diseases/etiologyABSTRACT
Resumen La esperanza de vida de las personas ha aumentado en los últimos años, como resultado, la prevalencia de octagenarios y nonagenarios con el diagnóstico de síndrome coronario agudo tipo infarto con elevación del segmento ST ha aumentado. La evidencia respecto al tratamiento con intervención coronaria percutánea (ICP) primaria en estos pacientes es poca y su prescripción es controvertida. Muchos estudios retrospectivos evaluaron el tratamiento con ICP primaria en adultos octogenarios, concluyendo que una ICP primaria exitosa puede reducir la mortalidad a corto y largo plazos. Con base en la evidencia actual, la decisión de realizar una ICP primaria a un paciente nonagenario no debe basarse solamente en la edad, debe evaluarse el beneficio de cada paciente de manera individual, asesorar si es apto a la revascularización y deben tomarse en cuenta las posibles complicaciones que pueden ocurrir durante y después del procedimiento. En este artículo se comunica el caso clínico de una paciente de 93 años de edad, que tuvo síndrome coronario agudo de tipo infarto con elevación del segmento ST, a quien se realizó intervención coronaria percutánea de manera exitosa.
Abstract The life expectancy of people has increased in the last years, as a result, the prevalence of octogenarians with the diagnosis of acute myocardial infarction with ST-segment elevation (STEMI) has augmented. The evidence about the treatment with primary percutaneous coronary intervention (PCI) in this group of patients is limited and its prescription is controversial. Many retrospective assays have studied primary PCI in octogenarians with STEMI, and conclude that successful primary PCI can result in a reduction of early and long-term mortality. Taking into account the current evidence, the decision to perform primary PCI in the elderly should not be based on chronological age alone, but rather on each patient's benefit and eligibility for revascularization, we should consider the possible complications during and after the procedure. This article reports a clinical case of a female patient of 93 years old, that presented with acute myocardial infarction with ST-segment elevation, in which primary percutaneous intervention was performed successfully.
