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1.
BMC Pulm Med ; 21(1): 74, 2021 Mar 02.
Artigo em Inglês | MEDLINE | ID: mdl-33653314

RESUMO

BACKGROUND: Blood eosinophil count may predict treatment response in patients with chronic obstructive pulmonary disease (COPD) during acute exacerbations (AE). However, the ability and thresholds of blood eosinophil counts in stable status to predict eosinophilic AECOPD have not been completely investigated. METHODS: This was a retrospective multicenter study performed January 2010 to December 2014. COPD subjects hospitalized with exacerbations, were included. Blood samples were obtained at the time of AE and stable disease at outpatient clinic before or after admission. We identified a blood eosinophil count cut-off point at stable COPD, either taken as a percentage or as absolute value, for identification of eosinophilic exacerbation. RESULTS: There was significant positive correlation of eosinophil counts between stable COPD and AECOPD. The best cut-off value of blood eosinophil count in stable status for the prediction of eosinophilic COPD exacerbation based on blood eosinophil count ≥ 2% was 300 cells/µL (area under the ROC curve [AUC] 0.614, P = 0.001, 39% sensitivity, 83.8% specificity). When the eosinophilic COPD exacerbation was based on blood eosinophil count ≥ 300 cells/µL, the best cut-off value of blood eosinophil count in stable status for the prediction of eosinophilic COPD exacerbation was also 300 cells/uL (AUC 0.634, P = 0.046, 45.8% sensitivity, 80.9% specificity). CONCLUSIONS: We demonstrated association between blood eosinophil counts at stable COPD and those with AECOPD. The thresholds of blood counts at stable COPD to predict eosinophilic exacerbations was 300 cells/µL. Further and prospective studies in other populations should validate our results.


Assuntos
Eosinofilia/sangue , Eosinófilos , Doença Pulmonar Obstrutiva Crônica/sangue , Idoso , Idoso de 80 Anos ou mais , Progressão da Doença , Eosinofilia/complicações , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Unidades de Terapia Intensiva/estatística & dados numéricos , Tempo de Internação/estatística & dados numéricos , Contagem de Leucócitos , Masculino , Pessoa de Meia-Idade , Mortalidade , Prognóstico , Doença Pulmonar Obstrutiva Crônica/complicações , Doença Pulmonar Obstrutiva Crônica/terapia , Respiração Artificial/estatística & dados numéricos , Estudos Retrospectivos
3.
BMJ Case Rep ; 14(1)2021 Jan 18.
Artigo em Inglês | MEDLINE | ID: mdl-33461987

RESUMO

Kimura's disease is a rare, benign, chronic inflammatory disorder characterised by its eosinophilic infiltrate. Patients often present with one or more progressively enlarging subcutaneous lymph nodes in the head and neck region or enlarging salivary glands. We describe the case of a 26-year-old man presenting with severe peripheral eosinophilia and upper airway inflammatory symptoms, who later developed cervical lymphadenopathy and formally diagnosed with Kimura's disease. Based on our English-language MEDLINE literature search, to our knowledge this is the first case report describing treatment of Kimura's disease with mepolizumab.


Assuntos
Anti-Inflamatórios/uso terapêutico , Anticorpos Monoclonais Humanizados/uso terapêutico , Eosinofilia/tratamento farmacológico , Rinite/tratamento farmacológico , Sinusite/tratamento farmacológico , Adulto , Eosinofilia/complicações , Eosinofilia/diagnóstico , Humanos , /diagnóstico , Masculino , Rinite/complicações , Rinite/diagnóstico , Rinite/imunologia , Sinusite/complicações , Sinusite/diagnóstico , Sinusite/imunologia
4.
BMJ Case Rep ; 14(1)2021 Jan 08.
Artigo em Inglês | MEDLINE | ID: mdl-33419755

RESUMO

Eosinophilic granulomatosis with polyangiitis (EGPA) is a rare disease with an estimated annual incidence of 0.5-6.8 per million. It is characterised by necrotising vasculitis with multiorgan eosinophilic infiltration. Pulmonary manifestations are the most common presentation of EGPA, and cardiac complications are the most common cause of death. Anaesthetic management of EGPA is challenging due to perioperative pulmonary complications, multiorgan involvement and greater risk of cholinesterase enzyme deficiency. We are reporting the anaesthetic management of a 58-year-old woman, diagnosed with EGPA 3 years ago, who underwent urgent intramedullary nail insertion for a femur fracture. The anaesthetic technique comprised femoral nerve block and spinal anaesthesia, thereby avoiding (1) the need for upper airway manipulation, (2) potential adverse effects of anticholinesterase drugs (for reversal of neuromuscular blockade) and (3) histamine release associated with morphine administration perioperatively. Surgery and anaesthesia were uneventful.


Assuntos
Raquianestesia , Eosinofilia/complicações , Fraturas do Fêmur/cirurgia , Fixação Intramedular de Fraturas , Granulomatose com Poliangiite/complicações , Bloqueio Nervoso , Feminino , Fraturas do Fêmur/complicações , Humanos , Pessoa de Meia-Idade
5.
N Engl J Med ; 383(17): 1624-1634, 2020 10 22.
Artigo em Inglês | MEDLINE | ID: mdl-33085861

RESUMO

BACKGROUND: Eosinophilic gastritis and duodenitis are characterized by gastrointestinal mucosal eosinophilia, chronic symptoms, impaired quality of life, and a lack of adequate treatments. Mast-cell activity may contribute to the pathogenesis of the conditions. AK002 (lirentelimab) is an anti-Siglec-8 antibody that depletes eosinophils and inhibits mast cells and that has shown potential in animal models as a treatment for eosinophilic gastritis and duodenitis. METHODS: In this phase 2 trial, we randomly assigned adults who had symptomatic eosinophilic gastritis, eosinophilic duodenitis, or both conditions in a 1:1:1 ratio to receive four monthly infusions of low-dose AK002, high-dose AK002, or placebo. The primary end point was the change in gastrointestinal eosinophil count from baseline to 2 weeks after the final dose; to maximize statistical power, we evaluated this end point in the placebo group as compared with the combined AK002 group. Secondary end points were treatment response (>30% reduction in total symptom score and >75% reduction in gastrointestinal eosinophil count) and the change in total symptom score. RESULTS: Of the 65 patients who underwent randomization, 43 were assigned to receive AK002 and 22 were assigned to receive placebo. The mean percentage change in gastrointestinal eosinophil count was -86% in the combined AK002 group, as compared with 9% in the placebo group (least-squares mean difference, -98 percentage points; 95% confidence interval [CI], -121 to -76; P<0.001). Treatment response occurred in 63% of the patients who received AK002 and in 5% of the patients who received placebo (difference, 58 percentage points; 95% CI, 36 to 74; P<0.001). The mean change in total symptom score was -48% with AK002 and -22% with placebo (least-squares mean difference, -26 percentage points; 95% CI, -44 to -9; P = 0.004). Adverse events associated with AK002 were similar to those with placebo, with the exception of higher percentages of patients having mild-to-moderate infusion-related reactions with AK002 (60% in the combined AK002 group and 23% in the placebo group). CONCLUSIONS: In patients with eosinophilic gastritis or duodenitis, AK002 reduced gastrointestinal eosinophils and symptoms. Infusion-related reactions were more common with AK002 than with placebo. (Funded by Allakos; ENIGMA ClinicalTrials.gov number, NCT03496571.).


Assuntos
Anticorpos Monoclonais Humanizados/administração & dosagem , Duodenite/tratamento farmacológico , Enterite/tratamento farmacológico , Eosinofilia/tratamento farmacológico , Eosinófilos , Gastrite/tratamento farmacológico , Lectinas/antagonistas & inibidores , Adolescente , Adulto , Idoso , Anticorpos Monoclonais Humanizados/efeitos adversos , Anticorpos Monoclonais Humanizados/farmacologia , Antígenos CD/imunologia , Antígenos de Diferenciação de Linfócitos B/imunologia , Relação Dose-Resposta a Droga , Método Duplo-Cego , Duodenite/complicações , Enterite/complicações , Eosinofilia/complicações , Feminino , Gastrite/complicações , Trato Gastrointestinal/imunologia , Humanos , Infusões Intravenosas/efeitos adversos , Lectinas/imunologia , Contagem de Leucócitos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
9.
Ann Hematol ; 99(7): 1561-1564, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32451710

RESUMO

NUT midline carcinoma (NMC) is an aggressive neoplasm and mainly involved in the head and neck area. The defining genetic hallmark on these tumors is that testis-specific nuclear gene (NUTM1) fuses to bromodomain protein family member 4 gene (BRD4), resulting in the formation of BRD4-NUTM1 transcript. Here, we report a case with myeloid neoplasm complicating with eosinophilia (MLN-Eo) and rearrangement of PDGFRA, which co-exists with a new nucleosome assemble protein 1-like 4 gene (NAP1L4) NAP1L4-NUTM1 fusion. The patient have unusually clinical features and therapeutic reaction to imatinib mesylate. The cloned NAP1L4-NUTM1 gene structure is also determined.


Assuntos
Cromossomos Humanos Par 11/genética , Cromossomos Humanos Par 15/genética , Eosinofilia/genética , Transtornos Mieloproliferativos/tratamento farmacológico , Transtornos Mieloproliferativos/genética , Proteínas de Neoplasias/genética , Proteínas Nucleares/genética , Adulto , Eosinofilia/complicações , Eosinofilia/tratamento farmacológico , Humanos , Síndrome Hipereosinofílica/genética , Síndrome Hipereosinofílica/patologia , Síndrome Hipereosinofílica/terapia , Mesilato de Imatinib/uso terapêutico , Leucemia/genética , Leucemia/patologia , Leucemia/terapia , Masculino , Mutação , Transtornos Mieloproliferativos/complicações , Transtornos Mieloproliferativos/patologia , Proteínas de Fusão Oncogênica/genética , Proteínas de Fusão Oncogênica/isolamento & purificação , Receptor alfa de Fator de Crescimento Derivado de Plaquetas/genética , Indução de Remissão , Translocação Genética/fisiologia
11.
Fetal Pediatr Pathol ; 39(3): 263-268, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32401577

RESUMO

Background: Cardiac damage is frequently referred to in patients with SARS-CoV-2, is usually diagnosed by enzyme elevations, and is generally thought to be due to underlying coronary artery disease. There are references to cardiomyopathies accompanying coronavirus, but there has been no histologic confirmation.Case report: A previously healthy 17 year male old presented in full cardiac arrest to the emergency department after a 2 day history of headache, dizziness, nausea and vomiting. Autopsy demonstrated an enlarged flabby heart with eosinophilic myocarditis. There was no interstitial pneumonia or diffuse alveolar damage. Postmortem nasopharyngeal swabs detected severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) known to cause coronavirus disease 2019 (COVID-19). No other cause for the eosinophilic myocarditis was elucidated.Conclusion: Like other viruses, SARS-CoV-2 may be associated with fulminant myocarditis.


Assuntos
Infecções por Coronavirus/mortalidade , Eosinofilia/mortalidade , Miocardite/mortalidade , Miocardite/virologia , Pneumonia Viral/mortalidade , Adolescente , Betacoronavirus , Infecções por Coronavirus/complicações , Eosinofilia/complicações , Evolução Fatal , Parada Cardíaca/complicações , Parada Cardíaca/virologia , Humanos , Masculino , Miocardite/complicações , Pandemias , Pneumonia Viral/complicações
12.
Ann Otol Rhinol Laryngol ; 129(9): 872-877, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32389067

RESUMO

OBJECTIVES/HYPOTHESIS: The presence of eosinophilia and nasal polyps are well-established prognostic indicators of chronic rhinosinusitis (CRS). The importance of demographic background, such as age, as independent variables has not been elucidated while taking these factors into account. STUDY DESIGN: Respective review. METHODS: CRS patients who underwent primary surgical treatment were subdivided based on age (young adults = age 18-39, adults = age 40-64, and elderly = age 65+). Groups were then subdivided based on tissue eosinophilia and nasal polyposis. Sinonasal Outcome Test (SNOT-22), Lund-Kennedy (LK) endoscopy scores, and Lund-McKay (LM) CT scores were compared preoperatively, and postoperatively during a 5-year period. RESULTS: A total of 431 CRS patients identified and then subsequently broken down into 63 young adults (YA), 209 adults (A), and 159 elderly (E). There was no statistical difference between tissue eosinophilia and presence of polyps between the groups. All three groups had similar short- and long-term SNOT-22 patterns postoperatively. At presentation, young adults had significantly higher SNOT-22 score (33.2 YA, 25.3 A, 23.5 E, P = .029) and significantly higher rhinologic scores (1.9 YA, 1.3 A, 1.3 E, P = .0012) than the adult and elderly patients. Objective disease severity using LK endoscopy scores were only significantly higher in young adults at 1-year time (P = .0026). There was no statistical difference between the groups in regards to preoperative LM CT scores. CONCLUSIONS: Young adults are more likely to present with overall higher subjective SNOT-22 scores over adults and elderly patients, despite similar objective findings in the groups. Short- and long-term postoperative improvement holds across all age groups. LEVEL OF EVIDENCE: 4.


Assuntos
Rinite/diagnóstico , Rinite/cirurgia , Sinusite/diagnóstico , Sinusite/cirurgia , Adolescente , Adulto , Fatores Etários , Idoso , Doença Crônica , Eosinofilia/complicações , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pólipos Nasais/complicações , Estudos Retrospectivos , Rinite/complicações , Sinusite/complicações , Resultado do Tratamento , Adulto Jovem
13.
Acta Chir Plast ; 60(2-4): 59-61, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32370519

RESUMO

Eosinophilic angiocentric fibrosis (EAF) is a rare benign lesion of unknown aetiology, found predominantly in the upper respiratory tract. The fibrosis must be confirmed by considering other lesions in the differential diagnosis. The typical histological characteristics are the basis for establishing the diagnosis. We present a patient with long-term nasal obstruction caused by EAF. The patient had repeated resections of the lesion for its recurrences. As follows from the literature, radical resection is crucial for the treatment of EAF. This procedure may be difficult at times given the extent and localization of the disease..


Assuntos
Eosinofilia/complicações , Fibrose/etiologia , Obstrução Nasal/etiologia , Eosinofilia/cirurgia , Fibrose/cirurgia , Humanos , Obstrução Nasal/cirurgia , Recidiva , Reoperação
14.
Dermatol Online J ; 26(2)2020 Feb 15.
Artigo em Inglês | MEDLINE | ID: mdl-32239898

RESUMO

A 60-year old man developed skin hardening and edema on his extremities. Although he had been treated with oral prednisolone at another hospital, skin stiffness relapsed during tapering of prednisolone. At the initial visit to our department, physical examination showed skin hardening of the extremities and also symmetric erythematous macules on the back. Histological examination revealed fasciitis on the forearm and morphea on the back. Eosinophilic fasciitis is occasionally associated with morphea. However, cases of concurrent eosinophilic fasciitis and generalized morphea are rare. In the present case, CD34 was differentially expressed in both lesions, suggesting eosinophilic fasciitis and morphea are separate diseases with different origin of mesenchymal cells.


Assuntos
Eosinofilia/complicações , Fasciite/complicações , Escleroderma Sistêmico/complicações , Adulto , Idoso , Antígenos CD34/metabolismo , Eosinofilia/tratamento farmacológico , Eosinofilia/patologia , Fasciite/tratamento farmacológico , Fasciite/patologia , Feminino , Glucocorticoides/uso terapêutico , Humanos , Masculino , Pessoa de Meia-Idade , Prednisolona/uso terapêutico , Escleroderma Sistêmico/tratamento farmacológico , Escleroderma Sistêmico/patologia
15.
Arerugi ; 69(2): 123-128, 2020.
Artigo em Japonês | MEDLINE | ID: mdl-32188824

RESUMO

Eosinophilic esophagitis has been reported as a complication of oral immunotherapy (OIT), but there are only a few reports of eosinophilic gastroenteritis (EGE) occurring after OIT. EGE causes eosinophil infiltration into the gastrointestinal (GI) tract and is characterized by various digestive symptoms. We report the case of a 6-year-old boy with EGE. He was diagnosed as having immediate-type food allergies (egg, milk and wheat) by oral food challenges at 1 year of age. OIT for each food was carried out, and the amounts of the offending foods were able to be gradually increased without causing any immediate-type allergy symptoms. However, the total IgE and specific IgE values were remarkably increased at the age of 4 years and 4 months. He first developed oral mucosa symptoms and vomiting at 4 years and 10 months of age, and they gradually worsened. Stopping eggs and milk alleviated the symptoms. Nevertheless, he still occasionally vomited. He started Pica eating disorder (sand and sponge) due to anemia from 5 years and 10 months of age and developed eosinophilia without diarrhea or bloody stool. Upper and lower GI tract endoscopic examinations found no bleeding. The GI mucosa showed eosinophil infiltration of more than 40/high-power field in the stomach and duodenum, so he was diagnosed with EGE. No eosinophils were found in the esophageal mucosa. His GI symptoms and anemia improved on a multiple-food-elimination diet. Patients undergoing OIT should be closely followed up for a long time, and those with GI symptoms should be evaluated by GI endoscopy.


Assuntos
Enterite/diagnóstico , Eosinofilia/diagnóstico , Gastrite/diagnóstico , Imunoterapia/efeitos adversos , Pica/etiologia , Animais , Criança , Enterite/complicações , Eosinofilia/complicações , Hipersensibilidade Alimentar , Gastrite/complicações , Humanos , Masculino
17.
Pediatrics ; 145(3)2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32075872

RESUMO

Eosinophilic gastrointestinal diseases (EGIDs) are a diverse group of intestinal diseases involving the infiltration of eosinophils into the bowel wall. EGID can present with a variety of clinical conditions, which are largely dependent on the location of eosinophils in the intestinal wall. We describe the first reported pediatric cases of EGID presenting with symptomatic partial bowel obstruction from intestinal masses due to isolated focal mural involvement. Both patients subsequently responded favorably to therapy with exclusive elemental nutrition in the first case and exclusive elemental nutrition with steroids in the second case. These cases reveal the wide-ranging clinical manifestations of EGID, expand on the differential diagnosis of focal intestinal masses, and provide guidance on the evaluation of ambiguous cases.


Assuntos
Enterite/diagnóstico , Eosinofilia/diagnóstico , Gastrite/diagnóstico , Adolescente , Enterite/complicações , Eosinofilia/complicações , Feminino , Gastrite/complicações , Humanos , Obstrução Intestinal/etiologia
18.
Dtsch Med Wochenschr ; 145(1): 36-39, 2020 01.
Artigo em Alemão | MEDLINE | ID: mdl-31914467

RESUMO

HISTORY AND CLINICAL FINDINGS: A 53-year-old male presented with massive pruritus, whole-body exanthema, generalized muscle pain, and exercise dyspnoea NYHA II. FINDINGS AND DIAGNOSIS: Further hematologic examination lead to diagnosis of myeloid and lymphoid neoplasia with eosinophilia (MLN-EO) with FIPL1L1-PDGFRA fusion gene. An echocardiographic examination revealed a thrombus in the right ventricle. Magnetic resonance imaging (MRI) showed an extensive intracavitary thrombus extending from the apex to the right ventricular outflow tract. THERAPY AND COURSE: Oral anticoagulation with phenprocoumon and a targeted therapy with imatinib were initiated. Follow-up at 11- and 23-months revealed diminishing of the thrombus. Further follow-up did not show any complications. CONCLUSIONS: In summary, Loeffler's endocarditis caused by a myeloid and lymphoid neoplasm associated with eosinophilia and abnormalities of FIP1L1-PDGFRA rearrangement could be treated successfully with oral anticoagulation therapy and the tyrosine-kinase inhibitor imatinib.


Assuntos
Eosinofilia/complicações , Síndrome Hipereosinofílica/complicações , Mesilato de Imatinib/uso terapêutico , Linfoma , Antineoplásicos/uso terapêutico , Humanos , Linfoma/complicações , Linfoma/tratamento farmacológico , Masculino , Pessoa de Meia-Idade
19.
Pediatrics ; 145(2)2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31941759

RESUMO

A 4-week-old male neonate with a history of intermittent hypothermia in the newborn nursery presented with an acute onset of bilateral lower extremity paralysis and areflexia. Extensive workup demonstrated eosinophilic encephalomyelitis and multifocal hemorrhages of the brain and spinal cord. Funduscopic examination revealed bilateral chorioretinitis with macular scarring. The laboratory values were notable for peripheral eosinophilia and cerebrospinal fluid eosinophilic pleocytosis (28 white blood cells/µL, 28% eosinophils), markedly elevated protein (1214 mg/dL), and hypoglycorrhachia (20 mg/dL). Toxoplasma gondii immunoglobulin M (IgM) test result was positive. Reference testing obtained at the Palo Alto Medical Foundation Toxoplasma Serology Laboratory confirmed the diagnosis of congenital toxoplasmosis in the infant with a positive immunoglobulin G (IgG) dye test result, immunoglobulin A enzyme-linked immunosorbent assay, and IgM immunosorbent agglutination assay. The diagnosis of an infection acquired during gestation in the mother was established by a positive maternal IgG dye test result, IgM enzyme-linked immunosorbent assay, immunoglobulin A, immunoglobulin E, and low IgG avidity. At 6-month follow-up, the infant had marginal improvement in his retinal lesions and residual paraplegia with hyperreflexia and clonus of the lower extremities. A repeat MRI demonstrated interval development of encephalomalacia with suspected cortical laminar necrosis and spinal cord atrophy in the areas of previous hemorrhage. Clinicians should be aware of this severe spectrum of congenital toxoplasmosis disease and should remain vigilant for subtler signs that may prompt earlier testing, diagnosis, and treatment.


Assuntos
Encefalomielite/etiologia , Eosinofilia/complicações , Hemorragia/etiologia , Doenças da Medula Espinal/etiologia , Toxoplasmose Congênita/complicações , Anticorpos Antiprotozoários/sangue , Encefalomielite/diagnóstico por imagem , Encefalomielite/parasitologia , Hemorragia/diagnóstico por imagem , Humanos , Recém-Nascido , Imagem por Ressonância Magnética , Masculino , Doenças da Medula Espinal/diagnóstico por imagem , Toxoplasma/imunologia , Toxoplasmose Congênita/diagnóstico por imagem
20.
Niger J Clin Pract ; 23(1): 116-119, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31929217

RESUMO

We present two rare cases of hypereosinophilia (HE) in acute myeloid leukemia with normal karyotype (NK-AML) at diagnosis. The first case is a 29-year-old female who presented with HE. On evaluation, she was found to have NK-AML. She failed to achieve complete remission (CR) after the first induction therapy with standard idarubicin and cytarabine (IA). She achieved CR after two cycles of reinduction chemotherapy with cytarabine, aclarubicin, and granulocyte colony-stimulating factor (G-CSF) (CAG) but had early relapsed. Reinduction chemotherapy with fludarabine, Ara-C, and G-CSF (FLAG) led to her second remission, followed by unrelated umbilical cord hematopoietic stem cell transplantation (HSCT). Unfortunately, she died of thrombotic thrombocytopenic purpura. The second case is a 23-year-old male who was diagnosed as NK-AML with HE. IA regimen was successively used in two cycles treatment achieving CR. He underwent haploidentical HSCT but had a relapse after 17 months of sustained remission and died 4 months later. The presence of HE may be a poor prognostic feature in NK-AML.


Assuntos
Eosinofilia/complicações , Fator Estimulador de Colônias de Granulócitos , Transplante de Células-Tronco Hematopoéticas , Leucemia Mieloide Aguda/cirurgia , Adulto , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Evolução Fatal , Feminino , Humanos , Cariótipo , Leucemia Mieloide Aguda/patologia , Masculino , Prognóstico , Recidiva , Indução de Remissão , Adulto Jovem
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