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2.
Infect Dis Poverty ; 9(1): 16, 2020 Feb 07.
Artigo em Inglês | MEDLINE | ID: mdl-32029005

RESUMO

BACKGROUND: Loiasis is an uncommon and poorly understood parasitic disease outside endemic areas of Africa. The aim of this study was to describe the clinical and biological patterns and treatment of imported loiasis by sub-Saharan migrants diagnosed in Madrid, Spain. METHODS: A retrospective study was conducted with sub-Saharan immigrants seen at the Tropical Medicine Unit of the Carlos III Hospital in Madrid, Spain, a reference center, over 19 years. Categorical variables were expressed as frequency counts and percentages. Continuous variables were expressed as the mean and standard deviation (SD) or median and interquartile range (IQR: Q3-Q1). Chi-square tests were used to assess the association between categorical variables. The measured outcomes were expressed as the odds ratio (OR) with a 95% confidential interval. Continuous variables were compared by Student's t-tests or Mann-Whitney U tests. Binary logistic regression models were used. P <  0.05 was considered a statistically significant difference. RESULTS: One hundred thirty-one migrants from tropical and subtropical areas with loiasis were identified. Forty-nine patients were male (37.4%). The migrants' mean age (±SD) was 42.3 ± 17.3 years, and 124 (94.7%) were from Equatorial Guinea. The median time (IQR) between arrival in Spain and the first consultation was 2 (1-7) months. One hundred fifteen migrants had eosinophilia, and one hundred thirteen had hyper-IgE syndrome. Fifty-seven patients had pruritus (43.5%), and thirty patients had Calabar swelling (22.9%). Seventy-three patients had coinfections with other filarial nematodes (54.2%), and 58 migrants had only Loa loa infections (45.8%). One hundred two patients (77.9%) were treated; 45.1% (46/102) patients were treated with one drug, and 54.9% (56/102) patients were treated with combined therapy. Adverse reactions were described in 14 (10.7%) migrants. CONCLUSIONS: Our patients presented early clinical manifestations and few atypical features. Thus, physicians should systematically consider loiasis in migrants with a typical presentation. However, considering that 72.5% of the patients had only positive microfilaremia without any symptoms, we suggest searching for microfilaremia in every migrant from endemic countries for loiasis presenting with eosinophilia.


Assuntos
Loíase/epidemiologia , Adulto , Idoso , Anti-Helmínticos/uso terapêutico , Eosinofilia/diagnóstico , Eosinofilia/epidemiologia , Eosinofilia/etiologia , Guiné Equatorial/etnologia , Feminino , Humanos , Loíase/diagnóstico , Loíase/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Espanha/epidemiologia , Migrantes , Adulto Jovem
3.
Ann Otol Rhinol Laryngol ; 129(5): 512-516, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-31888343

RESUMO

BACKGROUND: Prior studies have demonstrated associations between serum eosinophilia and chronic rhinosinusitis (CRS) pathogenesis. However, the association of serum eosinophilia with histopathology profiling in CRS has not been fully delineated and may help better characterize CRS disease burden prior to surgery. METHODS: A structured histopathology report of 13 variables was utilized to analyze sinus tissue removed during functional endoscopic sinus surgery (FESS). Complete blood count (CBC) with differential was drawn within 4 weeks prior to FESS. Serum eosinophilia was defined as >6.0% (>0.60 th/µL). Histopathology variables were compared among patients. RESULTS: A total of 177 CRS patients (37 with serum eosinophilia and 140 with normal serum eosinophilia) were analyzed. Compared to CRS patients with normal serum eosinophil counts, CRS patients with serum eosinophilia demonstrated increased polypoid disease (67.6% vs 35.0%, P < .001), eosinophil aggregates (45.9% vs 20.7%, P = .003), and eosinophils per high-power field (>5/HPF) (67.6% vs 40.7%, P = .003). CONCLUSION: CRS patients with serum eosinophilia demonstrated severe disease burden on histopathology with high levels of polypoid disease and tissue eosinophilia. However, a considerable number of patients without serum eosinophilia demonstrated eosinophilic disease on histopathology, indicating that preoperative serum eosinophilia alone could not be reliably used to predict eosinophilic CRS. LEVEL OF EVIDENCE: 4.


Assuntos
Eosinofilia/sangue , Eosinófilos/patologia , Rinite/complicações , Sinusite/complicações , Doença Crônica , Eosinofilia/diagnóstico , Eosinofilia/etiologia , Feminino , Humanos , Contagem de Leucócitos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Otorrinolaringológicos/métodos , Período Pré-Operatório , Estudos Retrospectivos , Rinite/sangue , Rinite/diagnóstico , Índice de Gravidade de Doença , Sinusite/sangue , Sinusite/diagnóstico
4.
Ann Allergy Asthma Immunol ; 124(3): 219-226, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31778820

RESUMO

OBJECTIVE: To review novel therapeutics in development for treatment of eosinophilic gastrointestinal disorders (EGIDs). DATA SOURCES: Clinical trial data (clinicaltrials.gov) and literature search on PubMed. STUDY SELECTIONS: Studies on treatment and clinical trials in EGIDs were included in this review. RESULTS: During the past decade, significant progress has been made in understanding disease mechanisms in EGIDs. As a result, a variety of novel therapeutics have been developed for treatment of these disorders. Several monoclonal antibodies against targets, including interleukin (IL) 4, IL-5, IL-13, integrins, and siglec-8, have shown promise in early trials. Novel formulations of corticosteroids are also in development. CONCLUSION: The field of EGID research has advanced rapidly, and disease-modifying therapeutics are closer to clinical application.


Assuntos
Enterite/terapia , Eosinofilia/terapia , Gastrite/terapia , Terapia Biológica , Biomarcadores , Ensaios Clínicos como Assunto , Terapia Combinada , Gerenciamento Clínico , Suscetibilidade a Doenças , Enterite/diagnóstico , Enterite/etiologia , Enterite/metabolismo , Eosinofilia/diagnóstico , Eosinofilia/etiologia , Eosinofilia/metabolismo , Gastrite/diagnóstico , Gastrite/etiologia , Gastrite/metabolismo , Humanos , Terapia de Alvo Molecular , Padrão de Cuidado , Resultado do Tratamento
5.
Med Clin North Am ; 104(1): 1-14, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31757229

RESUMO

Physicians may encounter blood or tissue eosinophilia through a routine complete blood count with differential or a tissue pathology report. In this article, the basic biology of eosinophils is reviewed and definitions of blood eosinophilia, as well as the challenges of defining tissue eosinophilia, are discussed. Conditions associated with eosinophilia are briefly discussed as well as a general approach to evaluating eosinophilia. Future challenges include determining which eosinophil-associated diseases benefit from eosinophil-targeted therapy and identifying biomarkers for disease activity and diagnosis.


Assuntos
Eosinofilia/diagnóstico , Eosinófilos/metabolismo , Biomarcadores/sangue , Eosinofilia/sangue , Eosinofilia/etiologia , Humanos , Contagem de Leucócitos , Índice de Gravidade de Doença
6.
BMJ Case Rep ; 12(12)2019 Dec 23.
Artigo em Inglês | MEDLINE | ID: mdl-31874849

RESUMO

Acute coronary syndrome occurring during the course of a type I hypersensitivity reaction constitutes Kounis syndrome. We report a case of a 64-year-old man who presented with a non-ST elevation myocardial infarction and peripheral blood eosinophilia. He had rhinitis and constitutional symptoms for several days prior to presentation. Blood investigations revealed moderate eosinophilia and elevated IgE levels. A cardiac MRI showed generalised oedema with a subtle wall motion abnormality in basal inferior/inferolateral wall, and subendocardial high signal on late gadolinium enhancement suggesting a localised myocardial infarction. A coronary angiogram then revealed triple vessel disease. A diagnosis of Kounis syndrome was made. Within days of starting appropriate treatment, the patient's eosinophil count returned to normal with improvement of clinical picture.


Assuntos
Síndrome Coronariana Aguda/etiologia , Vasoespasmo Coronário/complicações , Hipersensibilidade Imediata/complicações , Síndrome de Kounis/complicações , Angiografia Coronária , Diagnóstico Diferencial , Eletrocardiografia , Eosinofilia/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio sem Supradesnível do Segmento ST/etiologia
7.
J Immunol ; 203(10): 2724-2734, 2019 11 15.
Artigo em Inglês | MEDLINE | ID: mdl-31586037

RESUMO

Alternatively activated macrophages are essential effector cells during type 2 immunity and tissue repair following helminth infections. We previously showed that Ym1, an alternative activation marker, can drive innate IL-1R-dependent neutrophil recruitment during infection with the lung-migrating nematode, Nippostrongylus brasiliensis, suggesting a potential role for the inflammasome in the IL-1-mediated innate response to infection. Although inflammasome proteins such as NLRP3 have important proinflammatory functions in macrophages, their role during type 2 responses and repair are less defined. We therefore infected Nlrp3 -/- mice with N. brasiliensis Unexpectedly, compared with wild-type (WT) mice, infected Nlrp3 -/- mice had increased neutrophilia and eosinophilia, correlating with enhanced worm killing but at the expense of increased tissue damage and delayed lung repair. Transcriptional profiling showed that infected Nlrp3 -/- mice exhibited elevated type 2 gene expression compared with WT mice. Notably, inflammasome activation was not evident early postinfection with N. brasiliensis, and in contrast to Nlrp3 -/- mice, antihelminth responses were unaffected in caspase-1/11-deficient or WT mice treated with the NLRP3-specific inhibitor MCC950. Together these data suggest that NLRP3 has a role in constraining lung neutrophilia, helminth killing, and type 2 immune responses in an inflammasome-independent manner.


Assuntos
Inflamassomos/fisiologia , Pneumopatias Parasitárias/imunologia , Proteína 3 que Contém Domínio de Pirina da Família NLR/fisiologia , Nippostrongylus/imunologia , Infecções por Strongylida/imunologia , Animais , Caspase 1/fisiologia , Quimiotaxia de Leucócito , Eosinofilia/etiologia , Eosinofilia/imunologia , Furanos/farmacologia , Imunidade Inata , Interleucina-4/farmacologia , Lectinas/biossíntese , Lectinas/genética , Pulmão/patologia , Pulmão/fisiologia , Pneumopatias Parasitárias/complicações , Pneumopatias Parasitárias/patologia , Pneumopatias Parasitárias/fisiopatologia , Macrófagos Alveolares/enzimologia , Camundongos , Camundongos Endogâmicos C57BL , Camundongos Knockout , Proteína 3 que Contém Domínio de Pirina da Família NLR/antagonistas & inibidores , Proteína 3 que Contém Domínio de Pirina da Família NLR/deficiência , Proteína 3 que Contém Domínio de Pirina da Família NLR/genética , Neutrófilos/imunologia , Regeneração , Infecções por Strongylida/complicações , Infecções por Strongylida/patologia , Infecções por Strongylida/fisiopatologia , Sulfonamidas/farmacologia , Transcrição Genética , beta-N-Acetil-Hexosaminidases/biossíntese , beta-N-Acetil-Hexosaminidases/genética
8.
Am J Case Rep ; 20: 1387-1393, 2019 Sep 20.
Artigo em Inglês | MEDLINE | ID: mdl-31541072

RESUMO

BACKGROUND Erythroderma is an exfoliative dermatitis that manifests as generalized erythema and scaling that involves 90% of the body surface. If untreated, erythroderma can be fatal because of its metabolic burden and risk of secondary infections. CASE REPORT The patient was a 56-year-old male with prior rash attributed to group A Streptococcal cellulitis and discharged on Augmentin, Clindamycin with hydrocortisone cream, and Bactrim, but he had been noncompliant. He was admitted again for rash involving the face, torso, and extremities characterized by diffuse, desquamative, dry scales in morbilliform pattern. The patient was septic with Staphylococcus aureus bacteremia and compromised skin barrier. He was started on vancomycin and switched to Cefazolin IV due to concern for drug reaction. Autoimmune workup included antibodies for anti-Jo-1, anti-dsDNA, anti-centromere, and ANCA. However, only antinuclear antibody and scleroderma antibody were positive. Given the unclear workup results and lack of response to antibiotics, the patient was started on prednisone 60 mg PO and topical Triamcinolone 0.1% cream. A skin biopsy revealed psoriasiform hyperplasia with atypical T cell infiltrate and eosinophils, but negative for T cell gene rearrangement. The rash resolved after day 12 of application of topical Triamcinolone. CONCLUSIONS This case is unique in terms of the rarity of erythroderma and the diagnostic challenge given confounding factors such as noncompliance and drug reaction. Serious causes, such as SLE and cutaneous T cell lymphoma, were ruled out. Fortunately, the rash responded well to steroids; however, given the adverse effects of long-term use of topical steroids, the patient will need follow up with Dermatology.


Assuntos
Dermatite Esfoliativa/diagnóstico , Eosinofilia/etiologia , Sepse/microbiologia , Administração Tópica , Celulite (Flegmão)/microbiologia , Dermatite Esfoliativa/tratamento farmacológico , Glucocorticoides/uso terapêutico , Humanos , Masculino , Adesão à Medicação , Pessoa de Meia-Idade , Infecções Estafilocócicas/complicações , Infecções Estreptocócicas/complicações , Streptococcus pyogenes , Triancinolona/uso terapêutico
9.
Korean J Gastroenterol ; 74(3): 163-167, 2019 Sep 25.
Artigo em Inglês | MEDLINE | ID: mdl-31554032

RESUMO

Eosinophilic gastrointestinal disorder (EGID) is an uncommon disease that is accompanied by intestinal eosinophil infiltration without a secondary cause of eosinophilia. Eosinophilic enteritis is a secondary portion of EGID that can present a range of gastrointestinal symptoms according to the affected depth of the intestinal layer. The subserosal type of eosinophilic enteritis presenting as ascites is relatively rarer than the mucosal type. In general, eosinophilic enteritis occurs in patients with food allergies, but its mechanism is unclear. The authors experienced a 29-year-old female patient with a large amount of ascites with diarrhea and abdominal pain. The patient was diagnosed with an influenza A infection one week earlier. Peripheral eosinophilia (absolute eosinophil count: 6,351 cells/mm3) and eosinophilic ascites (97% of white blood cells in the ascites are eosinophil) were present. Abdominal CT revealed a large amount of ascites and edematous changes in the ileum and ascending colon wall. A diagnosis of eosinophilic enteritis was confirmed as eosinophilic ascites by paracentesis, with eosinophil infiltration of the bowel wall by an endoscopic biopsy. The patient's symptoms improved rapidly after using steroids. To the best of the author's knowledge, this is the first report of eosinophilic enteritis with massive ascites after an influenza A virus infection in a Korean adult.


Assuntos
Enterite/diagnóstico , Eosinofilia/diagnóstico , Gastrite/diagnóstico , Influenza Humana/diagnóstico , Adulto , Antivirais/uso terapêutico , Ascite , Colonoscopia , Ciclopentanos/uso terapêutico , Enterite/tratamento farmacológico , Enterite/etiologia , Eosinofilia/tratamento farmacológico , Eosinofilia/etiologia , Eosinófilos/citologia , Feminino , Gastrite/tratamento farmacológico , Gastrite/etiologia , Guanidinas/uso terapêutico , Humanos , Vírus da Influenza A/isolamento & purificação , Influenza Humana/complicações , Influenza Humana/tratamento farmacológico , Influenza Humana/virologia , Esteroides/uso terapêutico , Tomografia Computadorizada por Raios X
11.
Am J Hematol ; 94(10): 1149-1167, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31423623

RESUMO

DISEASE OVERVIEW: The eosinophilias encompass a broad range of non-hematologic (secondary or reactive) and hematologic (primary, clonal) disorders with potential for end-organ damage. DIAGNOSIS: Hypereosinophilia has generally been defined as a peripheral blood eosinophil count greater than 1.5 × 109 /L, and may be associated with tissue damage. After exclusion of secondary causes of eosinophilia, diagnostic evaluation of primary eosinophilias relies on a combination of various tests. They include morphologic review of the blood and marrow, standard cytogenetics, fluorescence in situ-hybridization, flow immunophenotyping, and T-cell clonality assessment to detect histopathologic or clonal evidence for an acute or chronic hematolymphoid neoplasm. RISK STRATIFICATION: Disease prognosis relies on identifying the subtype of eosinophilia. After evaluation of secondary causes of eosinophilia, the 2016 World Health Organization endorses a semi-molecular classification scheme of disease subtypes. This includes the major category "myeloid/lymphoid neoplasms with eosinophilia and rearrangement of PDGFRA, PDGFRB, or FGFR1 or with PCM1-JAK2", and the MPN subtype, "chronic eosinophilic leukemia, not otherwise specified" (CEL, NOS). Lymphocyte-variant hypereosinophilia is an aberrant T-cell clone-driven reactive eosinophila, and idiopathic hypereosinophilic syndrome (HES) is a diagnosis of exclusion. RISK-ADAPTED THERAPY: The goal of therapy is to mitigate eosinophil-mediated organ damage. For patients with milder forms of eosinophilia (eg, <1.5 × 109 /L) without symptoms or signs of organ involvement, a watch and wait approach with close-follow-up may be undertaken. Identification of rearranged PDGFRA or PDGFRB is critical because of the exquisite responsiveness of these diseases to imatinib. Corticosteroids are first-line therapy for patients with lymphocyte-variant hypereosinophilia and HES. Hydroxyurea and interferon-alfa have demonstrated efficacy as initial treatment and in steroid-refractory cases of HES. In addition to hydroxyurea, second line cytotoxic chemotherapy agents, and hematopoietic stem cell transplantation have been used for aggressive forms of HES and CEL, with outcomes reported for limited numbers of patients. The use of antibodies against interleukin-5 (IL-5) (mepolizumab), the IL-5 receptor (benralizumab), as well as other targets on eosinophils remains an active area of investigation.


Assuntos
Eosinofilia , Corticosteroides/uso terapêutico , Adulto , Idoso , Antineoplásicos/uso terapêutico , Exame de Medula Óssea , Células Clonais/patologia , Gerenciamento Clínico , Eosinofilia/diagnóstico , Eosinofilia/epidemiologia , Eosinofilia/etiologia , Eosinofilia/terapia , Feminino , Neoplasias Hematológicas/sangue , Neoplasias Hematológicas/diagnóstico , Neoplasias Hematológicas/tratamento farmacológico , Humanos , Imunofenotipagem , Hibridização in Situ Fluorescente , Janus Quinase 2/genética , Masculino , Pessoa de Meia-Idade , Síndromes Mielodisplásicas/sangue , Síndromes Mielodisplásicas/diagnóstico , Síndromes Mielodisplásicas/tratamento farmacológico , Transtornos Mieloproliferativos/sangue , Transtornos Mieloproliferativos/diagnóstico , Transtornos Mieloproliferativos/tratamento farmacológico , Proteínas de Fusão Oncogênica/antagonistas & inibidores , Proteínas de Fusão Oncogênica/genética , Prognóstico , Receptor Tipo 1 de Fator de Crescimento de Fibroblastos/genética , Receptor alfa de Fator de Crescimento Derivado de Plaquetas/antagonistas & inibidores , Receptor alfa de Fator de Crescimento Derivado de Plaquetas/genética , Medição de Risco , Avaliação de Sintomas , Organização Mundial da Saúde , Adulto Jovem , Tirosina Quinase 3 Semelhante a fms/genética , Fatores de Poliadenilação e Clivagem de mRNA/antagonistas & inibidores , Fatores de Poliadenilação e Clivagem de mRNA/genética
12.
Orv Hetil ; 160(24): 952-957, 2019 Jun.
Artigo em Húngaro | MEDLINE | ID: mdl-31433234

RESUMO

We report a case of a 41-year-old female patient presenting with watery diarrhoea and myalgia in the winter-season. Before her symptoms started she had participated in a pig slaughtering with her family. Some of the family members also became ill. On her physical examination periorbital odema and myalgia were found. Eosinophilia, hypalbuminaemia, elevated lactate dehydrogenase and creatin kinase levels were detected on laboratory investigations. The clinical picture, the laboratory findings and background epidemiological data implied the diagnosis of trichinellosis and albendazol was started. Serum gained on the 22nd post-infectious day turned out to be equivocal for trichinellosis. For this reason and because of the refractory fever a muscle-biopsy was done. Granulomatous myositis described by histology and Trichinella seropositivity from the repeated serum sample on the 62nd post-infectious day finally confirmed the diagnosis. During the course of the disease, we experienced elevation of troponin I suggesting myocarditis, but it was accompanied neither with abnormal ECG signs nor characteristic symptoms. Almost a century ago, a case report was published in Hungarian with a similar introduction. Trichinellosis in that epidemic setting led to the death of five people. Orv Hetil. 2019; 160(24): 952-957.


Assuntos
Diarreia/etiologia , Febre/etiologia , Mialgia/etiologia , Miosite/etiologia , Trichinella/isolamento & purificação , Triquinelose/diagnóstico , Adulto , Albendazol/uso terapêutico , Animais , Anti-Helmínticos/uso terapêutico , Eosinofilia/etiologia , Feminino , Humanos , Músculo Esquelético/parasitologia , Miosite/tratamento farmacológico , Miosite/parasitologia , Estações do Ano , Suínos , Resultado do Tratamento , Triquinelose/sangue , Triquinelose/tratamento farmacológico
13.
Brain Behav ; 9(8): e01361, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31313505

RESUMO

PURPOSE: To analyze magnetic resonance imaging (MRI) findings and clinical diagnosis and treatment data relating to Angiostrongylus cantonensis infection to gain insight into the disease. MATERIALS AND METHODS: We retrospectively analyzed the epidemiology, clinical manifestations, diagnosis and treatment data, imaging manifestations, and outcomes of 27 patients who were clinically diagnosed with angiostrongyliasis and who underwent contrast-enhanced brain MRI. RESULTS: Patients with A. cantonensis infection had a history of eating raw mollusks in the endemic area, and they mainly presented with dizziness and headache of varying degrees and vomiting (n = 7). Laboratory examinations revealed increased peripheral blood and cerebrospinal fluid (CSF) eosinophils, as well as increased CSF protein levels. Brain MRI findings mainly included eosinophilic meningitis, whereas linear or nodular enhancement of the pia mater was observed in enhanced T1-weighted and fluid-attenuated inversion recovery images, accompanied by encephalitis or vasculitis. Meningitis manifested as multiple, thickened flow voids around the meninges, and contrast-enhanced scans showed substantial enhancement in intracranial dilated and hyperplastic blood vessels. CONCLUSION: The possibility of A. cantonensis infection should be considered in the effective use of albendazole or mebendazole as a treatment. Combining clinical history with laboratory examination is helpful in diagnosing A. cantonensis infection. A final definite diagnosis can be confirmed by detecting larvae in the CSF. The administration of corticosteroids during pathogen therapy can substantially reduce the therapeutic response.


Assuntos
Albendazol/administração & dosagem , Angiostrongylus cantonensis/isolamento & purificação , Encéfalo , Eosinofilia , Mebendazol/administração & dosagem , Meningite , Infecções por Strongylida , Adulto , Animais , Anti-Helmínticos/administração & dosagem , Encéfalo/diagnóstico por imagem , Encéfalo/patologia , China/epidemiologia , Eosinofilia/diagnóstico , Eosinofilia/etiologia , Feminino , Humanos , Imagem por Ressonância Magnética/métodos , Masculino , Meningite/diagnóstico , Meningite/etiologia , Estudos Retrospectivos , Infecções por Strongylida/sangue , Infecções por Strongylida/líquido cefalorraquidiano , Infecções por Strongylida/fisiopatologia , Infecções por Strongylida/terapia
14.
Otol Neurotol ; 40(8): e796-e802, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31290803

RESUMO

OBJECTIVE: To perform comparisons and clarify differences in clinical manifestations between eosinophilic otitis media (EOM) and otitis media associated with eosinophilic granulomatosis with polyangiitis (EGPA). STUDY DESIGN: Retrospective case review. SETTING: Tertiary referral center. PATIENTS: Twenty-two ears of 11 patients exhibiting EOM (EOM group) and 20 ears of 12 patients exhibiting otitis media associated with EGPA (EGPA group). MAIN OUTCOME MEASURES: Otological manifestations, nasal and paranasal manifestations, incidence of asthma, positivity for serum antineutrophil cytoplasmic antibodies (ANCA), total serum immunoglobulin (Ig) E level, peripheral blood eosinophil fraction, and hearing outcomes. RESULTS: The incidence and age of onset of asthma and chronic rhinosinusitis were comparable between the EOM and EGPA groups. Moreover, otological findings and hearing outcomes at the initial visit were similar in both groups. Computed tomography images of the paranasal sinus showed predominant opacification of the ethmoid sinus in both groups. Although the total serum IgE level was not significantly different, the peripheral blood eosinophil fraction was significantly larger in the EGPA group than in the EOM group (p = 0.0035). Furthermore, the rate of myeloperoxidase-antineutrophil cytoplasmic antibodies (ANCA) positivity was significantly higher in the EGPA group than in the EOM group (p = 0.019). CONCLUSIONS: The findings of the present study suggest that the phenotypic characteristics of EOM closely resemble those of otitis media associated with EGPA in early stages before the appearance of vasculitis. Therefore, it is challenging to differentiate the two conditions purely on the basis of otorhinological examinations.


Assuntos
Síndrome de Churg-Strauss , Eosinofilia/etiologia , Otite Média/etiologia , Otite Média/patologia , Adulto , Idoso , Síndrome de Churg-Strauss/complicações , Síndrome de Churg-Strauss/patologia , Feminino , Granulomatose com Poliangiite/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
16.
Ann Agric Environ Med ; 26(2): 256-259, 2019 Jun 17.
Artigo em Inglês | MEDLINE | ID: mdl-31232056

RESUMO

INTRODUCTION: The study presents the case report of a Wells Syndrome in a 18-year -ld female. Wells Syndrome is a rare inflammatory skin disorder which seems to present an abnormal eosinophilic response to a number of triggers. OBJECTIVE: The aim of the study is to discuss several problems related to the diagnosis and treatment of Wells Syndrome. MATERIAL AND METHODS: Medical examination, blood tests, abdominal ultrasound and skin biopsy were performed. RESULTS: Medical examination revealed plaques with tense blisters on feet and erythematous lesions on trunk. Blood tests showed raised anti-streptolysin O level. Skin biopsy revealed features of eosinophilic cellulitis. Oral administration of 0.5 mg per day prednisolone and antihistaminics with local therapy resulted in good clinical response. CONCLUSIONS: Sometimes several biopsy are required to establish diagnosis. In some cases lower doses of corticosteroids with antihistaminics and local anti-inflammatory treatment can by sufficient in treatment.


Assuntos
Celulite (Flegmão)/etiologia , Eosinofilia/etiologia , Mordeduras e Picadas de Insetos/complicações , Adolescente , Celulite (Flegmão)/tratamento farmacológico , Eosinofilia/tratamento farmacológico , Feminino , Humanos , Terfenadina/análogos & derivados , Terfenadina/uso terapêutico
17.
Clin Nephrol ; 92(2): 103-108, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31198171

RESUMO

We report a case of a 50-year-old Japanese man with a history of pediatric asthma diagnosed with nephrotic syndrome after 4 years of relapsing asthma with severe eosinophilia. Thrombospondin type-1 domain-containing 7A membranous nephropathy (THSD7A-MN) was diagnosed based on histological evaluation. We started a course of steroid semi-pulse therapy, high-dose oral prednisolone, mizoribine, and cyclosporine. Frequent relapse of asthma was observed after gradual tapering of prednisolone dose to 10 mg/day. After improvement of asthma symptoms and eosinophilia, his serum albumin level increased gradually. Considering the clinical course of refractory MN and asthma, we suggest that THSD7A-MN may be associated with severe asthma and eosinophilia.


Assuntos
Asma/etiologia , Eosinofilia/etiologia , Glomerulonefrite Membranosa/diagnóstico , Glomerulonefrite Membranosa/metabolismo , Síndrome Nefrótica/etiologia , Trombospondinas/metabolismo , Autoanticorpos/sangue , Glomerulonefrite Membranosa/complicações , Humanos , Masculino , Pessoa de Meia-Idade
18.
Chest ; 155(5): e149-e154, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-31060713

RESUMO

CASE PRESENTATION: A previously healthy 45-year-old man was admitted to our ED with a 3-week history of progressive dyspnea on exertion. He also presented with orthopnea, paroxysmal nocturnal dyspnea, and mild ankle swelling, but he showed no fever, wheezing, coughing, or sputum production. Outpatient laboratory studies, performed 1 week after symptom onset, revealed hypereosinophilia (4.100/µL). He was diagnosed with asthma and prescribed inhaled corticosteroids and low-dose prednisone, but he showed no symptomatic improvement. Over the last 48 h, he experienced rapid progression of dyspnea that made it difficult to speak with accompanying resting, substernal, nonradiating chest pain that became worse on inspiration. He had no allergies and reported no recent travels. Before symptom onset, he had not been taking any medication. He denied eating raw fish or meat and had not been exposed to mildew. His only exposure to animals was from his two indoor cats.


Assuntos
Albendazol/uso terapêutico , Asma/diagnóstico , Síndrome Hipereosinofílica/diagnóstico , Toxocaríase/diagnóstico , Corticosteroides/uso terapêutico , Animais , Asma/tratamento farmacológico , Gatos , Dor no Peito/diagnóstico , Dor no Peito/etiologia , Diagnóstico Diferencial , Progressão da Doença , Dispneia/diagnóstico , Dispneia/etiologia , Ecocardiografia/métodos , Eletrocardiografia/métodos , Serviço Hospitalar de Emergência , Eosinofilia/diagnóstico , Eosinofilia/etiologia , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Radiografia Torácica/métodos , Medição de Risco , Resultado do Tratamento
19.
J Dermatol ; 46(7): 618-621, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31144726

RESUMO

Eosinophilic dermatosis of hematological malignancy is a paraneoplastic skin eruption associated with chronic lymphocytic leukemia and other B-cell malignancies. It clinically resembles an insect bite reaction and it can precede the symptoms of the hematological malignancy or be related to a more aggressive course. Different treatments have been proposed, but partial response and recurrence are frequent. Herein, we describe a case of eosinophilic dermatosis associated with mantle cell lymphoma with remission after lenalidomide therapy.


Assuntos
Eosinofilia/tratamento farmacológico , Exantema/tratamento farmacológico , Lenalidomida/uso terapêutico , Linfoma de Célula do Manto/complicações , Síndromes Paraneoplásicas/tratamento farmacológico , Prurido/tratamento farmacológico , Eosinofilia/etiologia , Eosinofilia/patologia , Exantema/etiologia , Exantema/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Síndromes Paraneoplásicas/etiologia , Síndromes Paraneoplásicas/patologia , Prurido/etiologia , Prurido/patologia , Pele/patologia , Resultado do Tratamento
20.
BMJ Case Rep ; 12(5)2019 May 27.
Artigo em Inglês | MEDLINE | ID: mdl-31133546

RESUMO

A 31-year-old woman experienced tetany and was diagnosed with Hashimoto thyroiditis and hypoparathyroidism. At 33 years of age, her renal function gradually decreased. At 39 years of age, she moved to our hospital and was diagnosed with tubulointerstitial nephritis by renal biopsy. Simultaneously, she was diagnosed with Sjögren's syndrome by autoantibodies and salivary gland biopsy. At 40 years of age, based on hypoglycaemia and eosinophilia, she was suspected of adrenal insufficiency, and was diagnosed with primary adrenal insufficiency by both corticotropin stimulation and corticotropin-releasing hormone stimulation test. She was diagnosed as autoimmune polyglandular syndrome (APS) (Hashimoto thyroiditis and possible primary adrenal insufficiency) as well as primary hypoparathyroidism and Sjögren's syndrome, which are very rarely complicated in APS-2. Therefore, in this patient, it was helpful to pay attention for new onset of other autoimmune diseases.


Assuntos
Insuficiência Adrenal/diagnóstico , Doença de Hashimoto/diagnóstico , Hipoparatireoidismo/complicações , Poliendocrinopatias Autoimunes/diagnóstico , Síndrome de Sjogren/complicações , Insuficiência Adrenal/sangue , Insuficiência Adrenal/imunologia , Adulto , Autoanticorpos/sangue , Doenças Autoimunes , Diagnóstico Diferencial , Eosinofilia/diagnóstico , Eosinofilia/etiologia , Feminino , Humanos , Hipoglicemia/diagnóstico , Hipoglicemia/etiologia , Hipoparatireoidismo/diagnóstico , Nefrite Intersticial/diagnóstico , Nefrite Intersticial/etiologia , Poliendocrinopatias Autoimunes/imunologia , Doenças Raras , Síndrome de Sjogren/diagnóstico , Síndrome de Sjogren/imunologia
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