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1.
Cardiovasc Pathol ; 44: 107154, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31760242

RESUMO

Although the cause of eosinophilic coronary periarteritis (ECPA) remains unclear, an allergic background is present in fewer patients than expected. A 50-year-old man with no history of allergy or symptoms suggestive of cardiac or respiratory disorders suddenly died shortly after oral administration of loxoprofen sodium. Autopsy showed eosinophilic coronary periarteritis in three main branches of the coronary arteries, characterized by eosinophil-predominant inflammation without fibrinoid necrosis or granulomatous change in the adventitia and its surroundings of the three main branches of the coronary arteries, in addition to the localized sign of bronchial asthma in the lung. Immunohistochemical examination showed that many mast cells positive for human mast cell tryptase were evident in the perivascular tissue containing peripheral nerve trunks. Whereas the blood concentration of loxoprofen sodium was within the therapeutic range, significant elevation of the serum histamine and tryptase levels was found. The present case suggests that eosinophilic coronary periarteritis may be caused by a type I allergic reaction in some patients and that loxoprofen sodium can trigger a life-threatening type I allergic reaction, including eosinophilic coronary periarteritis, leading to sudden unexpected death.


Assuntos
Anti-Inflamatórios não Esteroides/efeitos adversos , Doença da Artéria Coronariana/induzido quimicamente , Vasos Coronários/efeitos dos fármacos , Morte Súbita Cardíaca/etiologia , Hipersensibilidade a Drogas/etiologia , Eosinofilia/induzido quimicamente , Fenilpropionatos/efeitos adversos , Dor de Ombro/tratamento farmacológico , Autopsia , Causas de Morte , Doença da Artéria Coronariana/imunologia , Doença da Artéria Coronariana/patologia , Vasos Coronários/imunologia , Vasos Coronários/patologia , Morte Súbita Cardíaca/patologia , Hipersensibilidade a Drogas/imunologia , Hipersensibilidade a Drogas/patologia , Eosinofilia/imunologia , Eosinofilia/patologia , Evolução Fatal , Humanos , Masculino , Mastócitos/efeitos dos fármacos , Mastócitos/imunologia , Mastócitos/patologia , Pessoa de Meia-Idade
2.
An Bras Dermatol ; 94(6): 724-728, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31789265

RESUMO

Eosinophilic spongiosis is a histological feature shared by some distinct inflammatory disorders, and is characterized by the presence of intraepidermal eosinophils associated with spongiosis. Most often, isolated eosinophilic spongiosis indicates the early stages of a subjacent autoimmune bullous dermatosis, such as the pemphigus group and bullous pemphigoid. Herein, the main causes of eosinophilic spongiosis are discussed, as well as the supplementary investigation needed to elucidate its etiology.


Assuntos
Eosinofilia/diagnóstico , Eosinofilia/patologia , Dermatopatias Vesiculobolhosas/diagnóstico , Dermatopatias Vesiculobolhosas/patologia , Diagnóstico Diferencial , Epiderme/patologia , Técnica Direta de Fluorescência para Anticorpo , Humanos
3.
Dermatol Online J ; 25(8)2019 Aug 15.
Artigo em Inglês | MEDLINE | ID: mdl-31553865

RESUMO

Eosinophilic fasciitis is a rare connective tissue disorder characterized by inflammation of the fascia that leads to painful, indurated skin. Because of its variable clinical presentation and overlap with conditions, such as morphea, the diagnosis of eosinophilic fasciitis can be challenging and relies on clinical presentation, histopathologic and laboratory analysis, and response to therapy. Herein, we present an unusual, solitary, isolated plaque with pathologic features and response to therapy most consistent with eosinophilic fasciitis.


Assuntos
Eosinofilia/patologia , Fasciite/patologia , Administração Cutânea , Administração Oral , Adolescente , Clobetasol/uso terapêutico , Eosinofilia/tratamento farmacológico , Fasciite/tratamento farmacológico , Feminino , Glucocorticoides/uso terapêutico , Humanos , Prednisona/uso terapêutico , Coxa da Perna
5.
BMJ Case Rep ; 12(8)2019 Aug 08.
Artigo em Inglês | MEDLINE | ID: mdl-31399413

RESUMO

Sclerosing mucoepidermoid carcinoma of the thyroid was first reported in 1991. This tumour type may develop as associated to Hashimoto thyroiditis. There are two variants of mucoepidermoid carcinoma of thyroid. The conventional and the sclerosing variants. Sclerosing mucoepidermoid carcinoma with eosinophilia of thyroid (SCME) has recently been recognised as a separate disease entity by the WHO. We report a case of SCME in a 62-year-old male patient who presented with a painless anterior neck swelling. Total thyroidectomy was performed, and no adjuvant treatment administered. The patient remained disease free up until 10 months of follow-up. Approximately 40 cases are reported in literature. We report the second case of SCME in Asian men. Sclerosing mucoepidermoid carcinoma with eosinophilia of thyroid should be differentiated from the conventional mucoepidermoid carcinoma. Patients should also be advised of long-term follow-up for surveillance.


Assuntos
Carcinoma Mucoepidermoide/patologia , Neoplasias da Glândula Tireoide/patologia , Biópsia por Agulha Fina , Carcinoma Mucoepidermoide/diagnóstico , Carcinoma Mucoepidermoide/cirurgia , Eosinofilia/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias da Glândula Tireoide/diagnóstico , Neoplasias da Glândula Tireoide/cirurgia , Tireoidectomia
6.
Acta Otolaryngol ; 139(10): 881-889, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31438745

RESUMO

Background: Olfactory dysfunction in eosinophilic chronic rhinosinusitis (ECRS) is poorly understood. Objective: To compare olfactory mucosal injury due to eosinophil infiltration in ECRS with postoperative olfactory function. Methods: Seventeen ECRS patients (ECRS group) and 18 bilateral rhinosinusitis (non-ECRS group) patients were compared. At 3 and 12 months post-endoscopic sinus surgery (ESS), all patients were evaluated for subjective symptoms (nasal obstruction, nasal discharge and olfactory dysfunction), endoscopic nasal findings, CT score and T&T olfactometer recognition threshold test. The eosinophil count, OMP-positive cells and epithelial erosion in olfactory mucosa collected during ESS were compared with the postoperative olfactory function. Results: The non-ECRS group showed significant improvement in all clinical findings at 3 and 12 months, but the ECRS group showed worsening of the olfactory dysfunction symptoms and T&T olfactometer recognition threshold at 12 months because of recurrence of sinusitis. The groups differed significantly in the ΔT&T value (i.e. pre-ESS T&T recognition threshold - post-ESS T&T recognition threshold) at both 3 and 12 months, and the degree of olfactory improvement differed. Histologically, the ECRS group showed significantly more eosinophils, fewer OMP-positive cells and greater epithelial erosion than the non-ECRS group. Conclusions: Eosinophilic inflammation was thought to cause olfactory mucosal injury/dysfunction.


Assuntos
Endoscopia , Eosinofilia/complicações , Transtornos do Olfato/etiologia , Transtornos do Olfato/patologia , Rinite/cirurgia , Sinusite/cirurgia , Adolescente , Adulto , Doença Crônica , Eosinofilia/patologia , Feminino , Humanos , Masculino , Mucosa Olfatória/patologia , Estudos Retrospectivos , Rinite/complicações , Rinite/patologia , Sinusite/complicações , Sinusite/patologia , Resultado do Tratamento , Adulto Jovem
8.
Allergol Int ; 68(4): 403-412, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31402319

RESUMO

Eosinophilic chronic rhinosinusitis (ECRS) is a subgroup of chronic rhinosinusitis with nasal polyps (CRSwNP), which is associated with severe eosinophilic infiltration and intractable. Its symptoms include dysosmia, nasal obstruction, and visous nasal discharge. The cause of ECRS is not clear, although it is thought that Staphylococcus aureus and its enterotoxins are involved in stimulating the Th2 system to promote IgE production and eosinophil infiltration through various pathways. While, the coagulation system is activated and the fibrinolytic system is suppressed, leading to deposition of fibrinous networks in nasal polyps. Therefore, a fibrin-degrading agent could be a new treatment for ECRS. Genetic analysis of nasal polyp cells using next-generation sequencing has identified some of the factors involved in ECRS, including periostin, which can be used as a biomarker of this condition. A protease inhibitor could be a therapeutic agent for ECRS. Regarding the role of eosinophils, many researchers have been interested in the mechanism of ETosis. However, the mechanism leading to development of nasal polyps is unknown. In Japan (as well as in East Asia), the incidence of non-ECRS is decreasing and that of ECRS is increasing, but the reason is also unknown. Thanks to the development of biologics therapy, it is thought that there will be a shift to precision medicine in the future.


Assuntos
Eosinofilia/patologia , Rinite/diagnóstico , Rinite/etiologia , Sinusite/diagnóstico , Sinusite/etiologia , Biomarcadores , Doença Crônica , Gerenciamento Clínico , Europa (Continente)/epidemiologia , Regulação da Expressão Gênica/efeitos dos fármacos , Humanos , Japão/epidemiologia , Rinite/epidemiologia , Rinite/terapia , Índice de Gravidade de Doença , Transdução de Sinais/efeitos dos fármacos , Sinusite/epidemiologia , Sinusite/terapia , Estados Unidos/epidemiologia
9.
Eur J Dermatol ; 29(3): 268-273, 2019 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-31389785

RESUMO

BACKGROUND: Mycosis fungoides (MF) is the most common variant of cutaneous T-cell lymphomas (CTCL). Itching can be a major symptom for patients with CTCL, however, itching associated with MF is not relieved by conventional therapy using anti-histamines, suggesting that histamine is not the main pruritogen. Therefore, the underlying mechanisms of itching in MF patients remain unclear. OBJECTIVES: To investigate the clinical and histopathological features associated with MF-related itching. MATERIALS AND METHODS: Skin sections from MF patients and healthy subjects were used for pathophysiological analysis and evaluation of protease activity. These results were compared with the degree of itching. RESULTS: Of the MF patients, 40% did not report itching and 60% reported itching (moderate itching: 40%; strong itching: 20%). The number of eosinophils, but not mast cells, that infiltrated into skin was increased in the group with strong itching. In the skin of patients, both serine protease activity and immunoreactivity to kallikrein 5 (KLK5), a known itch mediator, increased relative to the grade of itching. CONCLUSION: These results suggest that KLK5 and eosinophil infiltration may be involved in itching in patients with MF.


Assuntos
Eosinofilia/patologia , Calicreínas/metabolismo , Linfoma Cutâneo de Células T/patologia , Micose Fungoide/patologia , Prurido/fisiopatologia , Adulto , Biomarcadores/sangue , Biópsia por Agulha , Estudos de Casos e Controles , Progressão da Doença , Eosinofilia/fisiopatologia , Feminino , Humanos , Imuno-Histoquímica , Linfoma Cutâneo de Células T/fisiopatologia , Masculino , Pessoa de Meia-Idade , Micose Fungoide/fisiopatologia , Prognóstico , Valores de Referência , Índice de Gravidade de Doença , Calicreínas Teciduais/metabolismo
11.
Allergol Int ; 68(4): 515-520, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31257167

RESUMO

BACKGROUND: Asthma often coexists with chronic rhinosinusitis (CRS). Recent studies revealed that sinus inflammation in asthmatic patients was related to eosinophilic inflammation. However, the relationship between the severity of CRS and four different sputum inflammatory phenotypes as defined by the proportion of eosinophils and neutrophils is unknown. The aim of this study was to examine the impact of the severity of CRS on lower airway and systemic inflammation in asthmatic patients. METHODS: We enrolled 57 adult asthmatic patients who underwent sinus computed tomography (CT). The severity of CRS was evaluated by the Lund-Mackay score (LMS). The induced sputum inflammatory phenotype was defined by eosinophils (≥/<2%) and neutrophils (≥/<60%). Peripheral blood mononuclear cells (PBMC) were collected to examine cytokine productions. RESULTS: The median LMS of subjects was 6 (interquartile range, 0-11.5). The sputum inflammatory cell phenotype was categorized as paucicellular (n = 14), neutrophilic (n = 11), eosinophilic (n = 20), or mixed (n = 12). LMS was positively correlated with the percentage of blood eosinophils, sputum eosinophils, and mean fluorescence intensity (MFI) of IL-5 on CD4+ T cells. In the severe CRS group (LMS, 12-24), the number of mixed cellular phenotypes was higher than that in the group without CRS (LMS, 0-4) and mild-to-moderate CRS group (LMS, 5-11). CONCLUSIONS: In asthmatic patients with severe CRS, the proportion of the mixed cellular inflammatory phenotype was increased as well as eosinophilic inflammation.


Assuntos
Asma/complicações , Asma/patologia , Rinite/complicações , Sinusite/complicações , Idoso , Asma/diagnóstico por imagem , Asma/metabolismo , Biomarcadores , Eosinofilia/patologia , Feminino , Humanos , Imunofenotipagem , Contagem de Leucócitos , Linfócitos/imunologia , Linfócitos/metabolismo , Masculino , Pessoa de Meia-Idade , Neutrófilos/imunologia , Neutrófilos/metabolismo , Neutrófilos/patologia , Fenótipo , Rinite/diagnóstico , Índice de Gravidade de Doença , Sinusite/diagnóstico , Tomografia Computadorizada por Raios X
12.
Allergol Int ; 68(4): 430-436, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31266709

RESUMO

Eosinophilic granulomatosis with polyangiitis (EGPA) (formerly Churg-Strauss syndrome) is a rare form of anti-neutrophil cytoplasm antibody (ANCA)-associated vasculitis characterized by eosinophil-rich granulomatous inflammation and small to medium-size vessel vasculitis associated with bronchial asthma and eosinophilia. Its rarity and unique features such as eosinophilic inflammation have delayed progress of research regarding EGPA for several years, compared to other forms of ANCA-associated vasculitis. However, recently, attention to EGPA as a research subject has been gradually increasing. To resolve problems in existing criteria for EGPA, new classification criteria for EGPA generated by a large international cohort will be launched and is being expected to accelerate future studies. Pathogenesis and roles of ANCA in EGPA are still largely unknown; however, it has been reported that glomerulonephritis is more frequent in ANCA-positive patients than in ANCA-negative patients, while heart failure is more frequent in ANCA-negative patients than in ANCA-positive patients. In addition, a recent genome-wide association study has suggested the presence of two genetically distinct subgroups of EGPA, which correspond to ANCA-positive and -negative subgroups. Although responses to glucocorticoids in EGPA are generally good, patients with EGPA often experience a relapse. Currently, there is no standard therapy for EGPA based on accumulation of clinical trial results. Recently, clinical benefits of mepolizumab for EGPA were proved by a randomized controlled trial and mepolizumab was approved for EGPA. In addition, various new drugs are under evaluation. To find optimal use of these drugs and to resolve unmet needs, such as relapse prevention, will be needed in future.


Assuntos
Eosinofilia/patologia , Granulomatose com Poliangiite/diagnóstico , Granulomatose com Poliangiite/etiologia , Granulomatose com Poliangiite/terapia , Anticorpos Anticitoplasma de Neutrófilos/imunologia , Biomarcadores , Biópsia , Diagnóstico Diferencial , Suscetibilidade a Doenças , Eosinófilos/imunologia , Eosinófilos/metabolismo , Eosinófilos/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fenótipo
13.
Internist (Berl) ; 60(8): 783-791, 2019 Aug.
Artigo em Alemão | MEDLINE | ID: mdl-31292667

RESUMO

Sclerosing skin manifestations are more a symptom than a diagnosis and must therefore be meticulously clarified. Systemic scleroderma as a multiorgan disease must be distinguished from localized scleroderma or morphea because in addition to a different clinical picture they have a different prognosis and necessitate other therapeutic procedures. Rare sclerosing skin diseases with implications for internal medicine are eosinophilic fasciitis, Buschke's scleredema adultorum, scleromyxedema and nephrogenic systemic fibrosis.


Assuntos
Eosinofilia/patologia , Fasciite/patologia , Dermopatia Fibrosante Nefrogênica/patologia , Escleredema do Adulto/patologia , Esclerodermia Localizada/patologia , Escleroderma Sistêmico/patologia , Escleromixedema/patologia , Dermatopatias/complicações , Humanos , Esclerose , Dermatopatias/patologia
15.
Arch Dermatol Res ; 311(9): 705-710, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31350578

RESUMO

Eosinophils are seen in a number of dermatologic conditions. While the extent of their function in these diseases remains to be fully elucidated, pathogenic activity in bullous pemphigoid suggests a more significant role than previously thought. Several dermatoses have a fairly characteristic histologic morphology of eosinophil infiltration. We hypothesized that epidermal expression of eotaxins and TSLP would differ by disease, perhaps explaining the different histologic morphologies. We performed a retrospective study of eosinophil rich dermatoses to perform immunohistochemistry. We collected 49 specimens composed of bullous pemphigoid (n = 15), atopic dermatitis (n = 12), drug rash (n = 8), arthropod assault (n = 5), and non-bullous pemphigoid eosinophilic spongiosis (n = 5). We used lichen planus (n = 4) as a control for lymphocyte-mediated inflammation. TSLP was diffusely expressed in all epidermal samples, whereas eotaxins demonstrated a weaker staining. Eotaxins and TSLP demonstrated a gradient between basal and spinous keratinocytes. The correlation between overall basal keratinocyte and spinous keratinocyte staining of eotaxins and TSLP with the number of eosinophils demonstrated a significant correlation between eotaxin-1 (R = 0.404, P = 0.004), eotaxin-2 (R = 0.576, P < 0.001), and eotaxin-3 (R = 0.512, P < 0.001), but not TSLP (R = 0.164, P = 0.251). These remained significant after correcting for multiple comparisons. While we were unable to detect significant differences in epidermal expression of eotaxins and TSLP in various eosinophil rich dermatoses, we identified a significant correlation of spinous keratinocyte eotaxin staining with tissue eosinophilia. Our identification of a correlation of spinous keratinocyte eotaxin staining with tissue eosinophilia may provide insight into local eosinophil chemotaxis.


Assuntos
Quimiocina CCL11/metabolismo , Quimiocina CCL24/metabolismo , Quimiocina CCL26/metabolismo , Citocinas/metabolismo , Dermatite/patologia , Eosinofilia/patologia , Quimiocina CCL11/análise , Quimiocina CCL24/análise , Quimiocina CCL26/análise , Citocinas/análise , Dermatite/imunologia , Eosinofilia/imunologia , Eosinófilos/imunologia , Epiderme/imunologia , Epiderme/patologia , Humanos , Imuno-Histoquímica , Queratinócitos/imunologia , Queratinócitos/patologia , Estudos Retrospectivos
18.
Internist (Berl) ; 60(9): 973-981, 2019 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-31123761

RESUMO

Eosinophilic myocarditis is a rare condition with good treatment options, which can be difficult to diagnose. The clinical presentation can vary from asymptomatic to life-threatening forms. This article describes the case of a 44-year-old woman who suffered from vertigo, chest pain and dyspnea. The woman presented with an intermittent atrioventricular (AV) block II Mobitz type II° and mild impairment of left ventricular ejection fraction. Hypereosinophilia in the peripheral blood, cardiac magnetic resonance imaging (MRI) and endomyocardial biopsy led to the diagnosis of eosinophilic myocarditis, most likely as a result of an allergic reaction to Aspergillus fumigatus. A general treatment recommendation cannot be made due to the lack of evidence-based guidelines; however, recent scientific studies confirmed timely, high-dose steroid administration over several months to be the mainstay of treatment of eosinophilic myocarditis. The following article may be helpful in the early diagnosis and treatment of this underdiagnosed and insidious disease.


Assuntos
Bloqueio Atrioventricular/diagnóstico , Eosinofilia/diagnóstico , Miocardite/diagnóstico , Miocárdio/patologia , Adulto , Biópsia , Eosinofilia/patologia , Feminino , Humanos , Imagem por Ressonância Magnética , Miocardite/patologia
19.
Rev Gastroenterol Peru ; 39(1): 21-26, 2019.
Artigo em Espanhol | MEDLINE | ID: mdl-31042233

RESUMO

INTRODUCTION: Functional dyspepsia (FD) is a complex symptom. Currently there are multiple therapeutic options that are used for the management of these patients; however, FD therapies are based on symptomatic control and do not address the pathophysiological pathways involved in its development. The duodenum has been proposed as a key site to understand the complex pathophysiology involved in FD. OBJECTIVE: The aim of the study is to determine duodenal eosinophilia in patients with FD and establish the clinical-pathological correlation with the cardinal symptoms of dyspepsia. MATERIAL AND METHODS: Case-control study. Patients older than 18 years with dyspepsia according to the Rome IV criteria, and upper gastrointestinal endoscopy normal (FD group).Patients with iron deficiency anemia and chronic diarrhea (control group). Biopsies were taken in the stomach, duodenal bulb and second portion of duodenum. A sample size of 140 patients (70 patients in the FD group and 70 patients in the control group) was calculated. The collected information was described and analyzed by conventional statistical techniques. RESULTS: 243 patients were recruited. 84 patients were included in the FD group and 84 patients in the control group. 135 patients were women (80.3%). The mean age was 53.6 years (SD 14.9). Duodenal eosinophilia was found with significant difference in patients with early satiety (p=0.01). There was no difference in patients with postprandial fullness (p=0.63), epigastric pain or burning (p=0.26), gastroesophageal reflux symptoms (p=0.13), allergy and food intolerance (p=0.42) and smoking (p=0.28). There was no relationship between duodenal mastocytosis and early satiety (p=0.98), postprandial fullness (p=0.78), and epigastric pain or burning (p=0.82). CONCLUSIONS: Duodenal eosinophilia was similar in FD and controls. In subgroup analysis, duodenal eosinophilia occurs in patients with early satiety.


Assuntos
Duodenopatias/epidemiologia , Dispepsia/epidemiologia , Eosinofilia/epidemiologia , Dor Abdominal/epidemiologia , Adulto , Anemia Ferropriva/patologia , Estudos de Casos e Controles , Doença Crônica , Comorbidade , Diarreia/patologia , Duodenopatias/patologia , Dispepsia/patologia , Eosinofilia/patologia , Feminino , Intolerância Alimentar/epidemiologia , Refluxo Gastroesofágico/epidemiologia , Humanos , Masculino , Mastocitose/epidemiologia , Saciação , Fumar/epidemiologia , Avaliação de Sintomas
20.
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
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