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1.
Sarcoidosis Vasc Diffuse Lung Dis ; 37(2): 203-211, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33093784

RESUMO

Interleukin 18 (IL18), a pro-inflammatory cytokine, affects the development and progress of vasculitis. The production, expression, and function of this cytokine are affected by polymorphisms of promoter region of the IL18 gene. In this study, a meta-analysis of the associations between several IL18 polymorphisms and susceptibility to vasculitis was performed. Published literature from PubMed and Embase were retrieved. In total, nine studies comprising 1006 patients with vasculitis and 1499 controls combined, and the investigating the rs187238, rs194618, and rs360719 polymorphisms of the promoter region of the IL18 gene, were included in the meta-analysis. Pooled odds ratios (OR) and 95% confidence intervals (CI) were estimated with fixed-effects model or random-effects model. The recessive model of the rs194618 polymorphism was found to be significantly associated with a high susceptibility to vasculitis (OR = 1.54, 95% CI = 1.02-2.33, P = 0.04), especially in the Mongoloid race, where the A allele of rs194618 was associated with a low risk of the disease (OR = 0.77, 95% CI = 0.62-0.95, P = 0.01). By contrast, the rs187238 and rs360719 polymorphisms were not associated with this inflammatory condition. This meta-analysis showed that some IL18 polymorphisms are associated with susceptibility to vasculitis. (Sarcoidosis Vasc Diffuse Lung Dis 2020; 37 (2): 203-211).


Assuntos
Interleucina-18/genética , Polimorfismo de Nucleotídeo Único , Vasculite/genética , Predisposição Genética para Doença , Humanos , Fenótipo , Regiões Promotoras Genéticas , Medição de Risco , Fatores de Risco , Vasculite/diagnóstico , Vasculite/etnologia , Vasculite/imunologia
2.
Hautarzt ; 71(11): 870-879, 2020 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-32997218

RESUMO

Vasculitis is a rare cause of skin ulceration. Depending on the size of the affected vessel, the patient's comorbidities and the pathophysiology present, different clinical morphologies can be seen, which can often give preliminary indications of the type of underlying vasculitis. There may be systemic or cutaneous manifestations; thus, a targeted diagnostic workup should be initiated at an early stage. Treatment should be interdisciplinary if there is systemic participation. Vasculopathies (e.g., livedoid vasculopathy), in which occlusion of the vascular lumen is the main pathophysiological feature, should be delimitated from vasculitis. If vasculitic or vasculopathic ulceration is present, stage-appropriate wound management is recommended.


Assuntos
Dermatopatias Vasculares , Úlcera Cutânea , Vasculite , Diagnóstico Diferencial , Humanos , Dermatopatias Vasculares/diagnóstico , Dermatopatias Vasculares/terapia , Úlcera Cutânea/diagnóstico , Úlcera Cutânea/terapia , Vasculite/diagnóstico , Vasculite/terapia
5.
Presse Med ; 49(3): 104033, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32645416

RESUMO

Cutaneous vasculitis encompasses cutaneous components of systemic vasculitides, skin-limited variants of systemic vasculitides, such as IgA vasculitis or cutaneous polyarteritis nodosa, and single-organ cutaneous vasculitis, as individualized in 2012 in the Chapel Hill Consensus Conference Nomenclature. In this article, we focus on the management of skin-limited and single-organ vasculitides, often referred to, in clinical practice, as isolated "cutaneous leukocyctoclastic vasculitis", terms which may correspond to histological findings or descriptions, but are imprecise and not specific. Since most cases of isolated cutaneous vasculitis are self-limited and resolve spontaneously over 3 to 4 weeks, most patients require no systemic treatment. For those with severe, intractable, or chronic and recurring vasculitis, systemic therapy can be indicated and should be tailored to the severity of the disease. High-quality literature is lacking to guide management. Oral glucocorticoids may be required for a short period of time for painful, ulcerative, or otherwise severe disease in order to speed resolution. Among drugs which are reasonable longer-term options are colchicine, dapsone, azathioprine or hydroxychloroquine. Additional studies, including an ongoing multicenter randomized trial, are needed to determine the most effective therapies for skin-limited vasculitis.


Assuntos
Dermatopatias Vasculares/terapia , Vasculite/terapia , Azatioprina/uso terapêutico , Colchicina/uso terapêutico , Consenso , Diagnóstico Diferencial , Resistência a Medicamentos/fisiologia , Glucocorticoides/uso terapêutico , Humanos , Índice de Gravidade de Doença , Pele/patologia , Dermatopatias Vasculares/diagnóstico , Dermatopatias Vasculares/epidemiologia , Dermatopatias Vasculares/patologia , Vasculite/diagnóstico , Vasculite/epidemiologia , Vasculite/patologia
6.
J Thromb Thrombolysis ; 50(3): 499-511, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32700024

RESUMO

The COVID-19 pandemic now totaling 13,000,000 cases and over 571,000 deaths has continued to teach the medical, scientific and lay communities about viral infectious disease in the modern era. Among the many lessons learned for the medical community is the potential for transmissibility and host infectivity of the SARS-CoV-2 virus. Moreover, it has become clear that the virus can affect any organ including the circulatory system, directly via either tissue tropism or indirectly stemming from inflammatory responses in the form of innate immunity, leukocyte debris such as cell-free DNA and histones and RNA viral particles. The following review considers COVID-19-associated vasculitis and vasculopathy as a defining feature of a virus-induced systemic disease with acute, subacute and potential chronic health implications.


Assuntos
Betacoronavirus/patogenicidade , Vasos Sanguíneos/virologia , Infecções por Coronavirus/virologia , Pneumonia Viral/virologia , Vasculite/virologia , Animais , Betacoronavirus/imunologia , Coagulação Sanguínea , Vasos Sanguíneos/imunologia , Vasos Sanguíneos/patologia , Vasos Sanguíneos/fisiopatologia , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/imunologia , Infecções por Coronavirus/fisiopatologia , Interações Hospedeiro-Patógeno , Humanos , Mediadores da Inflamação/sangue , Pandemias , Pneumonia Viral/diagnóstico , Pneumonia Viral/imunologia , Pneumonia Viral/fisiopatologia , Prognóstico , Fatores de Risco , Vasculite/diagnóstico , Vasculite/imunologia , Vasculite/fisiopatologia
7.
Cesk Patol ; 56(2): 74-82, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32493023

RESUMO

By term „vasculitis“ inflammatory disease of blood vessels is designated that leads to vessel wall destruction followed by proliferation and occlusion of their lumina. Basic condition for this diagnosis is that vessel wall is a primary site of the pathological process. Clinical syndromes are a consequence of this process resulting into ischaemia of tissues supplied by the affected vessels and with constitutional symptoms associated to the inflammatory disease. Vasculitis can occur de novo as a primary involvement of vessel wall of unknown aetiology or it develops secondary to other diseases. The diagnosis of vasculitis is usually based on pathological findings from biopsy or abnormalities detected by imaging methods. This review describes the common primary vasculitides, their diagnostics and management.


Assuntos
Vasculite , Biópsia , Humanos , Vasculite/diagnóstico , Vasculite/terapia
8.
Cesk Patol ; 56(2): 83-88, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32493024

RESUMO

Secondary vasculitides usually accompany various common and rare conditions, Their clinical picture is very diverse, they can be loclaized or genaralized. Most frequently, we find parainfectious, drug-related and paraneoplastic vasculitides, less commonly in connective tissue diseases, after radiotherapy or transplantation. Vasculitides may be associated to infection of any origin. Drug-related vasculitides are mainly confined to the skin with picture of leukocytoclastic angiitis but visceral organs may be involved too. Paraneoplastic vasculitides usually accompany solid tumours and lymphoproliferative processes. When related to connective tissue diseases we can observe vasculitis in rheumatoid arthritis, systemic lupus erythematosus, Sjoegren syndrome, systemic sclerosis and other conditions. The diagnosis of vasculitis is usually based on pathological findings from biopsy. Management lies in treatment of underlying disease and if it is ineffective combined immunosuppression should be introduced.


Assuntos
Doenças do Tecido Conjuntivo , Vasculite Leucocitoclástica Cutânea , Vasculite , Doenças do Tecido Conjuntivo/complicações , Humanos , Vasculite/diagnóstico , Vasculite/etiologia , Vasculite/terapia
10.
Reumatol. clín. (Barc.) ; 16(3): 239-241, mayo-jun. 2020. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-194358

RESUMO

El síndrome pulmón-riñón rara vez ha sido reportado como cuadro clínico de presentación de vasculitis causada por el consumo de cocaína contaminada con levamisol. Se reporta el caso de un paciente con este cuadro clínico y se señalan las dificultades que se presentaron durante el abordaje diagnóstico y terapéutico


Pulmonary-renal syndrome has rarely been reported as the clinical presentation of vasculitis caused by the consumption of cocaine adulterated with levamisole. We report the case of a patient in whom we detected the clinical manifestations and indicate the difficulties that arose in relation to the diagnostic and therapeutic approach


Assuntos
Humanos , Masculino , Adulto , Transtornos Relacionados ao Uso de Cocaína/complicações , Levamisol/efeitos adversos , Vasculite/induzido quimicamente , Vasculite/diagnóstico , Glomerulonefrite/induzido quimicamente , Pneumopatias , Nefropatias/diagnóstico , Vasculite/imunologia , Vasculite/terapia , Pulmão/patologia , Pulmão/diagnóstico por imagem , Tomografia
11.
Reumatol. clín. (Barc.) ; 16(3): 242-244, mayo-jun. 2020. ilus
Artigo em Espanhol | IBECS | ID: ibc-194359

RESUMO

Se presenta el caso de un paciente de 47 años con antecedente de artritis psoriásica (AP) de 9 años de evolución en quien se encuentra compromiso renal, hipocomplementemia, neuropatía periférica, lesiones necróticas acrales y crioglobulinas positivas. Luego de realizar el abordaje diagnóstico se concluye que el cuadro clínico corresponde a una vasculitis crioglobulinémica concomitante a la AP. Se expone además del caso una revisión de la literatura referente a la presencia de estas 2 enfermedades en un solo paciente


We report the case of a 47-year-old man with a 9-year history of psoriatic arthritis (PsA) in whom we detected renal involvement, hypocomplementemia, peripheral neuropathy, acral necrotic lesions and positive cryoglobulins. The results of the diagnosis led us to conclude that the clinical picture corresponded to cryoglobulinemic vasculitis concomitant with PsA. In addition, we present a review of the literature on the presence of these two diseases in a single patient


Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Vasculite/etiologia , Crioglobulinemia/complicações , Artrite Psoriásica/etiologia , Vasculite/complicações , Vasculite/diagnóstico , Crioglobulinemia/diagnóstico , Psoríase/complicações , Psoríase/diagnóstico , Cotovelo/patologia , Braço/patologia , Metotrexato/uso terapêutico , Glucocorticoides/uso terapêutico , Rituximab/uso terapêutico
14.
Pathologe ; 41(4): 355-363, 2020 Jul.
Artigo em Alemão | MEDLINE | ID: mdl-32377833

RESUMO

The skin is one of the most frequently involved organs in primary systemic and secondary vasculitis; moreover, a vasculitis can occur as single organ vasculitis, limited to the skin. For most types of vasculitis, the lower extremities constitute common sites with clinical symptoms of palpable purpura, nodules, and ulcers. In histopathology of cutaneous vasculitis, it is of utmost importance to correctly identify the vessel types involved and to discriminate between vasculitic vessel damage, unspecific reactive vessel changes, vascular occlusive diseases, noninflammatory purpura, or perivascular infiltrates due to other inflammatory skin diseases. Small-vessel vasculitis is the most frequent type of cutaneous vasculitis; during florid phases, a dermal leukocytoclastic vasculitis is found regardless of etiology. Additional extravascular changes may give etiological clues, however, a correlation with the clinical picture, radiology, and serology is essential. The biopsy type and technique need to be adjusted to the suspected diagnosis and site of the vessels involved. Polyarteritis nodosa and nodular vasculitis can be diagnosed only in biopsies with sufficient subcutaneous tissue. Especially in cutaneous ulcers, a lateral rim of vital skin and subcutaneous tissue is indispensable for a correct diagnosis. Large-vessel vasculitis is not found in skin biopsies of the lower extremities.


Assuntos
Dermatopatias Vasculares , Vasculite , Biópsia , Diagnóstico Diferencial , Humanos , Extremidade Inferior , Dermatopatias Vasculares/diagnóstico , Dermatopatias Vasculares/patologia , Vasculite/diagnóstico , Vasculite/patologia
15.
Rev Mal Respir ; 37(5): 417-421, 2020 May.
Artigo em Francês | MEDLINE | ID: mdl-32360054

RESUMO

INTRODUCTION: IgA vasculitis is a leucocytoclastic vasculitis of small vessels with immune deposits of IgA. It tends to occur in a post-infectious context, though the pathogenic agent is rarely found. OBSERVATION: We report, for the first time, the case of an 81-year old patient who presented with an acute IgA vasculitis with cutaneous and joint involvement during a Klebsiella pneumoniae respiratory infection. Remission of vasculitis was observed after antibiotic therapy alone. CONCLUSION: This observation reminds us of the need to search carefully for any pathogenic agent that may be driving IgA vasculitis as this may be important both for understanding aetiology and for treatment.


Assuntos
Imunoglobulina A/efeitos adversos , Infecções por Klebsiella/complicações , Klebsiella pneumoniae/fisiologia , Pneumonia Bacteriana/complicações , Vasculite/etiologia , Idoso de 80 Anos ou mais , Humanos , Infecções por Klebsiella/imunologia , Klebsiella pneumoniae/imunologia , Abscesso Pulmonar/complicações , Abscesso Pulmonar/imunologia , Abscesso Pulmonar/microbiologia , Masculino , Pneumonia Bacteriana/imunologia , Pneumonia Bacteriana/microbiologia , Vasculite/diagnóstico , Vasculite Leucocitoclástica Cutânea/diagnóstico , Vasculite Leucocitoclástica Cutânea/etiologia , Vasculite Leucocitoclástica Cutânea/imunologia
16.
An Bras Dermatol ; 95(3): 355-371, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32307202

RESUMO

The term vasculitis refers to the inflammation of vessel walls. It may range in severity from a self-limited disorder in one single organ to a life-threatening disease due to multiple organ failure. It has many causes, although they result in only a few histological patterns of vascular inflammation. Vessels of any type and in any organ can be affected, a fact that results in a broad variety of signs and symptoms. Different vasculitides with indistinguishable clinical presentations have quite different prognosis and treatments. This condition presents many challenges to physicians in terms of classification, diagnosis, appropriate laboratory workup, and treatment. Moreover, it compels a careful follow-up. This article reviews the Chapel-Hill 2012 classification, etiology, recent insights in pathophysiology, some important dermatological clues for the diagnosis and summarizes treatment of some of these complex vasculitis syndromes.


Assuntos
Dermatopatias Vasculares/diagnóstico , Dermatopatias Vasculares/patologia , Vasculite/diagnóstico , Vasculite/patologia , Feminino , Humanos , Masculino , Necrose , Dermatopatias Vasculares/classificação , Síndrome , Vasculite/classificação
17.
Transplantation ; 104(7): e208-e213, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32235257

RESUMO

BACKGROUND: Histologic criteria for diagnosing acute rejection in vascularized composite tissue allograft (VCA) have been established by the Banff 2007 Working Classification of Skin-Containing Composite Tissue Allograft, but the role of early vascular lesions in graft rejection warrants additional analysis. METHODS: We performed a retrospective study of 34 skin biopsies performed over 430 d for rejection surveillance, in Canada's first face allotransplant recipient. Three observers reviewed all biopsies to assess the nature and intensity of the inflammatory skin infiltrate. A complete histological and immunohistochemical review of the vascular components was performed with a focus on lymphocytic vasculitis, intravascular fibrin, vessel caliber, extent of injury, C4d positivity, and inflammatory cell phenotyping. We then correlated these data points to clinical and immunosuppression parameters. RESULTS: Acute vascular damage in biopsies that would be classified as mild acute rejection correlates with troughs in immunosuppression and subsides when immunosuppressive tacrolimus doses are increased. Grade 0 Banff rejection and Grade I without lymphocytic vasculitis were almost indistinguishable, whereas Grade I with lymphocytic vasculitis was an easy and reproducible histologic finding. CONCLUSIONS: Our results highlight the possible relevance of vascular injury in the context of VCA, as its presence might underlie a more aggressive form of immune rejection. If these findings are validated in other VCA patients, vascular injury in mild rejection might warrant a different clinical approach.


Assuntos
Transplante de Face/efeitos adversos , Rejeição de Enxerto/diagnóstico , Imunossupressores/administração & dosagem , Tacrolimo/administração & dosagem , Vasculite/complicações , Idoso , Biópsia , Canadá , Aloenxertos Compostos/irrigação sanguínea , Aloenxertos Compostos/patologia , Relação Dose-Resposta a Droga , Rejeição de Enxerto/imunologia , Rejeição de Enxerto/patologia , Rejeição de Enxerto/prevenção & controle , Sobrevivência de Enxerto/efeitos dos fármacos , Sobrevivência de Enxerto/imunologia , Humanos , Imunossupressores/farmacocinética , Masculino , Estudos Retrospectivos , Índice de Gravidade de Doença , Pele/irrigação sanguínea , Pele/patologia , Tacrolimo/farmacocinética , Transplante Homólogo/efeitos adversos , Resultado do Tratamento , Vasculite/diagnóstico , Vasculite/tratamento farmacológico , Vasculite/imunologia
18.
J Neuropathol Exp Neurol ; 79(4): 355-364, 2020 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-32167544

RESUMO

Peripheral neuropathy is a common disorder with many possible etiologies including metabolic diseases, inflammatory conditions, infections, malignancy, inherited diseases, drugs, and toxins. In most instances, diagnosis and treatment plan can be established based on clinical presentation, family history, laboratory results, genetic testing, and electrophysiological studies. But in some situations, a peripheral nerve biopsy remains a valuable tool. This is especially true in patients with rapidly progressive disease, with atypical presentation or for whom other approaches fail to yield a definitive diagnosis. The pathologic examination starts with basic decisions about specimen triage. A few basic questions help to provide an initial framework for the assessment of a nerve biopsy-is the specimen adequate; are there inflammatory changes; are there vascular changes; is there amyloid; are there changes to axonal density and the Schwann cell-myelin-axon unit. In the appropriate context and with such an approach peripheral nerve biopsies can still represent a clinically helpful test.


Assuntos
Biópsia/métodos , Doenças do Sistema Nervoso Periférico/diagnóstico , Doenças do Sistema Nervoso Periférico/patologia , Amiloidose/diagnóstico , Amiloidose/patologia , Axônios/ultraestrutura , Humanos , Neuropatologia , Células de Schwann/patologia , Vasculite/diagnóstico , Vasculite/patologia
19.
J Clin Neurosci ; 73: 308-310, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32081598

RESUMO

The title "great imitator" refers to conditions which can cause varied manifestations and mimic many diseases. Lymphoma is worthy of this title. We describe three cases of lymphoma in which lymphoma mimicked other diseases causing neurological dysfunction, specifically sarcoidosis, vasculitis and infection respectively. Case 1 was a 66-year-old man with subacute progressive diplopia and gait disturbance and investigations revealing a supratentorial para-falcine soft tissue lesion, mid-thoracic cord enhancement and right axillary mass and an elevated serum ACE. Right axillary mass core biopsy was diagnostic of Burkitt lymphoma. Case 2 was a 50-year-old man with several weeks of constitutional symptoms and development of lower limb weakness and numbness, urinary retention and confusion while in hospital. MRI brain demonstrated multi-territory cerebral infarcts. Intravascular lymphoma was diagnosed on random skin biopsy. Case 3 was a 65-year-old man with several weeks of headache and diplopia on a background of previously treated Burkitt lymphoma. CSF analysis showed a lymphocytic pleocytosis and markedly low glucose with cytologic analysis negative for malignancy. Investigations for an infective cause were negative. FDG-PET demonstrated marked, disseminated spinal and cranial leptomeningeal disease and a multi-focal, intra-dural relapse of Burkitt lymphoma was diagnosed. The varied manifestations in our cases demonstrate the ability for lymphoma to mimic infective, inflammatory, granulomatous (including sarcoidosis) and neoplastic aetiologies. An elevated serum ACE appears insufficiently diagnostic to confirm sarcoidosis and tissue for histological examination should be sought whenever possible. When the diagnosis is uncertain, the possibility of this great imitator should be considered, especially for multi-focal disease.


Assuntos
Linfoma/patologia , Recidiva Local de Neoplasia/patologia , Sarcoidose/diagnóstico , Vasculite/diagnóstico , Idoso , Diagnóstico Diferencial , Humanos , Linfoma/diagnóstico por imagem , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/diagnóstico por imagem , Tomografia por Emissão de Pósitrons , Pele/patologia , Medula Espinal/patologia
20.
Chest ; 157(2): e37-e40, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-32033659

RESUMO

CASE PRESENTATION: A 50-year-old woman presented to the ED with a 3-day history of increasing confusion. Prior to her presentation, the patient had been in her usual state of health as reported by her family. She had a history of bipolar disorder and attention-deficit/hyperactivity disorder but had stopped her psychiatric medications for the past 4 days secondary to loss of insurance coverage. History was limited due to the patient's altered state and confusion, and was obtained from family. There was no history of headache, loss of consciousness, weakness of extremities, seizures, fever, or recent trauma. The patient's medical history also included cocaine abuse. The patient's family believed she had been abstinent from cocaine use for several years.


Assuntos
Adjuvantes Imunológicos/efeitos adversos , Transtornos Relacionados ao Uso de Cocaína/complicações , Confusão/induzido quimicamente , Contaminação de Medicamentos , Dermatoses Faciais/induzido quimicamente , Levamisol/efeitos adversos , Rabdomiólise/induzido quimicamente , Vasculite/induzido quimicamente , Cocaína , Inibidores da Captação de Dopamina , Equimose/induzido quimicamente , Equimose/diagnóstico , Dermatoses Faciais/diagnóstico , Feminino , Humanos , Pessoa de Meia-Idade , Rabdomiólise/diagnóstico , Vasculite/diagnóstico
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