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1.
Internist (Berl) ; 61(3): 261-269, 2020 Mar.
Artigo em Alemão | MEDLINE | ID: mdl-32072188

RESUMO

Vasculitic neuropathies result from inflammation of the vasa nervorum followed by ischemia and destruction of the peripheral nerve. The inflammation can be systemic or localized, i.e. non-systemic. Systemic vasculitis can be divided into primary and secondary forms. The latter is associated with, e.g. connective tissue diseases, infections, cancer or induced by certain drugs. Around two thirds of patients with systemic vasculitis develop vasculitic neuropathy presenting as characteristic painful, multifocal mononeuropathy of acute onset. The group of non-systemic neuropathies has grown in recent years with the addition of diabetic and non-diabetic lumbosacral radiculoplexus neuropathies, among others. Within the group of connective tissue diseases, other non-vasculitic neuropathies can occur as nerve-entrapment syndromes and sensory ataxic neuropathy. The aim of this article is to present a condensed overview of neuropathies associated with vasculitis and connective tissue diseases and to communicate characteristic clinical symptoms supporting rapid diagnostic and therapeutic procedures.


Assuntos
Doenças do Tecido Conjuntivo/complicações , Doenças do Sistema Nervoso Periférico/complicações , Polineuropatias/diagnóstico , Vasculite/complicações , Vasculite/diagnóstico , Humanos , Dor/diagnóstico , Dor/etiologia , Nervos Periféricos/patologia , Doenças do Sistema Nervoso Periférico/diagnóstico , Doenças do Sistema Nervoso Periférico/terapia , Polineuropatias/terapia , Vasculite/terapia
2.
Mayo Clin Proc ; 94(9): 1769-1780, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31486380

RESUMO

OBJECTIVE: To describe the differences in clinical characteristics and outcome between adult- and childhood-onset biopsy-proven IgA vasculitis (IgAV) in North America. PATIENTS AND METHODS: Patients with IgAV diagnosed from January 1, 1997, through December 31, 2016, were retrospectively identified. Data were abstracted from direct medical record review. Kaplan-Meier methods were used to estimate survival rates. RESULTS: A total of 243 patients with IgAV were included (227 [93.4%] white, 141 [58.0%] male); 174 patients were adults (≥21 years), and 69 were younger than 21 years. Compared with patients younger than 21 years, adults at baseline more frequently had ulcerative skin lesions (19 [10.9%] vs 1 [1.4%]; P=.02) and nephrotic-range proteinuria (21 of 96 [21.9%] vs 1 of 38 [2.6%]; P=.007) but less commonly had abdominal pain (59 [33.9%] vs 42 [60.9%]; P<.001), ischemic gastrointestinal tract involvement (18 [10.3%] vs 14 [20.3%]; P=.04), and arthralgias (66 [37.9%] vs 42 [60.8%]; P<.001). During 389 person-years of follow-up, 29 deaths were observed. Five-year survival rates for patients aged younger than 21, 21 to 50, and 51 years or older were 100%, 94%, and 40%, respectively. In comparison to data from the United States life tables for whites, patients 51 years or older at diagnosis had a greater than 7-fold increased risk of mortality (standardized mortality, 7.60 [95% CI, 5.01-11.06]; P<.001). CONCLUSION: IgA vasculitis in adults is associated with more severe skin/kidney involvement and poorer renal outcome. Among adults with IgAV, patients aged 51 years or older at diagnosis have significantly higher mortality (P<.001).


Assuntos
Corticosteroides/uso terapêutico , Glomerulonefrite por IGA/epidemiologia , Imunoglobulina A/imunologia , Vasculite/epidemiologia , Vasculite/patologia , Centros Médicos Acadêmicos , Adulto , Idade de Início , Biópsia por Agulha , Criança , Estudos de Coortes , Bases de Dados Factuais , Feminino , Glomerulonefrite por IGA/tratamento farmacológico , Glomerulonefrite por IGA/patologia , Humanos , Imuno-Histoquímica , Estimativa de Kaplan-Meier , Masculino , Prevalência , Prognóstico , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Medição de Risco , Índice de Gravidade de Doença , Taxa de Sobrevida , Resultado do Tratamento , Vasculite/imunologia , Vasculite/terapia
3.
In Vivo ; 33(4): 1325-1328, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31280225

RESUMO

Herein, we report a case of immunoglobulin A vasculitis (IgAV) onset in an elderly patient. A 61-year-old male presented to our hospital with palpable purpura on his right leg and abdomen and diffuse abdominal pain. Computed tomography revealed thickened intestinal wall and ascites. In addition, his serum IgA and urinary protein levels were elevated. The histopathological finding of palpable purpura indicated vasculitis, and he was diagnosed with IgAV. Accordingly, steroid therapy was initiated. Gradually, purpura and abdominal pain disappeared, and he was discharged on day 26 after admission. Although IgAV is common in children, only few cases have been reported in elderly. Thus, when examining patients, including elderly, with palpable purpura and abdominal pain, the possibility of IgAV should be considered.


Assuntos
Imunoglobulina A/imunologia , Imunossupressores/uso terapêutico , Esteroides/uso terapêutico , Vasculite/etiologia , Vasculite/terapia , Fatores Etários , Biópsia , Humanos , Masculino , Pessoa de Meia-Idade , Fenótipo , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Vasculite/diagnóstico
4.
Am J Case Rep ; 20: 886-895, 2019 Jun 23.
Artigo em Inglês | MEDLINE | ID: mdl-31230060

RESUMO

BACKGROUND Systemic vasculitides constitute heterogenous conditions affecting many organs and systems through blood vessel inflammation. Although there are some classifications for vasculitis, several vasculitides are "unclassified" because they cannot be clearly assigned to one of the known entities. CASE REPORT We report an autopsy case of a 67-year-old Japanese man who presented with fever, ocular pain, erythema, chest pain, and headache. The disease caused episcleritis, thrombophlebitis, extensive deep vein thrombosis, multiple pulmonary nodules and masses, hypertrophic pachymeningitis, and hyper-intensity areas in brain parenchyma on magnetic resonance images. Histopathology of the pulmonary nodule confirmed vasculitis affecting medium-to-small veins and arteries without necrotizing vasculitis or granulomatous inflammation. We diagnosed the patient with unclassified vasculitis based on the clinicopathological characteristics. Steroids in combination with immunosuppressants were used, but the disease was refractory and relapsing. The disease activity was eventually controlled with rituximab, but the patient died of bronchopneumonia. On autopsy, lung and brain findings indicated healed vascular inflammation. CONCLUSIONS This is the first case report of unclassified vasculitis, which is characterized as medium-to-small-sized arteritis and phlebitis, causing episcleritis, thrombophlebitis, deep vein thrombosis, pulmonary vasculitis, and intracranial vasculitis. The clinical conditions share some similarities with granulomatosis with polyangiitis and Behçet's disease; however, they meet no classification criteria of any specific vasculitis. More cases need to be analyzed to confirm our findings.


Assuntos
Esclerite/diagnóstico , Tromboflebite/diagnóstico , Vasculite/diagnóstico , Trombose Venosa/diagnóstico , Idoso , Autopsia , Evolução Fatal , Humanos , Masculino , Esclerite/complicações , Esclerite/terapia , Tromboflebite/complicações , Tromboflebite/terapia , Vasculite/complicações , Vasculite/terapia , Trombose Venosa/complicações , Trombose Venosa/terapia
5.
J Am Podiatr Med Assoc ; 109(2): 150-154, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31135196

RESUMO

BACKGROUND: Since 2006 there have been increased reports of severe agranulocytosis and vasculitis associated with levamisole use. Historically, levamisole was an immunomodulatory agent used in various cancer treatments in the United States. Currently the drug is used as an antihelminthic veterinary medication, but it is also used as an additive in freebase cocaine. There are multiple reports of levamisole-induced vasculitis in the head and neck but limited reported cases in the lower extremities. This article describes a 60-year-old woman who presented to the emergency department with multiple painful lower-extremity ulcerations. RESULTS: Radiographs, laboratory studies, and punch biopsy were performed. Physical examination findings and laboratory results were negative for signs of infection. Treatment included local wound care and education on cocaine cessation, and the patient was transferred to a skilled nursing facility. Her continued use of cocaine, however, prevented her ulcers from healing. CONCLUSIONS: Local wound care and cocaine cessation is the optimal treatment for levamisole-induced lesions. With the increase in the number of patients with levamisole-induced vasculitis, podiatric physicians and surgeons would benefit from the immediate identification of these ulcerations, as their appearance alone can be distinct and pathognomonic. Early identification of levamisole-induced ulcers is important for favorable treatment outcomes. A complete medical and social history is necessary for physicians to treat these lesions with local wound care and provide therapy for patients with addictions.


Assuntos
Adjuvantes Imunológicos/efeitos adversos , Transtornos Relacionados ao Uso de Cocaína/complicações , Levamisol/efeitos adversos , Extremidade Inferior , Vasculite/induzido quimicamente , Feminino , Humanos , Pessoa de Meia-Idade , Vasculite/patologia , Vasculite/terapia
6.
Neurol Clin ; 37(2): 171-200, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30952404

RESUMO

The systemic vasculitides are heterogeneous clinicopathologic disorders that share the common feature of vascular inflammation. The resulting disorder can vary depending on involvement of specific organs, caliber of blood vessels, the underlying inflammatory process, and individual host factors. The cumulative result is diminished blood flow, vascular alterations, and eventual occlusion with variable ischemia, necrosis, and tissue damage. An international revised nomenclature system provides the necessary nosology and findings relevant to classify each of the vasculitides. This article is an introduction and overview of the clinical presentation, differential diagnosis, laboratory evaluation, and treatment of systemic and nervous system vasculitides.


Assuntos
Vasculite/diagnóstico , Vasculite/patologia , Vasculite/terapia , Humanos
7.
Biomed Res Int ; 2019: 3727635, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30956979

RESUMO

Radiation vasculitis is one of the most common detrimental effects of radiotherapy for malignant tumors. This is developed at the vasculature of adjacent organs. Animal experiments have showed that transplantation of mesenchymal stem cells (MSCs) restores vascular function after irradiation. But the population of MSCs being engrafted into irradiated vessels is too low in the conventional models to make assessment of therapeutic effect difficult. This is presumably because circulating MSCs are dispersed in adjacent tissues being irradiated simultaneously. Based on the assumption, a rat model, namely, RT (radiation) plus TX (transplantation), was established to promote MSC homing by sequestering irradiated vessels. In this model, a 1.5 cm long segment of rat abdominal aorta was irradiated by 160kV X-ray at a single dose of 35Gy before being procured and grafted to the healthy counterpart. F344 inbred rats served as both donors and recipients to exclude the possibility of immune rejection. A lead shield was used to confine X-ray delivery to a 3 cm×3 cm square-shaped field covering central abdominal region. The abdominal viscera especially small bowel and colon were protected from irradiation by being pushed off the central abdominal cavity. Typical radiation-induced vasculopathy was present on the 90th day after irradiation. The recruitment of intravenously injected MSCs to irradiated aorta was significantly improved by using the RT-plus-TX model as compared to the model with irradiation only. Generally, the RT-plus-Tx model promotes MSC recruitment to irradiated aorta by separating irradiated vascular segment from adjacent tissue. Thus, the model is preferred in the study of MSC-based therapy for radiation vasculitis when the evaluation of MSC homing is demanding.


Assuntos
Transplante de Células-Tronco Mesenquimais , Células-Tronco Mesenquimais/metabolismo , Lesões Experimentais por Radiação/terapia , Vasculite/terapia , Raios X/efeitos adversos , Aloenxertos , Animais , Feminino , Células-Tronco Mesenquimais/patologia , Lesões Experimentais por Radiação/metabolismo , Lesões Experimentais por Radiação/patologia , Ratos , Ratos Endogâmicos F344 , Vasculite/etiologia , Vasculite/metabolismo , Vasculite/patologia
8.
Acta Dermatovenerol Croat ; 27(1): 28-32, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31032788

RESUMO

Cutaneous necrotizing eosinophilic vasculitis (CNEV) is a rare type of vasculitis. Eosinophilic vasculitis is a necrotizing vasculitis with eosinophilic vascular infiltration, in which eosinophils mediate vascular damage in the disease process. We present a case of an 18-year-old girl who developed palpable purpura and hemorrhagic bullae over the lower extremities associated with itching, 7 days after the commencement of penicillin therapy. Plasma cryofibrinogen was positive. Histopathology showed an infiltration of eosinophils within and around the vessel walls and a complete absence of nuclear dust and neutrophils. Oral prednisone at 1 mg/kg induced remission in 2 weeks; the prednisone dose was tapered and discontinued after 2.5 months. There was no evidence of recurrence after 37 months of follow-up. Our patient represents a rare case of drug/penicillin-induced CNEV associated with cryofibrinogenemia, without systemic organ involvement.


Assuntos
Antibacterianos/efeitos adversos , Crioglobulinemia/complicações , Eosinofilia/induzido quimicamente , Penicilinas/efeitos adversos , Vasculite/induzido quimicamente , Adolescente , Crioglobulinemia/diagnóstico , Crioglobulinemia/terapia , Eosinofilia/diagnóstico , Eosinofilia/terapia , Feminino , Humanos , Vasculite/diagnóstico , Vasculite/terapia
9.
Curr Cardiol Rep ; 21(5): 34, 2019 03 18.
Artigo em Inglês | MEDLINE | ID: mdl-30887249

RESUMO

PURPOSE OF REVIEW: This review aims to discuss the use of fluorodeoxyglucose (FDG) positron emission tomography (PET/CT) for diagnosis and management of patients with large-vessel vasculitis (LVV). RECENT FINDINGS: Incidence of LVV is likely underestimated, in part due to its non-specific symptoms. Nevertheless, early diagnosis of LVV is essential to initiate timely therapy in order to prevent vascular complications, such as stenoses and aneurysms. FDG PET/CT imaging has the ability to detect LVV during the acute phase, prior to edema and other vascular structural changes, with its high sensitivity for inflammatory activity. FDG PET/CT was shown to be a powerful prognostic marker by allowing identification of patients at risk of vascular complications. Additionally, preliminary data support the use of FDG PET/CT to follow therapy efficacy. FDG PET/CT allows early detection of inflammation, before morphological and irreversible vascular changes can be observed, allowing prompt diagnosis and treatment of LVV.


Assuntos
Arterite de Células Gigantes/diagnóstico por imagem , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Arterite de Takayasu/diagnóstico por imagem , Fluordesoxiglucose F18 , Arterite de Células Gigantes/terapia , Humanos , Inflamação/diagnóstico por imagem , Inflamação/terapia , Prognóstico , Compostos Radiofarmacêuticos , Arterite de Takayasu/terapia , Vasculite/diagnóstico por imagem , Vasculite/terapia
16.
Intern Med ; 58(1): 31-38, 2019 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-30101942

RESUMO

Objective This case series aimed to identify the clinical and pathological characteristics of elderly patients (≥60 years) with biopsy-proven IgA vasculitis with nephritis (IgAVN). Methods The clinical and pathological presentation and treatment outcomes were compared between two groups. Patients Patients with IgAVN who were ≥19 years old at the time of their renal biopsy were divided into elderly (≥60 years) and adult (19-59 years) groups. Results Of the 23 patients in our study, 13 were elderly. In the elderly group, the median age at the diagnosis was 68 years (range, 60-85 years), with a median follow-up period of 15 months (range, 3-80 months). Twelve elderly patients had comorbidities, including hypertension, diabetes mellitus, chronic kidney disease, cardiovascular disease, and malignancies. A decrease in the estimated glomerular filtration rate, as well as massive proteinuria and rapidly progressive nephritic syndrome, were more frequent in the elderly group than in the adult group. Furthermore, renal pathological changes, including cellular or fibrocellular crescents, interstitial fibrosis, tubular atrophy, and arteriosclerosis, were more severe among elderly patients than adult patients. All elderly patients were treated with glucocorticoids and had no incidence of end-stage renal disease at the final follow-up; in addition, nine elderly patients had reduced proteinuria with a preserved renal function. Adverse events, including infection, diabetes mellitus, and vascular disorders, were identified in nine patients. Three elderly patients died from severe infections. Conclusion IgAVN in elderly patients is characterized by severe renal involvement. Elderly patients are at higher risk than adults for treatment-related adverse events.


Assuntos
Imunoglobulina A , Nefrite/etiologia , Nefrite/patologia , Vasculite/etiologia , Vasculite/patologia , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Taxa de Filtração Glomerular , Glucocorticoides/uso terapêutico , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Nefrite/terapia , Resultado do Tratamento , Vasculite/complicações , Vasculite/terapia , Adulto Jovem
17.
Vasc Med ; 24(1): 79-88, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30355272

RESUMO

Despite being recognised over a century ago, the aetiology and pathogenesis of large vessel vasculitis (LVV) still remains elusive. Takayasu's arteritis (TA) and giant cell arteritis (GCA) represent the two major categories of LVV, each with distinctive clinical features. Over the last 10 years an increased understanding of the immunopathogenesis of the inflammatory cascade within the aortic wall has revived the view that LVVs may represent subtypes of the same pathological process, with implications in the treatment of this disease. In this review, the histological, genetic and immunopathological features of TA and GCA will be discussed and the evidence for a common underlying disease mechanism examined. Novel markers of disease activity and therapies based on advances in our understanding of the immunopathogenesis of these conditions will also be discussed.


Assuntos
Artérias , Vasculite/etiologia , Artérias/imunologia , Artérias/metabolismo , Artérias/patologia , Autoimunidade , Biomarcadores/sangue , Predisposição Genética para Doença , Humanos , Fenótipo , Prognóstico , Fatores de Risco , Vasculite/diagnóstico , Vasculite/genética , Vasculite/terapia
18.
J Clin Rheumatol ; 25(3): e16-e26, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29782427

RESUMO

OBJECTIVES: The aims of this study were to describe clinical and laboratory manifestations of patients with levamisole-adulterated cocaine-induced vasculitis/vasculopathy and to propose a skin classification according to the distribution and severity of lesions. METHODS: We report the characteristics of 30 patients admitted with levamisole-adulterated cocaine-induced vasculitis/vasculopathy in 4 high-complexity institutions in Colombia, from December 2010 to May 2017. We compare our findings with the main published series. RESULTS: Median age was 31 years (interquartile range, 27-38 years) with a male-to-female ratio of 5:1. Eighty-three percent of the patients had retiform purpura affecting the limbs, buttocks, face, or abdomen; 73% had ear necrosis, 50% cutaneous ulcers, 17% genital necrosis, 13% oral ulcers, and 10% digital necrosis. Cutaneous involvement was classified according to the frequency of the compromised corporal area, and purpuric lesions were stratified in 4 grades of severity. Anti-neutrophil cytoplasmic autoantibodies were positive in 85% of the cases, lupus anticoagulant in 73%, and antinuclear autoantibodies in 57%; rheumatoid factor was negative in all cases. We found nephritis in 17 cases (57%). Prednisolone was used in most of the patients (70%), with other immunosuppressive agents being used in a lower percentage. Improvement was observed in 93% of the patients, but symptoms recurred in 40%, attributed to relapses in consumption. End-stage chronic renal disease developed in 10% of the cases, and 1 patient died. CONCLUSIONS: Because of rising cocaine consumption and levamisole adulteration frequency, levamisole-adulterated cocaine-induced vasculitis/vasculopathy is becoming more common. Detailed characterization of skin involvement coupled with multiple antibody positivity is essential for a diagnosis. Renal involvement is frequent, clinically and histologically heterogeneous, and potentially serious.


Assuntos
Transtornos Relacionados ao Uso de Cocaína/complicações , Cocaína , Glomerulonefrite , Levamisol , Púrpura , Vasculite , Adjuvantes Farmacêuticos/efeitos adversos , Adjuvantes Farmacêuticos/farmacologia , Adulto , Autoanticorpos/sangue , Cocaína/farmacologia , Colômbia , Inibidores da Captação de Dopamina/farmacologia , Contaminação de Medicamentos , Feminino , Glomerulonefrite/induzido quimicamente , Glomerulonefrite/diagnóstico , Glomerulonefrite/imunologia , Glomerulonefrite/terapia , Humanos , Levamisol/efeitos adversos , Levamisol/farmacologia , Masculino , Necrose , Administração dos Cuidados ao Paciente/métodos , Púrpura/induzido quimicamente , Púrpura/diagnóstico , Púrpura/imunologia , Púrpura/terapia , Pele/patologia , Resultado do Tratamento , Vasculite/induzido quimicamente , Vasculite/diagnóstico , Vasculite/imunologia , Vasculite/terapia
20.
Int J Low Extrem Wounds ; 17(4): 218-226, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30501545

RESUMO

Cutaneous and other vasculitides are specific inflammations of the blood vessel wall that can take place in any organ system of the body including the skin. Vasculitis has been traditionally divided according to the size of the vessel involved (small, medium, and large). Vasculitis is more of a reaction pattern rather than a specific disease entity. Therefore, the clinical presentation of vasculitis (most commonly palpable purpura on the lower extremities) dictates a thorough history, review of systems, and a meticulous physical examination. The diagnosis of vasculitis relies also on the histopathological and immunofluorescence studies. Wound care specialist may face with vasculitis-associated ulcers along with a spectrum of other cutaneous presentations associated with vasculitis. The focus of this article is to update the types, etiology, pathogenesis, and management options for cutaneous vasculitis.


Assuntos
Dermatopatias Vasculares/patologia , Dermatopatias Vasculares/terapia , Vasculite/patologia , Vasculite/terapia , Terapia Combinada , Tratamento Conservador , Feminino , Humanos , Masculino , Manejo da Dor/métodos , Prognóstico , Púrpura de Schoenlein-Henoch/patologia , Púrpura de Schoenlein-Henoch/terapia , Índice de Gravidade de Doença , Dermatopatias Vasculares/diagnóstico , Resultado do Tratamento , Vasculite/diagnóstico
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