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Cameron C, Tong JY, Patel S, Foreman A, Selva D. Disseminated thrombosis of the internal jugular vein, superior ophthalmic vein and cavernous sinus as the primary manifestation of occult malignancy: a case report. Orbit 2023:1-6. [PMID: 36995033 DOI: 10.1080/01676830.2023.2186436] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 02/25/2023] [Indexed: 06/19/2023]
Abstract
Internal jugular vein (IJV) thrombosis is a life-threatening condition most often associated with local risk factors such as head or neck infection or central venous catheterisation. Underlying malignancy is a rare but important aetiology to consider in patients presenting with spontaneous IJV thrombosis. We describe a case of necrotic cervical lymphadenopathy with thrombosis of the IJVs, cavernous sinuses and superior ophthalmic veins in a patient with metastatic squamous cell carcinoma, which was further complicated by an orbital compartment syndrome. The differential diagnosis of IJV thrombosis includes a range of infective, metastatic and thrombophilic pathologies. This case illustrates that, in the absence of an underlying precipitating factor, spontaneous IJV thrombosis should prompt further systemic investigations. Furthermore, patients with thrombotic events affecting the orbital venous drainage system should be monitored closely for signs of an acute orbital compartment syndrome.
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Affiliation(s)
- Cassie Cameron
- Discipline of Ophthalmology and Visual Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Jessica Y Tong
- Discipline of Ophthalmology and Visual Sciences, University of Adelaide, Adelaide, South Australia, Australia
- South Australian Institute of Ophthalmology, The Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Sandy Patel
- Department of Radiology, The Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Andrew Foreman
- Department of Otorhinolaryngology, The Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Dinesh Selva
- Discipline of Ophthalmology and Visual Sciences, University of Adelaide, Adelaide, South Australia, Australia
- South Australian Institute of Ophthalmology, The Royal Adelaide Hospital, Adelaide, South Australia, Australia
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2
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Agostini E, De Luca G, Bruni C, Bartoli F, Tofani L, Campochiaro C, Pacini G, Moggi-Pignone A, Guiducci S, Bellando-Randone S, Shoenfeld Y, Dagna L, Matucci-Cerinic M. Intravenous immunoglobulins reduce skin thickness in systemic sclerosis: evidence from Systematic Literature Review and from real life experience. Autoimmun Rev 2021; 20:102981. [PMID: 34718166 DOI: 10.1016/j.autrev.2021.102981] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 07/17/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Intravenous immunoglobulins (IVIG) are a new therapeutic approach in systemic sclerosis SSc. An immunomodulatory and antifibrotic activity has been postulated. IVIG are generally well tolerated and have only rare side effects. Our retrospective study focused its attention on SSc, an autoimmune connective tissue disease, characterized by several complications which has a significant impact on patient's quality of life. The pathophysiology comprises fibrotic, vascular and immunological aspects. AIM The aim of this study was to verify the effectiveness of IVIG on SSc skin involvement. Moreover, a systematic review of the literature (SLR) of the results obtained to date on the use of Intravenous immunoglobulin (IVIG) in SSc has been also performed. PATIENTS AND METHODS The data of 24 patients (21 women, 3 male) with refractory diffuse SSc skin involvement were evaluated (mean age was 52.13 years). IVIG infusion at a dosage of 2 g/Kg body weight for 4 consecutive days/month, was started between 2002 and 2019. Skin involvement was evaluated with the modified Rodnan Skin Score (mRSS) before therapy and then again after 6 and 12 months. To perform the SLR, the PubMed, Medline, Embase, and Web of Science database were searched from 1990 to 2020 (keywords: IVIG, systemic sclerosis). Three assessors (E.A., C.B. & M.M.C) identified the criteria to scan all papers. RESULTS From the total SLR (106 results), 17 papers were identified after the separation of the clinical cases from the studies (total number of treated patients 183). The studies were classified according to the organ involvement considered in each study, as well as the prescribed dose (high or low doses), and the therapeutic regimens. In the selected papers, the organs mainly involved were the skin, the gastrointestinal, the joint and the cardiovascular systems. Only in one case, plasmapheresis was associated to IVIG. All papers reported significant reduction of the skin involvement, although generally the strength of the works was limited the lack of control cases or by the low number of patients involved. From the real life experience, a statistically significant reduction of mRSS was obtained at 6 months follow-up (average value of -6.61 ± 5.2, p < 0.001), and it was further maintained with a significant stabilization after 12-months (-11.45 ± 9.63, p < 0.002). DISCUSSION This SLR and the data of the retrospective study suggest that IVIG may improve skin involvement reducing mRSS in particular in those patients that were refractory to other standard of care therapies and represents a therapeutic option in patients with concomitant myositis. The literature review revealed encouraging perspectives on the use of this therapy, given the effectiveness found in the selected works.
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Affiliation(s)
- Elana Agostini
- Dept. Experimental and Clinical Medicine, University of Florence, Italy; Division of Rheumatology, AOUC, Florence, Italy
| | - Giacomo De Luca
- Unit of Immunology, Rheumatology, Allergy and Rare diseases (UnIRAR), IRCCS San Raffaele Hospital, 20132 Milan, Italy; Vita-Salute San Raffaele University, 20132 Milan, Italy
| | - Cosimo Bruni
- Dept. Experimental and Clinical Medicine, University of Florence, Italy; Division of Rheumatology, AOUC, Florence, Italy
| | - Francesca Bartoli
- Dept. Experimental and Clinical Medicine, University of Florence, Italy; Division of Rheumatology, AOUC, Florence, Italy
| | - Lorenzo Tofani
- Dept. Experimental and Clinical Medicine, University of Florence, Italy; Division of Rheumatology, AOUC, Florence, Italy
| | - Corrado Campochiaro
- Unit of Immunology, Rheumatology, Allergy and Rare diseases (UnIRAR), IRCCS San Raffaele Hospital, 20132 Milan, Italy; Vita-Salute San Raffaele University, 20132 Milan, Italy
| | - Giovanni Pacini
- Dept. Experimental and Clinical Medicine, University of Florence, Italy; Division of Rheumatology, AOUC, Florence, Italy
| | - Alberto Moggi-Pignone
- Dept. Experimental and Clinical Medicine, University of Florence, Italy; Division of Internal Medicine, AOUC, Florence, Italy
| | - Serena Guiducci
- Dept. Experimental and Clinical Medicine, University of Florence, Italy; Division of Rheumatology, AOUC, Florence, Italy
| | - Silvia Bellando-Randone
- Dept. Experimental and Clinical Medicine, University of Florence, Italy; Division of Rheumatology, AOUC, Florence, Italy
| | - Yehuda Shoenfeld
- Ariel University, Israel; Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel Hashomer, Israel; Saint Petersburg State University, Saint-Petersburg, Russia
| | - Lorenzo Dagna
- Unit of Immunology, Rheumatology, Allergy and Rare diseases (UnIRAR), IRCCS San Raffaele Hospital, 20132 Milan, Italy; Vita-Salute San Raffaele University, 20132 Milan, Italy
| | - Marco Matucci-Cerinic
- Dept. Experimental and Clinical Medicine, University of Florence, Italy; Unit of Immunology, Rheumatology, Allergy and Rare diseases (UnIRAR), IRCCS San Raffaele Hospital, 20132 Milan, Italy; Division of Rheumatology, AOUC, Florence, Italy.
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3
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Burenbatu, Wang Y, Wang S, Narisu, Wuritunashun, Gong C, Hashengaowa, Eerdunduleng, Sarula, Guihua, Bai H. iTRAQ-based quantitative proteomics analysis of immune thrombocytopenia patients before and after Qishunbaolier treatment. RAPID COMMUNICATIONS IN MASS SPECTROMETRY : RCM 2021; 35:e8993. [PMID: 33140498 PMCID: PMC7757159 DOI: 10.1002/rcm.8993] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 10/07/2020] [Accepted: 10/13/2020] [Indexed: 10/08/2023]
Abstract
RATIONALE Treatment of immune thrombocytopenia (ITP) usually involves long-term use of immunosuppressive corticosteroids and splenectomy. However, these treatments often have side effects in patients. The Mongolian medicine Qishunbaolier (QSBLE) has a high curative effect, reduces the chances of relapse, and has no obvious side effects. This study was designed to identify potential therapeutic targets of QSBLE for treating ITP. METHODS To reveal differences in protein expression between ITP patients (ITPs) before and after QSBLE treatment, comparative proteomics studies were performed using isobaric tags for relative and absolute quantification (iTRAQ). The analysis used nanospray liquid chromatography/tandem mass spectrometry (nano-LC/MS/MS) in positive ion electrospray ionization mode. Key proteins relevant to ITP were revealed by the Kyoto Encyclopedia of Genes and Genomes (KEGG) and other bioinformatics tools. Real-time polymerase chain reaction (RT-PCR) analysis was carried out for confirmation of differentially expressed proteins. RESULTS A total of 982 differentially expressed proteins were identified in ITPs compared with the controls. Compared with the pre-QSBLE treatment group, 61 differentially expressed proteins were identified in the post-QSBLE treatment group, with 48 proteins being significantly upregulated and 13 downregulated. Twenty-nine pathways were significantly enriched. Q6N030 and other proteins were the key players in the protein-pathway network. Twenty proteins that may play important roles in the treatment of ITP were further filtered. RT-PCR and Western blot analyses further confirmed that MIF, PGK1 and IGHM were upregulated in ITPs after QSBLE treatment, in accordance with the proteomics data. CONCLUSIONS It is believed that the identified proteins and the results of bioinformatics analysis will provide a potential therapeutic target site for QSBLE for ITP therapy and biomarkers.
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Affiliation(s)
- Burenbatu
- Affiliated Hospital of Inner Mongolia University for NationalitiesTongliaoInner Mongolia028000China
| | - Yanbo Wang
- College of Life Sciences and Food SciencesInner Mongolia University for NationalitiesTongliaoInner Mongolia028000China
- Inner Mongolia Engineering and Technical Research Center for Personalized MedicineInner Mongolia University for NationalitiesTongliaoInner Mongolia028000China
| | - Shuanglian Wang
- Affiliated Hospital of Inner Mongolia University for NationalitiesTongliaoInner Mongolia028000China
| | - Narisu
- Affiliated Hospital of Inner Mongolia University for NationalitiesTongliaoInner Mongolia028000China
| | - Wuritunashun
- Affiliated Hospital of Inner Mongolia University for NationalitiesTongliaoInner Mongolia028000China
| | - Cuiqin Gong
- Affiliated Hospital of Inner Mongolia University for NationalitiesTongliaoInner Mongolia028000China
| | - Hashengaowa
- Affiliated Hospital of Inner Mongolia University for NationalitiesTongliaoInner Mongolia028000China
| | - Eerdunduleng
- Affiliated Hospital of Inner Mongolia University for NationalitiesTongliaoInner Mongolia028000China
| | - Sarula
- Affiliated Hospital of Inner Mongolia University for NationalitiesTongliaoInner Mongolia028000China
| | - Guihua
- Affiliated Hospital of Inner Mongolia University for NationalitiesTongliaoInner Mongolia028000China
| | - Haihua Bai
- College of Life Sciences and Food SciencesInner Mongolia University for NationalitiesTongliaoInner Mongolia028000China
- Inner Mongolia Engineering and Technical Research Center for Personalized MedicineInner Mongolia University for NationalitiesTongliaoInner Mongolia028000China
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Song SY, Wang ZA, Ding YC, Ji XM, Meng R. Cyclosporine-A-Induced Intracranial Thrombotic Complications: Systematic Review and Cases Report. Front Neurol 2021; 11:563037. [PMID: 33643175 PMCID: PMC7906016 DOI: 10.3389/fneur.2020.563037] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Accepted: 12/23/2020] [Indexed: 12/04/2022] Open
Abstract
This study reported two cases of intracranial thrombotic events of aplastic anemia (AA) under therapy with cyclosporine-A (CsA) and reviewed both drug-induced cerebral venous thrombosis (CVT) and CsA-related thrombotic events systematically. We searched PubMed Central (PMC) and EMBASE up to Sep 2019 for publications on drug-induced CVT and Cs-A-induced thrombotic events. Medical subject headings and Emtree headings were used with the following keywords: "cyclosporine-A" and "cerebral venous thrombosis OR cerebral vein thrombosis" and "stroke OR Brain Ischemia OR Brain Infarction OR cerebral infarction OR intracerebral hemorrhage OR intracranial hemorrhage." We found that CsA might be a significant risk factor in inducing not only CVT but also cerebral arterial thrombosis in patients with AA.
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Affiliation(s)
- Si-ying Song
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
- Advanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
- Department of China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Zhong-ao Wang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
- Advanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
- Department of China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yu-chuan Ding
- Department of China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China
- Department of Neurosurgery, Wayne State University School of Medicine, Detroit, MI, United States
| | - Xun-ming Ji
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
- Advanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
- Department of China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Ran Meng
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
- Advanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
- Department of China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China
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5
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Intravenous immunoglobulins for rheumatic disorders and thromboembolic events—a case series and review of the literature. Immunol Res 2018; 66:668-674. [DOI: 10.1007/s12026-018-9047-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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6
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Dural Venous Sinus Thrombosis and Pulmonary Embolism Following Immunoglobulin Treatment in Pediatric Patient With Immune Thrombocytopenic Purpura. J Pediatr Hematol Oncol 2017; 39:e508-e511. [PMID: 29068869 DOI: 10.1097/mph.0000000000000841] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Intravenous immunoglobulin (IVIG) is a widely used agent as the first choice of treatment of immune thrombocytopenic purpura (ITP). IVIG has several side effects, but it is a relatively safe treatment. Life-threatening thrombosis has been reported in adults and rarely in children. We report a case of a 14-year-old boy with dural venous sinus thrombosis and pulmonary embolism after treatment with IVIG for ITP. The patient was treated with low-molecular-weight heparin followed by warfarin and the symptoms were recovered. If a patient with ITP shows mental change or respiratory difficulty, we should consider thrombosis as well as hemorrhage.
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7
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Hsu WY, Chiou SS, Liao YM, Shu HL, Zeng YS, Wong CC, Lin PC. Successful management of multilineage autoimmune cytopenia complicated with severe infection and deep vein thrombosis in a patient with Hodgkin lymphoma post-autologous hematopoietic stem cell transplantation. Pediatr Transplant 2016; 20:168-71. [PMID: 26670732 DOI: 10.1111/petr.12644] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/28/2015] [Indexed: 12/18/2022]
Abstract
Autoimmune cytopenia (AIHA, AITP or AIN) were uncommon paraneoplastic manifestations of HL and have been recognized in patients after HSCT with dismal outcome. We presented a case of 16-yr-old male with Hodgkin's lymphoma who developed severe AIC involving all three cell lineages after autologus bone marrow transplantation. No disease relapse was noted. Treatments with steroid, IVIG and immunosuppresants were in vain and the disease course was complicated with sepsis and deep vein thrombosis. Rituximab was administered along with broad-spectrum antibiotics and low-molecular weight heparin. The condition became stable and pancytopenia recovered after four doses of rituximab treatment. Severe multi-lineage AIC post HSCT is usually refractory to first-line treatment and difficult to manage. Second-line treatment, such as rituximab, and dedicated care for pancytopenia-induced or treatment-related complications may provide a better outcome.
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Affiliation(s)
- Wan-Yi Hsu
- Division of Hematology and Oncology, Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Shyh-Shin Chiou
- Division of Hematology and Oncology, Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Department of Pediatrics, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yu-Mei Liao
- Division of Hematology and Oncology, Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Hsiu-Lan Shu
- Division of Hematology and Oncology, Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Department of Nursing, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Yu-Sheng Zeng
- Division of Hematology and Oncology, Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Cheong-Chew Wong
- Division of Hematology and Oncology, Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Pei-Chin Lin
- Division of Hematology and Oncology, Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Department of Pediatrics, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Graduate Institute of Clinical Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
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8
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Späth PJ, Granata G, La Marra F, Kuijpers TW, Quinti I. On the dark side of therapies with immunoglobulin concentrates: the adverse events. Front Immunol 2015; 6:11. [PMID: 25699039 PMCID: PMC4318428 DOI: 10.3389/fimmu.2015.00011] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Accepted: 01/07/2015] [Indexed: 12/26/2022] Open
Abstract
Therapy by human immunoglobulin G (IgG) concentrates is a success story ongoing for decades with an ever increasing demand for this plasma product. The success of IgG concentrates on a clinical level is documented by the slowly increasing number of registered indication and the more rapid increase of the off-label uses, a topic dealt with in another contribution to this special issue of Frontiers in Immunology. A part of the success is the adverse event (AE) profile of IgG concentrates which is, even at life-long need for therapy, excellent. Transmission of pathogens in the last decade could be entirely controlled through the antecedent introduction by authorities of a regulatory network and installing quality standards by the plasma fractionation industry. The cornerstone of the regulatory network is current good manufacturing practice. Non-infectious AEs occur rarely and mainly are mild to moderate. However, in recent times, the increase in frequency of hemolytic and thrombotic AEs raised worrying questions on the possible background for these AEs. Below, we review elements of non-infectious AEs, and particularly focus on hemolysis and thrombosis. We discuss how the introduction of plasma fractionation by ion-exchange chromatography and polishing by immunoaffinity chromatographic steps might alter repertoire of specificities and influence AE profiles and efficacy of IgG concentrates.
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Affiliation(s)
- Peter J. Späth
- Institute of Pharmacology, University of Berne, Berne, Switzerland
| | - Guido Granata
- Department of Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Fabiola La Marra
- Department of Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Taco W. Kuijpers
- Department of Pediatric Hematology, Immunology and Infectious Disease, Academic Medical Centre, University of Amsterdam, Amsterdam, Netherlands
| | - Isabella Quinti
- Department of Molecular Medicine, Sapienza University of Rome, Rome, Italy
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9
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Cotillon M, Lebas A, Blanc T, Schneider P, Vannier JP, Buchbinder N. [Cerebral venous thrombosis and immune thrombocytopenia in a 7-year-old girl: a fortuitous association?]. Arch Pediatr 2014; 21:1367-9. [PMID: 25445130 DOI: 10.1016/j.arcped.2014.09.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2014] [Revised: 05/11/2014] [Accepted: 09/24/2014] [Indexed: 10/24/2022]
Abstract
Primary immune thrombocytopenia (ITP) is an autoimmune disorder characterized by autoantibody-mediated peripheral platelet destruction. It is rarely accompanied by thrombosis. Here, we describe a wide cerebral venous thrombosis that occurred at the onset of a primary ITP in a 7-year-old girl. ITP was confirmed by the presence of anti-platelet antibodies. Whether ITP is a risk factor for venous thrombosis is a matter of debate. The platelet microparticles released during the platelet destruction and the interaction between the autoantibodies and the platelet glycoproteins may contribute to platelet activation. Increased risk of thromboembolic events should be considered in all patients with ITP, including children.
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Affiliation(s)
- M Cotillon
- Service d'onco-immuno-hématopédiatrie, CHU Charles-Nicolle, 1, rue de Germont, 76031 Rouen cedex, France.
| | - A Lebas
- Service de neurophysiologie, CHU Charles-Nicolle, 1, rue de Germont, 76031 Rouen cedex, France
| | - T Blanc
- Service de réanimation pédiatrique et néonatale, CHU Charles-Nicolle, 1, rue de Germont, 76031 Rouen cedex, France
| | - P Schneider
- Service d'onco-immuno-hématopédiatrie, CHU Charles-Nicolle, 1, rue de Germont, 76031 Rouen cedex, France
| | - J-P Vannier
- Service d'onco-immuno-hématopédiatrie, CHU Charles-Nicolle, 1, rue de Germont, 76031 Rouen cedex, France
| | - N Buchbinder
- Service d'onco-immuno-hématopédiatrie, CHU Charles-Nicolle, 1, rue de Germont, 76031 Rouen cedex, France
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10
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Benadiba J, Robitaille N, Lambert G, Itaj NK, Pastore Y. Intravenous immunoglobulin-associated thrombosis: is it such a rare event? Report of a pediatric case and of the Quebec Hemovigilance System. Transfusion 2014; 55:571-5. [PMID: 25355613 DOI: 10.1111/trf.12897] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2014] [Revised: 08/12/2014] [Accepted: 08/14/2014] [Indexed: 01/01/2023]
Abstract
BACKGROUND Intravenous immunoglobulin (IVIG) is frequently given in autoimmune disorders. Side effects are usually mild but severe complications such as thrombosis may occur. After one patient with IVIG-associated thrombotic complication at Sainte-Justine Hospital, the incidence of serious adverse events (SAEs) reported to the Quebec Hemovigilance System (QHS) was reviewed. STUDY DESIGN AND METHODS This study was a retrospective review of QHS database of IVIG-related thrombotic complications since 2003, including a case report of a pediatric patient. RESULTS QHS is one of the rare national hemovigilance systems that have included IVIG reports for almost a decade. Over an extended period of 11 years (2003-2013), there have been eight cases of IVIG-related thrombosis, seven in adults and one in the pediatric population (respective rate of 0.06 case and 0.17 case per 100,000 g of IVIG given). The single pediatric case occurred in a 16-year-old female receiving IVIG for severe immune thrombocytopenia. CONCLUSION Thrombosis after IVIG is a rare though SAE occurring mostly in adults. This underlines the importance of properly reporting IVIG SAEs to improve hemovigilance data and study such rare events.
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Affiliation(s)
- Joy Benadiba
- Department of Paediatric Hematology-Oncology, Sainte Justine Hospital, Montreal, Quebec, Canada
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11
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Bilateral jugular vein and sigmoid sinus thrombosis related to an inherited coagulopathy: an unusual presentation. Case Rep Vasc Med 2014; 2014:873402. [PMID: 25221687 PMCID: PMC4158254 DOI: 10.1155/2014/873402] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2014] [Accepted: 08/10/2014] [Indexed: 11/29/2022] Open
Abstract
Internal jugular vein thrombosis (IJVT) is a rare condition associated with malignancy, coagulopathy, and trauma. The optimal management of any IJVT must be individualized and depends on the condition of the patient. Case Presentation. We report the case of a 42-year-old woman with a history of a first trimester spontaneous abortion. Apart from a tension-type headache, she had no neurological symptoms. She reported an incidental diagnosis of right-sided IJVT when she was evaluated for hyperthyroidism ultrasonographically. On ultrasonography, we observed bilateral jugular vein thrombosis. The patient was started on oral warfarin. Seven months later, when she was adequately anticoagulated, she developed a second thrombosis. According to the etiological workup, she had a mutation in the homozygous methylene tetrahydrofolate reductase (MTHFR) gene and reduced protein C levels and activity. Conclusion. This report illustrates an unusual presentation of a rare condition. In this case, the etiology was associated with the coagulopathy, which occurred despite adequate anticoagulation.
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12
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Cerebral infarctions after intravenous immunoglobulin therapy for ITP in a child. Pediatr Neurol 2014; 50:188-91. [PMID: 24262342 DOI: 10.1016/j.pediatrneurol.2013.09.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2012] [Revised: 09/09/2013] [Accepted: 09/14/2013] [Indexed: 02/04/2023]
Abstract
BACKGROUND Intravenous immunoglobulin is the favored therapy in childhood immune thrombocytopenic purpura. It is usually well tolerated with manageable side effects, but venous and arterial thrombosis following its administration have been described, mostly in adults. METHODS We describe a 3-year-old girl with immune thrombocytopenic purpura and intracranial hemorrhage who received intravenous immunoglobulin therapy and subsequently developed multifocal cerebral infarctions. RESULTS Product specific as well as other factors may play a role in the development of this complication of intravenous immunoglobulin therapy. This is the only reported case of intravenous immunoglobulin-related thrombosis in a child with immune thrombocytopenic purpura and intracranial hemorrhage. CONCLUSIONS Thrombotic complications are associated with intravenous immunoglobulin administration and this includes cerebral infarcts.
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13
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Shimizu S, Koyama T, Mizota T, Fukuda K. Acute obstruction of craniocervical venous drainage in a lung-transplant patient. J Cardiothorac Vasc Anesth 2013; 28:1586-8. [PMID: 24035061 DOI: 10.1053/j.jvca.2013.04.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Indexed: 11/11/2022]
Affiliation(s)
- Satoshi Shimizu
- Department of Anesthesia, Kyoto University Hospital, 54 Shogoinkawaharacho, Sakyo-ku, Kyoto, 606-8507, Japan.
| | - Tomohiro Koyama
- Department of Anesthesia, Kyoto University Hospital, 54 Shogoinkawaharacho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Toshiyuki Mizota
- Department of Anesthesia, Kyoto University Hospital, 54 Shogoinkawaharacho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Kazuhiko Fukuda
- Department of Anesthesia, Kyoto University Hospital, 54 Shogoinkawaharacho, Sakyo-ku, Kyoto, 606-8507, Japan
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14
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Stiehm ER. Adverse effects of human immunoglobulin therapy. Transfus Med Rev 2013; 27:171-8. [PMID: 23835249 DOI: 10.1016/j.tmrv.2013.05.004] [Citation(s) in RCA: 191] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2012] [Revised: 04/08/2013] [Accepted: 05/21/2013] [Indexed: 01/20/2023]
Abstract
Human immunoglobulin (IG) is used for IgG replacement therapy in primary and secondary immunodeficiency, for prevention and treatment of certain infections, and as an immunomodulatory agent for autoimmune and inflammatory disorders. IG has a wide spectrum of antibodies to microbial and human antigens. Several high-titered IGs are also available enriched in antibodies to specific viruses or bacterial toxins. IG can be given intravenously (IGIV), intramuscularly (IGIM) or by subcutaneous infusions (SCIG). Local adverse reactions such as persistent pain, bruising, swelling and erythema are rare with IGIV infusions but common (75%) with SCIG infusions. By contrast, adverse systemic reactions are rare with SCIG infusions but common with IGIV infusions, occurring as often as 20% to 50% of patients and 5% to 15% of all IGIV infusions. Systemic adverse reactions can be immediate (60% of reactions) occurring within 6 hours of an infusion, delayed (40% of reactions) occurring 6 hours-1 week after an infusion, and late (less than 1% of reactions), occurring weeks and months after an infusion. Immediate systemic reactions such as head and body aches, chills and fever are usually mild and readily treatable. Immediate anaphylactic and anaphylactoid reactions are uncommon. The most common delayed systemic reaction is persistent headache. Less common but more serious delayed reactions include aseptic meningitis, renal failure, thromboembolism, and hemolytic reactions. Late reactions are uncommon but often severe, and include lung disease, enteritis, dermatologic disorders and infectious diseases. The types, incidence, causes, prevention, and management of these reactions are discussed.
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Affiliation(s)
- E Richard Stiehm
- Mattel Children's Hospital, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
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Singhal R, Gudimetla V, Stewart A, Luscombe KL, Charalambous CP. Perioperative care of a patient with refractory idiopathic thrombocytopenic purpura undergoing total knee arthroplasty. Knee Surg Relat Res 2012; 24:245-8. [PMID: 23269964 PMCID: PMC3526763 DOI: 10.5792/ksrr.2012.24.4.245] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2012] [Revised: 09/21/2012] [Accepted: 10/24/2012] [Indexed: 11/05/2022] Open
Abstract
Idiopathic thrombocytopenic purpura (ITP) is an autoimmune disorder leading to low platelet count and an increased risk of bleeding. Major joint replacement surgery in a patient with ITP can be associated with severe postoperative bleeding. We present our experience of perioperative management in a patient with severe refractory chronic idiopathic thrombocytopenic purpura who successfully underwent a cemented total knee replacement.
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Affiliation(s)
- Rohit Singhal
- Department of Trauma and Orthopaedics, Leighton Hospital, Crewe, United Kingdom
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16
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Girolami A, de Marinis GB, Bonamigo E, Treleani M, Vettore S. Arterial and venous thromboses in patients with idiopathic (immunological) thrombocytopenia: a possible contributing role of cortisone-induced hypercoagulable state. Clin Appl Thromb Hemost 2012; 19:613-8. [PMID: 22790661 DOI: 10.1177/1076029612452114] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Immunological thrombocytopenias, as other forms of thrombocytopenia, are associated with bleeding. Occasionally, these patients manifest thrombotic events. A total of at least 29 patients were reported to have had either arterial (20 cases) or venous (9 cases) thrombosis while platelet count was less than 50 × 10(3)/μL. The most frequent clinical manifestation was a myocardial infarction. Thrombosis occurred in the large majority of patients during prednisone therapy. Patients receiving cortisone or patients with Cushing syndrome show a hypercoagulable state characterized by elevated factor VIII levels, decreased fibrinolysis, and abnormal von Willebrand factor multimers composition. The same is probably true for prednisone-treated patients with thrombocytopenia. However, the 2 conditions are not identical since prednisone is a mainly glycoactive compound, whereas cortisol produced in excess in Cushing syndrome is mainly mineraloactive. The presence of large, young, hyperactive platelets may also play a role. Prednisone-treated patients with thrombocytopenia have to be considered as potentially thrombophilic.
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Affiliation(s)
- Antonio Girolami
- 1Department of Medical and Surgical Sciences, University of Padua Medical School, Padua, Italy
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Al-Riyami AZ, Lee J, Connolly M, Shereck E. Cerebral sinus thrombosis following IV immunoglobulin therapy of immune thrombocytopenia purpura. Pediatr Blood Cancer 2011; 57:157-9. [PMID: 21445949 DOI: 10.1002/pbc.22968] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2010] [Accepted: 11/15/2010] [Indexed: 01/29/2023]
Abstract
We present a pediatric patient treated with high dose intravenous immunoglobulin (IVIG) for acute immune thrombocytopenic purpura (ITP), who developed cerebral sinus thrombosis in the absence of any identifiable hypercoagulable state. This report describes the successful management of this rare complication in this challenging setting. This report shows IVIG induced cerebral sinus thrombosis in ITP.
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Affiliation(s)
- Arwa Z Al-Riyami
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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