1
|
Song Q, Wang Z. Association of Sjögren's syndrome with immune-mediated thrombotic thrombocytopenic purpura and posterior reversible encephalopathy syndrome: A case report. Heliyon 2024; 10:e36212. [PMID: 39224298 PMCID: PMC11367448 DOI: 10.1016/j.heliyon.2024.e36212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Revised: 06/19/2024] [Accepted: 08/12/2024] [Indexed: 09/04/2024] Open
Abstract
Background A patient with Sjögren's syndrome (SS), immune-mediated thrombotic thrombocytopenic purpura (ITTP), and posterior reversible encephalopathy syndrome (PRES) was reported, and all published cases with thrombotic thrombocytopenic purpura (TTP), PRES, and SS were retrieved and analysed. The patient's clinical data and treatment procedure have been discussed. Case summary A 45-year-old Chinese female was hospitalized with headache and low platelet count. She had previously presented to a local hospital with a 7-month history of epigastric discomfort and anorexia, and was diagnosed with SS and ITTP. Laboratory investigations after admission showed platelet (PLT) of 13*10^9/L, red blood cell (RBC) fragments of 6 %, ADAMTS13 Activity<0.2 %, anti-ADAMTS13 IgG of 88.3U/mL. Brain magnetic resonance imaging (MRI) showed gyriform restricted diffusion along with increased T2-FLAIR signal in the left frontal cortex and bilateral parietal temporal cortex. She was diagnosed with SS, ITTP and PRES, and received the treatment of methylprednisolone, cyclosporine, plasma exchange, IVIG, and rituximab. This patient did not experience the recurrence during the 8-month follow-up period. Conclusion ITTP and PRES are rare manifestations of SS. After a suspected or confirmed diagnosis of ITTP, plasma exchange and immunosuppressive therapy should be immediately administered. We suggest that rituximab could have additional therapeutic value for SS combined with ITTP and PRES.
Collapse
Affiliation(s)
- Qicheng Song
- First Clinical Medical College, Shandong University of Traditional Chinese Medicine, Shandong, Jinan, PR China
| | - Zhankui Wang
- Department of Rheumatology and Clinical Immunology, Qianfoshan Hospital, Shandong, Jinan, PR China
| |
Collapse
|
2
|
Li Z, Lei Z, Yang W, Jing C, Sun X, Yang G, Zhao X, Zhang M, Xu M, Tang Y, Wang Q, Zhao J, Zhou Z, Wen Z, Chen X, Peng Q, Wang G, Zhang P, Sun E, Shen N, Xu W, Li Z, Yang H, Yin Z. Anti-Toxoplasma gondii antibodies as a risk factor for the prevalence and severity of systemic lupus erythematosus. Parasit Vectors 2024; 17:44. [PMID: 38291478 PMCID: PMC10826107 DOI: 10.1186/s13071-024-06141-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Accepted: 01/17/2024] [Indexed: 02/01/2024] Open
Abstract
BACKGROUND Systemic lupus erythematosus (SLE) is a complex systemic autoimmune disease characterized by the presence of numerous autoantibodies. The interaction of infectious agents (viruses, bacteria and parasites) and a genetically susceptible host may be a key mechanism for SLE. Toxoplasma gondii is a widespread intracellular parasite that has been implicated in the pathogenesis of autoimmune diseases. However, the relationship between T. gondii infection and the increased risk of SLE in Chinese populations remains unclear. METHODS The seroprevalence of T. gondii infection was assessed in 1771 serum samples collected from Chinese individuals (908 healthy controls and 863 SLE patients) from different regions of China using an enzyme-linked immunosorbent assay. Serum autoantibodies and clinical information were obtained and analysed. RESULTS Our observations revealed a higher prevalence of anti-T. gondii antibodies (ATxA) immunoglobulin G (IgG) in serum samples from SLE patients (144/863, 16.7%) than in those from the healthy controls (53/917, 5.8%; P < 0.0001), indicating a 2.48-fold increased risk of SLE in the ATxA-IgG+ population, after adjustment for age and sex (95% confidence interval [CI] 1.70-3.62, P < 0.0001). ATxA-IgG+ SLE patients also showed a 1.75-fold higher risk of developing moderate and severe lupus symptoms (95% CI 1.14-2.70, P = 0.011) compared to ATxA-IgG- patients. Relative to ATxA-IgG- patients, ATxA-IgG+ patients were more likely to develop specific clinical symptoms, including discoid rash, oral ulcer, myalgia and alopecia. Seven antibodies, namely anti-ribosomal RNA protein (rRNP), anti-double stranded DNA (dsDNA), anti-cell membrane DNA (cmDNA), anti-scleroderma-70 (Scl-70), anti-cardiolipin (CL), anti-beta2-glycoprotein-I (B2GPI) and rheumatoid factor (RF), occurred more frequently in ATxA-IgG+ patients. When combined with anti-dsDNA and RF/anti-rRNP/anti-cmDNA/ESR, ATxA-IgG significantly increased the risk for severe lupus. CONCLUSIONS Our results suggest that ATxA-IgG may be a significant risk factor for SLE prevalence and severity in Chinese populations.
Collapse
Affiliation(s)
- Zhongzhen Li
- Guangdong Provincial Key Laboratory of Tumor Interventional Diagnosis and Treatment, Zhuhai Institute of Translational Medicine, Zhuhai People's Hospital (Zhuhai Clinical Medical College of Jinan University), Jinan University, Zhuhai, 519000, China
| | - Zhiwei Lei
- Department of Basic Medical Research, The Sixth Affiliated Hospital of Guangzhou Medical University, Qingyuan People's Hospital, Qingyuan, 511518, China
| | - Wanying Yang
- Guangdong Provincial Key Laboratory of Tumor Interventional Diagnosis and Treatment, Zhuhai Institute of Translational Medicine, Zhuhai People's Hospital (Zhuhai Clinical Medical College of Jinan University), Jinan University, Zhuhai, 519000, China
| | - Chunxia Jing
- Department of Epidemiology, School of Medicine, Jinan University, Guangzhou, 510632, China
- Guangdong Key Laboratory of Environmental Pollution and Health, Jinan University, Guangzhou, 510632, China
| | - Xiaolin Sun
- Department of Rheumatology and Immunology, Peking University People's Hospital and Beijing Key Laboratory for Rheumatism Mechanism and Immune Diagnosis (BZ0135), Beijing, 100034, China
| | - Guang Yang
- Department of Pathogen Biology, School of Medicine, Jinan University, Guangzhou, 510632, China
| | - Xiaozhen Zhao
- Department of Rheumatology and Immunology, Peking University People's Hospital and Beijing Key Laboratory for Rheumatism Mechanism and Immune Diagnosis (BZ0135), Beijing, 100034, China
| | - Mingjiao Zhang
- Department of Rheumatology and Immunology, The Third Affiliated Hospital, Southern Medical University, Guangzhou, 510630, China
- Institute of Clinical Immunology, Academy of Orthopedics Guangdong Province, Guangzhou, 510630, China
| | - Miaomiao Xu
- Guangdong Provincial Key Laboratory of Tumor Interventional Diagnosis and Treatment, Zhuhai Institute of Translational Medicine, Zhuhai People's Hospital (Zhuhai Clinical Medical College of Jinan University), Jinan University, Zhuhai, 519000, China
| | - Yuanjia Tang
- Shanghai Institute of Rheumatology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200001, China
| | - Qingwen Wang
- Department of Rheumatism and Immunology, Peking University Shenzhen Hospital, Shenzhen, 518036, China
| | - Jing Zhao
- Department of Rheumatology and Immunology, Peking University People's Hospital and Beijing Key Laboratory for Rheumatism Mechanism and Immune Diagnosis (BZ0135), Beijing, 100034, China
| | - Zixing Zhou
- Department of Epidemiology, School of Medicine, Jinan University, Guangzhou, 510632, China
| | - Zihao Wen
- Department of Epidemiology, School of Medicine, Jinan University, Guangzhou, 510632, China
| | - Xiaojing Chen
- Department of Epidemiology, School of Medicine, Jinan University, Guangzhou, 510632, China
| | - Qinglin Peng
- Department of Rheumatology, Beijing Key Lab for Immune-Mediated Inflammatory Diseases, China-Japan Friendship Hospital, Beijing, 100029, China
| | - Guochun Wang
- Department of Rheumatology, Beijing Key Lab for Immune-Mediated Inflammatory Diseases, China-Japan Friendship Hospital, Beijing, 100029, China
| | - Pingjing Zhang
- Shanghai Institute of Rheumatology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200001, China
| | - Erwei Sun
- Department of Rheumatology and Immunology, The Third Affiliated Hospital, Southern Medical University, Guangzhou, 510630, China
- Institute of Clinical Immunology, Academy of Orthopedics Guangdong Province, Guangzhou, 510630, China
| | - Nan Shen
- Shanghai Institute of Rheumatology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200001, China
| | - Weiguo Xu
- Guangdong Provincial Key Laboratory of Tumor Interventional Diagnosis and Treatment, Zhuhai Institute of Translational Medicine, Zhuhai People's Hospital (Zhuhai Clinical Medical College of Jinan University), Jinan University, Zhuhai, 519000, China.
| | - Zhanguo Li
- Department of Rheumatology and Immunology, Peking University People's Hospital and Beijing Key Laboratory for Rheumatism Mechanism and Immune Diagnosis (BZ0135), Beijing, 100034, China
| | - Hengwen Yang
- Guangdong Provincial Key Laboratory of Tumor Interventional Diagnosis and Treatment, Zhuhai Institute of Translational Medicine, Zhuhai People's Hospital (Zhuhai Clinical Medical College of Jinan University), Jinan University, Zhuhai, 519000, China.
| | - Zhinan Yin
- Guangdong Provincial Key Laboratory of Tumor Interventional Diagnosis and Treatment, Zhuhai Institute of Translational Medicine, Zhuhai People's Hospital (Zhuhai Clinical Medical College of Jinan University), Jinan University, Zhuhai, 519000, China.
- Department of Basic Medical Research, The Sixth Affiliated Hospital of Guangzhou Medical University, Qingyuan People's Hospital, Qingyuan, 511518, China.
| |
Collapse
|
3
|
Zhou L, Zhu Y, Jiang M, Su J, Liu X, Jiang Y, Mu H, Yin J, Yang L, Liu H, Pan W, Su M, Liu H. Pregnancy-associated thrombotic thrombocytopenic purpura complicated by Sjögren's syndrome and non-neutralising antibodies to ADAMTS13: a case report. BMC Pregnancy Childbirth 2021; 21:804. [PMID: 34861845 PMCID: PMC8641216 DOI: 10.1186/s12884-021-04167-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 09/30/2021] [Indexed: 12/17/2022] Open
Abstract
Background Thrombotic thrombocytopenic purpura (TTP) is a severe and life-threatening disease. Given its heterogeneous clinical presentation, the phenotype of TTP during pregnancy and its management have not been well documented. Case presentation We report here a 25-year-old woman, G1P0 at 36 weeks gestation, who developed severe thrombocytopenia and anemia. She was performed an emergent caesarean section 1 day after admission because of multiple organ failure. As ADAMTS 13 enzyme activity of the patient was 0% and antibodies were identified by enzyme-linked immunosorbent assay, she was diagnosed as acquired thrombotic thrombocytopenic purpura (aTTP). Furthermore, asymptomatic primary Sjögren’s syndrome was incidentally diagnosed on screening. After treatment with rituximab in addition to PEX and steroids, the activity of the ADAMTS 13 enzyme increased significantly from 0 to 100%. Conclusions To the best of our knowledge, this is the first case report of concomitant TTP and asymptomatic Sjögren’s syndrome in a pregnant woman. It highlights the association between pregnancy, autoimmune disease, and TTP. It also emphasizes the importance of an enzyme-linked immunosorbent assay in the diagnosis and rituximab in the treatment of patients with acquired TTP. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-021-04167-9.
Collapse
Affiliation(s)
- Lu Zhou
- Hematology department, Affiliated Hospital of Nantong University, No 20 Xisi Road, Nantong, 226001, Jiangsu, China
| | - Yu Zhu
- Obstetrics and Gynecology Department, Affiliated Hospital of Nantong University, No 20 Xisi Road, Nantong, 226001, Jiangsu, China
| | - Miao Jiang
- Key Laboratory of Thrombosis & Hemostasis of Ministry of Health, Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Jian Su
- Key Laboratory of Thrombosis & Hemostasis of Ministry of Health, Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Xiaofan Liu
- State Key Laboratory of Experimental Hematology, Key Laboratory of Gene Therapy of Blood Diseases, Institute of Hematology and Blood Disease Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
| | - Yizhi Jiang
- Hematology department, The First Affiliated Hospital of Wannan Medical College, Wuhu, China
| | - Hui Mu
- Hematology department, Affiliated Hospital of Nantong University, No 20 Xisi Road, Nantong, 226001, Jiangsu, China
| | - Jie Yin
- Key Laboratory of Thrombosis & Hemostasis of Ministry of Health, Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Li Yang
- Hematology department, Affiliated Hospital of Nantong University, No 20 Xisi Road, Nantong, 226001, Jiangsu, China
| | - Haiyan Liu
- Hematology department, Affiliated Hospital of Nantong University, No 20 Xisi Road, Nantong, 226001, Jiangsu, China
| | - Weidong Pan
- Obstetrics and Gynecology Department, Affiliated Hospital of Nantong University, No 20 Xisi Road, Nantong, 226001, Jiangsu, China
| | - Min Su
- Obstetrics and Gynecology Department, Affiliated Hospital of Nantong University, No 20 Xisi Road, Nantong, 226001, Jiangsu, China.
| | - Hong Liu
- Hematology department, Affiliated Hospital of Nantong University, No 20 Xisi Road, Nantong, 226001, Jiangsu, China
| |
Collapse
|
4
|
Martis N, Jamme M, Bagnis-Isnard C, Pouteil-Noble C, Presne C, Vigneau C, Grangé S, Burtey S, Coindre JP, Wynckel A, Hamidou MA, Kanouni T, Azoulay E, Hié M, Chauveau D, Veyradier A, Rondeau E, Coppo P. Systemic autoimmune disorders associated with thrombotic microangiopathy: A cross-sectional analysis from the French National TMA registry: Systemic autoimmune disease-associated TMA. Eur J Intern Med 2021; 93:78-86. [PMID: 34175183 DOI: 10.1016/j.ejim.2021.05.040] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 05/16/2021] [Accepted: 05/28/2021] [Indexed: 12/30/2022]
Abstract
CONTEXT The management of systemic auto-immune diseases (SAID) -associated thrombotic microangiopathies (TMA) [SAID-TMA] remains debated. OBJECTIVES To provide a demographic, clinical and therapeutic picture of SAID-TMA. METHODS A cross-sectional analysis was conducted on adult patients presenting with SAID and TMA from the French National TMA Registry over a 20-year period. Clinical features were extracted and compared to those from a historical cohort of atypical haemolytic and uremic syndrome (aHUS) patients. RESULTS Forty-one patients with SAID-TMA were compared to 78 patients with aHUS from a historical cohort. Connective tissue diseases (CTD) were systemic lupus erythematosus (n=18), primary Sjögren's syndrome (n=7), systemic sclerosis (n=11), mixed CTD (n=2) and 2 cases of vasculitides, including 7 overlapping forms and 8 cases of primary antiphospholipid syndromes (APLS). Patients with SAID-TMA generally had pre-existing chronic kidney failure (OR= 3.17, 95%CI: 1.204 to 7.923; p= 0.016) compared to aHUS patients, though creatinine levels were significantly lower (216 [IQR, 108-334] µmol/L vs. 368 [IQR, 170-722] µmol/L; p= 0.002). Patients were less likely to recover if renal replacement therapy was needed at onset (OR= 0.07; 0.02 to 0.34; p <0.0005). Two patients died. Thirty patients responded to immunosuppressive treatment and complete remission was achieved in 25 cases. By contrast, therapeutic plasma exchange (TPE) did not have an early effect on TMA features at Day-7 nor Day-15 (p >0.05). CONCLUSION The management of SAID-TMA implies an early initiation of immunosuppressive drugs for flares of the associated SAID, whereas TPE seem ineffective. KEY MESSAGES.
Collapse
Affiliation(s)
- Nihal Martis
- Internal Medicine Department, University Hospital of Nice; Côte d'Azur University, Nice, France; French Reference Centre for Thrombotic Microangiopathies, Saint-Antoine Hospital, Paris, France.
| | - Matthieu Jamme
- French Reference Centre for Thrombotic Microangiopathies, Saint-Antoine Hospital, Paris, France; Nephrology Department, C.H. Intercommunal Poissy/Saint-Germain-en-Laye, Poissy, France
| | | | - Claire Pouteil-Noble
- French Reference Centre for Thrombotic Microangiopathies, Saint-Antoine Hospital, Paris, France; Nephrology Department, Édouard Herriot Hospital, Lyon, France
| | - Claire Presne
- French Reference Centre for Thrombotic Microangiopathies, Saint-Antoine Hospital, Paris, France; Nephrology Department, Hôpital Sud, Amiens, France
| | - Cécile Vigneau
- French Reference Centre for Thrombotic Microangiopathies, Saint-Antoine Hospital, Paris, France; University of Rennes, University Hospital of Rennes - Inserm, EHESP, Institut de recherche en santé, Environnement et Travail - UMR_S 1085, F-35000 Rennes, France
| | - Steven Grangé
- French Reference Centre for Thrombotic Microangiopathies, Saint-Antoine Hospital, Paris, France; Intensive Care Unit, C.H.U Rouen, Rouen, France
| | - Stéphane Burtey
- Nephrology Department, C.H.U. de la Conception, Marseille, France
| | | | - Alain Wynckel
- French Reference Centre for Thrombotic Microangiopathies, Saint-Antoine Hospital, Paris, France; Nephrology Department, Hôpital Maison Blanche, Reims Cedex, France
| | - Mohamed A Hamidou
- French Reference Centre for Thrombotic Microangiopathies, Saint-Antoine Hospital, Paris, France; Internal Medicine Department, Hôtel Dieu Hospital, Nantes, France
| | - Tarik Kanouni
- French Reference Centre for Thrombotic Microangiopathies, Saint-Antoine Hospital, Paris, France; Therapeutic Apheresis Department, C.H.U de Montpellier, Montpellier, France
| | - Elie Azoulay
- French Reference Centre for Thrombotic Microangiopathies, Saint-Antoine Hospital, Paris, France; Medical Intensive Care Unit, Saint-Louis Hospital, Paris, France
| | - Miguel Hié
- French Reference Centre for Thrombotic Microangiopathies, Saint-Antoine Hospital, Paris, France; Internal Medicine Department, Pitié-Salpêtrière Hospital, Paris, France
| | - Dominique Chauveau
- French Reference Centre for Thrombotic Microangiopathies, Saint-Antoine Hospital, Paris, France; Nephrology and Kidney transplant Unit, Rangueil Hospital, Toulouse, France
| | - Agnès Veyradier
- French Reference Centre for Thrombotic Microangiopathies, Saint-Antoine Hospital, Paris, France; Haemostasis Department, Lariboisière Hospital, Paris, France
| | - Eric Rondeau
- French Reference Centre for Thrombotic Microangiopathies, Saint-Antoine Hospital, Paris, France; Nephrology and Kidney transplant Unit, Tenon Hospital, Paris, France
| | - Paul Coppo
- French Reference Centre for Thrombotic Microangiopathies, Saint-Antoine Hospital, Paris, France; Haematology Department, Saint-Antoine Hospital, Paris, France; Sorbonne University, Paris, France.
| |
Collapse
|
5
|
Carvalho JF, Shoenfeld Y. Sjögren's Syndrome Associated With Thrombotic Thrombocytopenic Purpura: A Case-Based Review. Rheumatol Ther 2021; 8:621-629. [PMID: 33315186 PMCID: PMC7991010 DOI: 10.1007/s40744-020-00265-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 11/26/2020] [Indexed: 11/01/2022] Open
Abstract
OBJECTIVE To review all published cases of the rare association between thrombotic thrombocytopenic purpura (TTP) and Sjögren's syndrome (SS). The authors report an additional case of this unique association. METHODS Systematic review of the literature and a case report. The database were articles published in PubMed/MEDLINE, Web of Science, LILACS, and SciELO, registered from 1966 to August 2020. The DESH terms were "Sjögren's syndrome" and "thrombotic thrombocytopenic purpura," without language limitation. RESULTS Most patients were female (88%), and the age varied from 30 to 75 years old. Concerning the sequence of disease appearance, SS followed by TTP was seen in seven articles, TTP and SS in three, and simultaneous appearance of both diseases in three studies. Primary SS was observed in 16 patients, and secondary SS was detected in two cases: dermatomyositis and rheumatoid arthritis. Anemia was the most common TTP manifestation, followed by thrombocytopenia, fever, consciousness alteration, renal impairment, and schistocytes' appearance on a blood smear. Treatment involved plasmapheresis, plasma exchange, rituximab, glucocorticoid, and cyclophosphamide. A good outcome was noted in most studies; few patients died. CONCLUSIONS TTP is a rare manifestation associated with SS. After the TTP diagnosis, plasmapheresis and/or plasma exchange should be immediately implemented.
Collapse
Affiliation(s)
- Jozélio F Carvalho
- Institute for Health Sciences from Federal University of Bahia, Salvador, Bahia, Brazil.
| | - Yehuda Shoenfeld
- Chaim Sheba Medical Center The Zabludowicz Center for Autoimmune Diseases, Tel Hashomer, Israel
- I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Saint Petersburg, Russia
| |
Collapse
|
6
|
Parisis D, Chivasso C, Perret J, Soyfoo MS, Delporte C. Current State of Knowledge on Primary Sjögren's Syndrome, an Autoimmune Exocrinopathy. J Clin Med 2020; 9:E2299. [PMID: 32698400 PMCID: PMC7408693 DOI: 10.3390/jcm9072299] [Citation(s) in RCA: 85] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 07/15/2020] [Accepted: 07/16/2020] [Indexed: 12/13/2022] Open
Abstract
Primary Sjögren's syndrome (pSS) is a chronic systemic autoimmune rheumatic disease characterized by lymphoplasmacytic infiltration of the salivary and lacrimal glands, whereby sicca syndrome and/or systemic manifestations are the clinical hallmarks, associated with a particular autoantibody profile. pSS is the most frequent connective tissue disease after rheumatoid arthritis, affecting 0.3-3% of the population. Women are more prone to develop pSS than men, with a sex ratio of 9:1. Considered in the past as innocent collateral passive victims of autoimmunity, the epithelial cells of the salivary glands are now known to play an active role in the pathogenesis of the disease. The aetiology of the "autoimmune epithelitis" still remains unknown, but certainly involves genetic, environmental and hormonal factors. Later during the disease evolution, the subsequent chronic activation of B cells can lead to the development of systemic manifestations or non-Hodgkin's lymphoma. The aim of the present comprehensive review is to provide the current state of knowledge on pSS. The review addresses the clinical manifestations and complications of the disease, the diagnostic workup, the pathogenic mechanisms and the therapeutic approaches.
Collapse
Affiliation(s)
- Dorian Parisis
- Laboratory of Pathophysiological and Nutritional Biochemistry, Université Libre de Bruxelles, 1070 Brussels, Belgium; (D.P.); (C.C.); (J.P.)
- Department of Rheumatology, Erasme Hospital, Université Libre de Bruxelles, 1070 Brussels, Belgium;
| | - Clara Chivasso
- Laboratory of Pathophysiological and Nutritional Biochemistry, Université Libre de Bruxelles, 1070 Brussels, Belgium; (D.P.); (C.C.); (J.P.)
| | - Jason Perret
- Laboratory of Pathophysiological and Nutritional Biochemistry, Université Libre de Bruxelles, 1070 Brussels, Belgium; (D.P.); (C.C.); (J.P.)
| | | | - Christine Delporte
- Laboratory of Pathophysiological and Nutritional Biochemistry, Université Libre de Bruxelles, 1070 Brussels, Belgium; (D.P.); (C.C.); (J.P.)
| |
Collapse
|
7
|
Okumura T, Hashimoto K, Aomura D, Kurasawa Y, Hara Y, Fujii K, Masuda T, Sonoda K, Yamaguchi A, Ogawa Y, Kamijo Y. Thrombotic Thrombocytopenic Purpura Treated with Rituximab Associated with Primary Sjögren's Syndrome and Primary Hypothyroidism. Intern Med 2020; 59:715-719. [PMID: 31708547 PMCID: PMC7086329 DOI: 10.2169/internalmedicine.3722-19] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
A 47-year-old man was admitted to our hospital because of thrombocytopenia and consciousness disturbance. As his laboratory data showed undetectable activity of a disintegrin-like and metalloproteinase with thrombospondin type 1 motifs 13 (ADAMTS13) and the presence of ADAMTS13 inhibitor, he was diagnosed with acquired thrombotic thrombocytopenic purpura (TTP). Asymptomatic primary Sjögren's syndrome (SS) and primary hypothyroidism were incidentally diagnosed on screening. After initial plasma exchange therapy and pulse corticosteroid therapy, the patient received rituximab therapy for refractory TTP with "inhibitor boosting" and recovered. TTP secondary to primary SS is rare but can trigger refractory TTP. Treatment with rituximab, which is considered "inhibitor boosting," should be considered when re-exacerbation occurs.
Collapse
Affiliation(s)
- Taiki Okumura
- Department of Nephrology, Shinshu University School of Medicine, Japan
| | - Koji Hashimoto
- Department of Nephrology, Shinshu University School of Medicine, Japan
| | - Daiki Aomura
- Department of Nephrology, Shinshu University School of Medicine, Japan
| | - Yukihumi Kurasawa
- Department of Nephrology, Shinshu University School of Medicine, Japan
| | - Yuuta Hara
- Department of Nephrology, Shinshu University School of Medicine, Japan
| | - Kazuaki Fujii
- Department of Nephrology, Shinshu University School of Medicine, Japan
| | - Tomoe Masuda
- Department of Nephrology, Shinshu University School of Medicine, Japan
| | - Kosuke Sonoda
- Department of Nephrology, Shinshu University School of Medicine, Japan
| | - Akinori Yamaguchi
- Department of Nephrology, Shinshu University School of Medicine, Japan
| | - Yohei Ogawa
- Department of Nephrology, Shinshu University School of Medicine, Japan
| | - Yuji Kamijo
- Department of Nephrology, Shinshu University School of Medicine, Japan
| |
Collapse
|
8
|
Gan L, Chen H, Sun JF. Recurrent purpura: A clue to Sjögren's syndrome. Indian J Dermatol Venereol Leprol 2019; 86:335. [PMID: 31736466 DOI: 10.4103/ijdvl.ijdvl_7_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Lu Gan
- Department of Pathology, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, China
| | - Hao Chen
- Department of Pathology, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, China
| | - Jian-Fang Sun
- Department of Pathology, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, China
| |
Collapse
|
9
|
Sun R, Gu W, Ma Y, Wang J, Wu M. Relapsed/refractory acquired thrombotic thrombocytopenic purpura in a patient with Sjögren syndrome: Case report and review of the literature. Medicine (Baltimore) 2018; 97:e12989. [PMID: 30412131 PMCID: PMC6221612 DOI: 10.1097/md.0000000000012989] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
RATIONALE Thrombotic thrombocytopenic purpura (TTP) is a rare, fatal disorder which could be caused by autoimmune diseases. However, TTP secondary to Sjögren syndrome (SS) is extremely rare. PATIENT CONCERNS A 47-year- old woman with an 8-year history of SS was admitted due to skin ecchymosis and bleeding gums. Then she gradually developed fever and headache. DIAGNOSES Laboratory investigations suggested anemia, thrombocytopenia, increased lactic dehydrogenase, and a disintegrin-like metalloproteinase with thrombospondin motif type 1 member 13 (ADAMTS13) activity deficiency with high inhibitor titers. Acquired TTP was thus diagnosed. INTERVENTIONS Plasma exchange (PE) was the first choice for treatment, while glucocorticoid, cyclosporine A (CSA), rituximab, and intravenous immunoglobulin (IVIG) were used simultaneously. Bortezomib, a selective proteasome inhibitor and thereby inducing apoptosis in both B-cells and plasma cells, was added. OUTCOMES She was discharged from the hospital and then treated with prednisone of 40 mg/d and hydroxychloroquine. The patient remained in full remission. LESSONS We conclude that bortezomib should be considered for patients with TTP refractory to PE, steroids, and rituximab due to its efficacy and relatively favorable side effect profile.
Collapse
Affiliation(s)
- Rurong Sun
- Department of Immunology and Rheumatology
| | - Weiying Gu
- Department of Hematology, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | | | - Jing Wang
- Department of Immunology and Rheumatology
| | - Min Wu
- Department of Immunology and Rheumatology
| |
Collapse
|