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Rao S, Khan A, Sampat P, Sandhu M, Weinberg AM. An Uncommon Incidence of Pulmonary Hypertension Associated With Neurofibromatosis Type 1: A Case Report. J Investig Med High Impact Case Rep 2021; 9:23247096211032821. [PMID: 34269074 PMCID: PMC8287350 DOI: 10.1177/23247096211032821] [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] [Indexed: 11/16/2022] Open
Abstract
Pulmonary hypertension (PH) is often a difficult condition to diagnose, since it occurs
insidiously and is a diagnosis of exclusion. Patients with neurofibromatosis type 1 (NFT1)
have been associated with severe exacerbations of PH. To our knowledge, less than 20 cases
of PH in NFT1 patients have been reported. However, the severity of presenting symptoms
requires physicians to be aware of this association and pursue the appropriate diagnostic
workup. In our report, we present a 54-year-old NFT1 patient who presented with worsening
dyspnea secondary to PH, which was being treated with trepostanil and macitetan. She
required a right heart catheterization to assess her pulmonary artery pressures (which
remained elevated). She was placed on tadalafil in addition to trepostanil and macitetan
and noted significant resolution of her symptoms. Further studies are required to explore
the association between PH and NFT1 and examine the efficacy of triple therapy with
endothelin receptor antagonists, phosphodiesterase 5 inhibitors, and parenteral
prostanoids in the initial treatment of PH in the aforementioned patient population.
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Affiliation(s)
- Suman Rao
- SUNY Upstate Medical University, Syracuse, NY, USA
| | - Alisha Khan
- SUNY Upstate Medical University, Syracuse, NY, USA
| | - Parth Sampat
- SUNY Upstate Medical University, Syracuse, NY, USA
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Al-Qadi M, LeVarge B, Ford HJ. Epidemiology, Pathogenesis, and Clinical Approach in Group 5 Pulmonary Hypertension. Front Med (Lausanne) 2021; 7:616720. [PMID: 33842491 PMCID: PMC8026868 DOI: 10.3389/fmed.2020.616720] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 12/17/2020] [Indexed: 01/19/2023] Open
Abstract
Pulmonary hypertension (PH) is recognized to be associated with a number of comorbid conditions. Based on these associations, PH is classified into 5 groups, considering common pathophysiologic drivers of disease, histopathologic features, clinical manifestations and course, and response to PH therapy. However, in some of these associated conditions, these characteristics are less well-understood. These include, among others, conditions commonly encountered in clinical practice such as sarcoidosis, sickle cell disease, myeloproliferative disorders, and chronic kidney disease/end stage renal disease. PH in these contexts presents a significant challenge to clinicians with respect to disease management. The most recent updated clinical classification schemata from the 6th World Symposium on PH classifies such entities in Group 5, highlighting the often unclear and/or multifactorial nature of PH. An in-depth review of the state of the science of Group 5 PH with respect to epidemiology, pathogenesis, and management is provided. Where applicable, future directions with respect to research needed to enhance understanding of the clinical course of these entities is also discussed.
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Affiliation(s)
- Mazen Al-Qadi
- Division of Pulmonary and Critical Care Medicine, Pulmonary Hypertension Program, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Barbara LeVarge
- Division of Pulmonary and Critical Care Medicine, Pulmonary Hypertension Program, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - H James Ford
- Division of Pulmonary and Critical Care Medicine, Pulmonary Hypertension Program, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
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Alves Júnior SF, Zanetti G, Alves de Melo AS, Souza AS, Souza LS, de Souza Portes Meirelles G, Irion KL, Hochhegger B, Marchiori E. Neurofibromatosis type 1: State-of-the-art review with emphasis on pulmonary involvement. Respir Med 2019; 149:9-15. [PMID: 30885426 DOI: 10.1016/j.rmed.2019.01.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2018] [Revised: 01/04/2019] [Accepted: 01/11/2019] [Indexed: 12/16/2022]
Abstract
Neurofibromatosis type 1 (NF-1), also known as von Recklinghausen's disease, is an autosomal dominant dysplasia of the ectoderm and mesoderm with a variable clinical expression, but near-complete penetrance before the age of 5 years. The estimated incidence is 1 in 3000 births. NF-1 is characterized by collections of neurofibromas, café-au-lait spots, axillary and inguinal freckling, and pigmented hamartomas in the iris (Lisch nodules). Pulmonary manifestations of NF-1, which usually include bilateral basal reticulations and apical bullae and cysts, are reported in 10-20% of adult patients. Clinically, neurofibromatosis-associated diffuse lung disease (NF-DLD) usually presents with nonspecific respiratory symptoms, including dyspnea on exertion, shortness of breath, and chronic cough or chest pain, at the time of diagnosis. Computed tomography (CT) is highly accurate for the identification and characterization of NF-DLD; it is the most reliable method for the diagnosis of this lung involvement. Various CT findings of NF-DLD, including cysts, bullae, ground-glass opacities, bibasilar reticular opacities, and emphysema, have been described in patients with NF-1. The typical CT pattern, however, is characterized by upper-lobe cystic and bullous disease, and basilar interstitial lung disease. Currently, the goal of NF-DLD treatment is the earliest possible diagnosis, focusing on symptom relief and interventions that positively alter the course of the disease, such as smoking cessation. The aim of this review is to describe the main clinical, pathological, and imaging aspects of NF-1, with a focus on pulmonary involvement.
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Affiliation(s)
| | - Gláucia Zanetti
- Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.
| | | | - Arthur Soares Souza
- Faculdade de Medicina de São José do Rio Preto (Famerp) and Ultra X, São José do Rio Preto, SP, Brazil.
| | - Luciana Soares Souza
- Faculdade de Medicina de São José do Rio Preto (Famerp) and Ultra X, São José do Rio Preto, SP, Brazil.
| | | | | | - Bruno Hochhegger
- Santa Casa de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil.
| | - Edson Marchiori
- Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.
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Jutant EM, Girerd B, Jaïs X, Savale L, O'Connell C, Perros F, Sitbon O, Humbert M, Montani D. Pulmonary hypertension associated with neurofibromatosis type 1. Eur Respir Rev 2018; 27:27/149/180053. [PMID: 30158278 PMCID: PMC9488681 DOI: 10.1183/16000617.0053-2018] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2018] [Accepted: 07/28/2018] [Indexed: 12/11/2022] Open
Abstract
Neurofibromatosis type 1 (NF1), also known as von Recklinghausen disease, is a frequent autosomal dominant genetic disorder with a prevalence of 1 in 3000. Pulmonary hypertension (PH) associated with NF1 (PH-NF1) is a rare but severe complication of NF1 and is classified as Group 5 PH, defined as “PH with unclear and/or multifactorial mechanisms”. A literature review in PubMed on the association between NF1 and PH identified 18 articles describing 31 cases. PH-NF1 was characterised by a female predominance, an advanced age at diagnosis, an association with parenchymal lung disease in two out of three cases and poor long-term prognosis. NF1 is generally associated with interstitial lung disease but some cases of severe PH without parenchymal lung disease suggest that there could be a specific pulmonary vascular disease. There is no data available on the efficacy of specific pulmonary arterial hypertension treatment in PH-NF1. Therefore, these patients should be evaluated in expert PH centres and referred for lung transplantation at an early stage. As these patients have an increased risk of malignancy, careful assessment of the post-transplant malignancy risk prior to listing for transplantation is necessary. Clinical trials are needed to evaluate promising treatments targeting the RAS-downstream signalling pathways. Pulmonary hypertension is a rare but severe complication of neurofibromatosis type 1. There are no data about the efficacy of specific PAH treatment in this disease and lung transplantation should be discussed at an early stage.http://ow.ly/JMU030lezfY
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Affiliation(s)
- Etienne-Marie Jutant
- Université Paris-Sud, Faculté de Médecine, Paris, France.,AP-HP, Centre de Référence de l'Hypertension Pulmonaire Sévère, Dépt Hospitalo-Universitaire (DHU) Thorax Innovation (TORINO), Service de Pneumologie, Hôpital de Bicêtre, Paris, France.,UMR_S 999, Univ. Paris-Sud, INSERM, Laboratoire d'Excellence (LabEx) en Recherche sur le Médicament et l'Innovation Thérapeutique (LERMIT), Hôpital Marie-Lannelongue, Paris, France
| | - Barbara Girerd
- Université Paris-Sud, Faculté de Médecine, Paris, France.,AP-HP, Centre de Référence de l'Hypertension Pulmonaire Sévère, Dépt Hospitalo-Universitaire (DHU) Thorax Innovation (TORINO), Service de Pneumologie, Hôpital de Bicêtre, Paris, France.,UMR_S 999, Univ. Paris-Sud, INSERM, Laboratoire d'Excellence (LabEx) en Recherche sur le Médicament et l'Innovation Thérapeutique (LERMIT), Hôpital Marie-Lannelongue, Paris, France
| | - Xavier Jaïs
- Université Paris-Sud, Faculté de Médecine, Paris, France.,AP-HP, Centre de Référence de l'Hypertension Pulmonaire Sévère, Dépt Hospitalo-Universitaire (DHU) Thorax Innovation (TORINO), Service de Pneumologie, Hôpital de Bicêtre, Paris, France.,UMR_S 999, Univ. Paris-Sud, INSERM, Laboratoire d'Excellence (LabEx) en Recherche sur le Médicament et l'Innovation Thérapeutique (LERMIT), Hôpital Marie-Lannelongue, Paris, France
| | - Laurent Savale
- Université Paris-Sud, Faculté de Médecine, Paris, France.,AP-HP, Centre de Référence de l'Hypertension Pulmonaire Sévère, Dépt Hospitalo-Universitaire (DHU) Thorax Innovation (TORINO), Service de Pneumologie, Hôpital de Bicêtre, Paris, France.,UMR_S 999, Univ. Paris-Sud, INSERM, Laboratoire d'Excellence (LabEx) en Recherche sur le Médicament et l'Innovation Thérapeutique (LERMIT), Hôpital Marie-Lannelongue, Paris, France
| | - Caroline O'Connell
- Service de Chirurgie Thoracique, Vasculaire et Transplantation Pulmonaire, Hôpital Marie-Lannelongue, Paris, France
| | - Frederic Perros
- Université Paris-Sud, Faculté de Médecine, Paris, France.,UMR_S 999, Univ. Paris-Sud, INSERM, Laboratoire d'Excellence (LabEx) en Recherche sur le Médicament et l'Innovation Thérapeutique (LERMIT), Hôpital Marie-Lannelongue, Paris, France
| | - Olivier Sitbon
- Université Paris-Sud, Faculté de Médecine, Paris, France.,AP-HP, Centre de Référence de l'Hypertension Pulmonaire Sévère, Dépt Hospitalo-Universitaire (DHU) Thorax Innovation (TORINO), Service de Pneumologie, Hôpital de Bicêtre, Paris, France.,UMR_S 999, Univ. Paris-Sud, INSERM, Laboratoire d'Excellence (LabEx) en Recherche sur le Médicament et l'Innovation Thérapeutique (LERMIT), Hôpital Marie-Lannelongue, Paris, France
| | - Marc Humbert
- Université Paris-Sud, Faculté de Médecine, Paris, France.,AP-HP, Centre de Référence de l'Hypertension Pulmonaire Sévère, Dépt Hospitalo-Universitaire (DHU) Thorax Innovation (TORINO), Service de Pneumologie, Hôpital de Bicêtre, Paris, France.,UMR_S 999, Univ. Paris-Sud, INSERM, Laboratoire d'Excellence (LabEx) en Recherche sur le Médicament et l'Innovation Thérapeutique (LERMIT), Hôpital Marie-Lannelongue, Paris, France
| | - David Montani
- Université Paris-Sud, Faculté de Médecine, Paris, France.,AP-HP, Centre de Référence de l'Hypertension Pulmonaire Sévère, Dépt Hospitalo-Universitaire (DHU) Thorax Innovation (TORINO), Service de Pneumologie, Hôpital de Bicêtre, Paris, France.,UMR_S 999, Univ. Paris-Sud, INSERM, Laboratoire d'Excellence (LabEx) en Recherche sur le Médicament et l'Innovation Thérapeutique (LERMIT), Hôpital Marie-Lannelongue, Paris, France
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