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Konda R, Rajasekaran A, Rizk DV. Antineutrophil cytoplasmic antibody-associated vasculitis. Curr Opin Nephrol Hypertens 2024:00041552-990000000-00167. [PMID: 38785128 DOI: 10.1097/mnh.0000000000001004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
PURPOSE OF REVIEW This review focuses on latest developments in managing antineutrophil cytoplasmic autoantibody (ANCA)-associated vasculitis (AAV), a systemic autoimmune condition characterized by inflammation and necrosis of small blood vessels due to circulating autoantibodies that target neutrophilic granules. RECENT FINDINGS Our understanding of AAV pathogenesis has evolved in the past decades highlighting the central pathogenic roles of autoantibodies and complement activation. In parallel, the appreciation for glucocorticoid toxicity has led the research on crucial steroid-sparing therapeutic alternatives. Complement inhibitors (like avacopan) that have emerged are associated with better preservation of kidney function in AAV patients with severe kidney impairment. The role of plasma-exchange (PLEX) was revisited in updated guidelines that recommended its potential use in the context of diffuse alveolar hemorrhage associated hypoxia and severe kidney involvement, particularly with a serum creatinine level above 3.4 mg/dl. The ANCA Kidney Risk Score risk prediction and Glucocorticoid Toxicity Index score aid in identifying high-risk patients and individualizing management plans. SUMMARY Kidney involvement in AAV requires prompt diagnosis and initiation of immunosuppression to prevent irreversible nephron loss. Newer therapeutic targets are on the horizon and offer hope for personalized treatment strategies.
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Affiliation(s)
- Raghunandan Konda
- Division of Nephrology, Department of Medicine, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Rajasekaran A, Rizk DV. Evolution of Therapy for ANCA-Associated Vasculitis with Kidney Involvement. KIDNEY360 2023; 4:1794-1805. [PMID: 37927005 PMCID: PMC10758519 DOI: 10.34067/kid.0000000000000289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 10/19/2023] [Indexed: 11/07/2023]
Abstract
ANCA-associated vasculitis (AAV) belongs to a group of small vessel systemic vasculitides characterized by granulomatous and neutrophilic inflammation of various tissues. Patients often have circulating autoantibodies targeting neutrophilic antigens. Although AAV was once associated with severe end-organ damage and extremely high mortality rates, the use of glucocorticoids and cyclophosphamide led to a paradigm change in its treatment. Over the past 20 years, significant progress in understanding the immunopathogenesis of AAV has enabled development of targeted immunotherapies, providing a much better prognosis for patients. This review describes the evolution of treatment of AAV, particularly for patients with kidney involvement.
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Affiliation(s)
- Arun Rajasekaran
- Division of Nephrology, Department of Medicine, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
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Oral and Lower Extremity Ulcers as the Initial Presentation of Granulomatosis with Polyangiitis. Case Rep Med 2022; 2022:2737242. [PMID: 36092308 PMCID: PMC9453098 DOI: 10.1155/2022/2737242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 08/23/2022] [Indexed: 11/17/2022] Open
Abstract
Background Granulomatosis with polyangiitis (GPA) is a small vessel vasculitis characterized by lung and kidney involvement. It is typically a disease of white females and has a poor prognosis with the average life expectancy of 5 months for a patient without treatment. Oral and skin ulcers are considered to be rare presentations. Case A 39-year-old black male presented to the hospital with oral and skin ulcers and was diagnosed with GPA based on the biopsies of both cutaneous lesions and kidney. He was started on rituximab with minimal improvement. Later he was admitted to the ICU and had plasmapheresis, and he gradually improved and was discharged home 8 days after admission. Conclusion GPA is an aggressive vascular disorder resulting in possible organ system damage and failure. The role of the sickle cell trait in this patient is undefined, but this combination of gender, race, and presenting symptoms in GPA is extremely unusual.
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Georgesen C, Fox LP, Harp J. Retiform purpura: Workup and therapeutic considerations in select conditions. J Am Acad Dermatol 2020; 82:799-816. [DOI: 10.1016/j.jaad.2019.07.113] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 07/15/2019] [Accepted: 07/28/2019] [Indexed: 02/07/2023]
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Abstract
PURPOSE To report a case of hemiretinal vein occlusion in a patient with Wegener's granulomatosis. RESULTS Retinal vein occlusion may occur in patients with Wegener's granulomatosis even in the absence of active inflammation affecting the retinal venules. CONCLUSIONS Wegener's granulomatosis should be considered in the diagnostic workup of young patients with major retinal vascular occlusion and concurrent history of pulmonary and/or renal disease.
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An Unusual Presentation of Limited Granulomatosis with Polyangiitis Involving Vagina and Urethra. Case Rep Rheumatol 2017; 2017:9407675. [PMID: 28386506 PMCID: PMC5366760 DOI: 10.1155/2017/9407675] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Accepted: 02/07/2017] [Indexed: 12/11/2022] Open
Abstract
Granulomatosis with polyangiitis (GPA) is a systemic necrotizing granulomatosis vasculitis characterized by predilection to affect small- and medium-sized blood vessels and commonly affects the upper and lower respiratory tract and kidneys in most cases. Genital involvement is reported in <1% of cases in large cohorts and nearly all cases have been in the setting of multisystemic disease or during the course of the disease in patients already diagnosed as GPA. A case is presented of uncommon limited urogenital GPA in a 66-year-old woman with an irregular mass occupying urethra and vagina. The patient showed a good response after Corticoids and Methotrexate.
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Stappaerts I, Colpaert C, Verbraecken J, Van Marck E, Vermeire P. Granulomatous Mastitis As Presenting Sign Of Wegener’S Granulomatosis. Acta Clin Belg 2016. [DOI: 10.1080/17843286.1999.11754233] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
| | - C. Colpaert
- Department of Pathology, University Hospital Antwerp (UZA), Wilrijkstraat 10, 2650 Edegem, Belgium
| | | | - E. Van Marck
- Department of Pathology, University Hospital Antwerp (UZA), Wilrijkstraat 10, 2650 Edegem, Belgium
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Swain SK, Sahu MC, Parida JR. Wegener's granulomatosis causing subglottic stenosis: Experiences at a tertiary care hospital of the Eastern India. J Taibah Univ Med Sci 2016. [DOI: 10.1016/j.jtumed.2016.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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10
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Preoperative assessment and classification of benign laryngotracheal stenosis: a consensus paper of the European Laryngological Society. Eur Arch Otorhinolaryngol 2015; 272:2885-96. [DOI: 10.1007/s00405-015-3635-4] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Accepted: 04/19/2015] [Indexed: 12/19/2022]
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Srivastava S, Devlin A, Yan-Naing Winn L, Tez D, Giles M. Wegener's granulomatosis - an unusual case of colonic haemorrhage. QJM 2014; 107:841-3. [PMID: 22351898 DOI: 10.1093/qjmed/hcs026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- S Srivastava
- From the Department of Nephrology, Freeman Hospital, Renal Services Centre, Freeman Hospital, High Heaton, Newcastle Upon Tyne NE7 7DN and James Cook University Hospital NHS Trust, Marton Road, Middlesbrough, TS4 3BW, UK
| | - A Devlin
- From the Department of Nephrology, Freeman Hospital, Renal Services Centre, Freeman Hospital, High Heaton, Newcastle Upon Tyne NE7 7DN and James Cook University Hospital NHS Trust, Marton Road, Middlesbrough, TS4 3BW, UK
| | - L Yan-Naing Winn
- From the Department of Nephrology, Freeman Hospital, Renal Services Centre, Freeman Hospital, High Heaton, Newcastle Upon Tyne NE7 7DN and James Cook University Hospital NHS Trust, Marton Road, Middlesbrough, TS4 3BW, UK
| | - D Tez
- From the Department of Nephrology, Freeman Hospital, Renal Services Centre, Freeman Hospital, High Heaton, Newcastle Upon Tyne NE7 7DN and James Cook University Hospital NHS Trust, Marton Road, Middlesbrough, TS4 3BW, UK
| | - M Giles
- From the Department of Nephrology, Freeman Hospital, Renal Services Centre, Freeman Hospital, High Heaton, Newcastle Upon Tyne NE7 7DN and James Cook University Hospital NHS Trust, Marton Road, Middlesbrough, TS4 3BW, UK
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Pereira Beceiro J, Rodríguez Alonso A, Bonelli Martín C, Pérez Valcárcel J, Mosquera Seoane T, Cuerpo Pérez MÁ. Prostatitis and acute urinary retention as first manifestations of Wegnener's granulomatosis. REUMATOLOGIA CLINICA 2014; 10:409-12. [PMID: 24555967 DOI: 10.1016/j.reuma.2013.08.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2012] [Revised: 08/01/2013] [Accepted: 08/28/2013] [Indexed: 11/17/2022]
Abstract
OBJECTIVES We present a case of prostatitis with acute urinary retention as a rare initial manifestation of Wegener' Granulomatosis. METHODS The case was a 48-year-old male with symptoms of prostatitis over ten days. The patient presented urinary retention, with partial response to antibiotic treatment. High levels of cytoplasmic antineutrophil cytoplasmic antibody and a prostatic biopsy were compatible with Wegener' Granulomatosis. RESULTS After starting treatment with glucocorticoids and cyclophosphamide, a significant improvement to the point of disappearance of symptoms was observed. At 3 months pulmonary and upper airway symptoms began, requiring higher doses of cyclophosphamide to control symptoms. CONCLUSIONS Wegener's Granulomatosis is a multisystem entity whose presentation as prostatitis with urinary retention is rare.
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Affiliation(s)
- Javier Pereira Beceiro
- Servicio de Urología, Complejo Hospitalario Universitario de Ferrol, Ferrol, A Coruña, España.
| | - Andrés Rodríguez Alonso
- Servicio de Urología, Complejo Hospitalario Universitario de Ferrol, Ferrol, A Coruña, España
| | - Carlos Bonelli Martín
- Servicio de Urología, Complejo Hospitalario Universitario de Ferrol, Ferrol, A Coruña, España
| | - Javier Pérez Valcárcel
- Servicio de Anatomía Patológica, Complejo Hospitalario Universitario de Ferrol, Ferrol, A Coruña, España
| | - Teresa Mosquera Seoane
- Servicio de Urología, Complejo Hospitalario Universitario de Ferrol, Ferrol, A Coruña, España
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Hughes J, Barkhoudarian G, Ciarlini P, Laws ER, Mody E, Inzucchi SE, Woodmansee WW. Refractory pituitary granulomatosis with polyangiitis (Wegener's) treated with rituximab. Endocr Pract 2013. [PMID: 23186961 DOI: 10.4158/ep12181.cr] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Granulomatosis with polyangiitis (GPA), also known as Wegener's granulomatosis, is an autoimmune disease characterized by inflammation of blood vessels most often seen in the upper respiratory tract, lungs, kidneys, and skin. Central nervous system (CNS) involvement of GPA is rare, particularly in the pituitary, and can be difficult to treat. METHODS Case report. RESULTS We present a 30-year-old woman with pituitary and ocular GPA, whose unusually recalcitrant disease led to the development of pan-hypopituitarism and near-total vision loss. After failing multiple systemic immunosuppressants, she was ultimately treated with the novel immunomodulatory agent rituximab together with pulse corticosteroids, which achieved a gratifying response. CONCLUSION Pituitary and optic chiasm involvement is a rare complication of GPA. We believe this case illustrates the complexity of management of pituitary GPA and provides insight into the potential utility of the biologic agent rituximab in this disease.
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Affiliation(s)
- Jing Hughes
- Section of Endocrinology and Metabolism, Yale University School of Medicine, New Haven, CT 06519, USA.
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14
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Unusual large tongue ulcer. Oral Surg Oral Med Oral Pathol Oral Radiol 2013; 116:4-8. [PMID: 23768874 DOI: 10.1016/j.oooo.2012.01.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2011] [Revised: 12/18/2011] [Accepted: 01/24/2012] [Indexed: 10/28/2022]
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Tourin O, de la Torre Carazo S, Smith DR, Fischer A. Pulmonary vasculitis as the first manifestation of rheumatoid arthritis. Respir Med Case Rep 2013; 8:40-2. [PMID: 26029614 PMCID: PMC3920422 DOI: 10.1016/j.rmcr.2013.01.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2012] [Revised: 01/03/2013] [Accepted: 01/07/2013] [Indexed: 11/16/2022] Open
Abstract
In this report, we describe a 61-year-old man that presented with isolated pulmonary vasculitis and a positive anti-cyclic citrullinated peptide (CCP) antibody. Within a few months, the patient developed the symmetric polyarthritis consistent with rheumatoid arthritis (RA). Because the anti-CCP antibody is highly specific for RA and vasculitis is a known association of RA, we suspect the pulmonary vasculitis in this patient was the first manifestation of underlying RA. This case extends on previous reports that have shown that lung disease may predate the development of articular RA and that anti-CCP positivity and lung disease may represent a pre-RA phenotype. To our knowledge, this is the first case report of pulmonary vasculitis as the first manifestation of RA.
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Affiliation(s)
- Olga Tourin
- Peak Pulmonary Consulting Inc., Calgary, Alberta, Canada
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Waller R, Ahmed A, Patel I, Luqmani R. Update on the classification of vasculitis. Best Pract Res Clin Rheumatol 2013; 27:3-17. [DOI: 10.1016/j.berh.2012.12.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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17
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Sugiyama K, Sada KE, Kurosawa M, Wada J, Makino H. Current status of the treatment of microscopic polyangiitis and granulomatosis with polyangiitis in Japan. Clin Exp Nephrol 2013; 17:51-8. [PMID: 22760432 PMCID: PMC3572371 DOI: 10.1007/s10157-012-0651-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2011] [Accepted: 05/28/2012] [Indexed: 01/09/2023]
Abstract
BACKGROUND This study aimed to describe the epidemiologic characteristics of microscopic polyangiitis (MPA) and granulomatosis with polyangiitis (GPA) in Japan. METHODS We used the database of the Ministry of Health, Labour and Welfare (MHLW) from 2006 to 2008, and analyzed data from 938 patients (MPA = 697, GPA = 241) who fulfilled the MHLW diagnostic criteria and had registered within a year after onset. RESULTS The mean ages of the MPA and GPA patients were 69.4 ± 0.4 and 58.4 ± 1.1 years, respectively. Renal (86.9 %), chest (73.7 %), and nervous system (45.2 %) symptoms were common in MPA patients. Ear, nose, and throat (86.7 %), chest (78.0 %), and renal (60.6 %) symptoms were frequently observed in GPA patients. The concomitant use of cyclophosphamide (CY) with corticosteroids was observed in 22.2 % of the MPA patients and 58.5 % of the GPA patients. In multivariate analysis, the concomitant use of CY was associated with a younger age and pulmonary hemorrhage in MPA patients, and the avoidance of CY was associated with nervous system symptoms and rapidly progressive glomerulonephritis in GPA patients. Plasma exchanges were inducted in 5.2 % of the MPA patients and 4.1 % of the GPA patients. The addition of plasma exchange was associated with elevation of the serum creatinine level in patients with both MPA and GPA. CONCLUSION A dominance of MPA and a reduced frequency of renal involvement in GPA patients may be significant features of the Japanese population. Clinical practice relating to MPA and GPA in Japan can be characterized as follows: CY is used less commonly, and plasma exchange is employed for patients with deteriorated renal function.
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Affiliation(s)
- Koichi Sugiyama
- Department of Medicine and Clinical Science, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558 Japan
| | - Ken-ei Sada
- Department of Medicine and Clinical Science, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558 Japan
| | - Michiko Kurosawa
- Department of Epidemiology and Environmental Health, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo Japan
| | - Jun Wada
- Department of Medicine and Clinical Science, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558 Japan
| | - Hirofumi Makino
- Department of Medicine and Clinical Science, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558 Japan
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Abstract
The skin is a common target organ in antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis. Skin lesions may present as the initial manifestation or as the associated cutaneous manifestations in ANCA-associated vasculitis. Visually assessing the cutaneous manifestations and performing a biopsy of skin lesions to facilitate histopathologic confirmation are highly valuable diagnostically. Vasculitis (which affects dermal small vessels and subcutaneous muscular vessels) and nonvasculitic inflammation cause various types of skin lesions. The coexistence of different levels of vasculitis and nonvasculitis can occur in one or in several lesions or on different occasions. These puzzling clinical and histopathologic features may be closely related to the disease activity. Understanding the complicated clinical and histopathologic spectrum of skin lesions will contribute to the early diagnosis of ANCA-associated vasculitis with cutaneous complications.
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Affiliation(s)
- Ko-Ron Chen
- Department of Dermatology, Saiseikai Central Hospital, 1-4-17 Mita, Minato-ku, Tokyo, 108-0073, Japan.
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Bazari H, Guimaraes AR, Kushner YB. Case records of the Massachusetts General Hospital. Case 20-2012. A 77-year-old man with leg edema, hematuria, and acute renal failure. N Engl J Med 2012; 366:2503-15. [PMID: 22738101 DOI: 10.1056/nejmcpc1111577] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Hasan Bazari
- Department of Medicine, Massachusetts General Hospital, Boston, USA
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Chee HK. Wegener's Granulomatosis: Strawberry Gums of the Oral Cavity. PROCEEDINGS OF SINGAPORE HEALTHCARE 2012. [DOI: 10.1177/201010581202100114] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Wegener's Granulomatosis is a rare and potentially life-threatening vasculitic disease of unknown origin. The diagnosis of Wegener's Granulomatosis is made on the basis of clinical presentation, positivity for serum c-ANCA and histologic examination of the lesions. This report details a case of limited Wegener's Granulomatosis with hyperplastic gingivitis lesions presenting as an initial manifestation of Wegener's Granulomatosis. The resemblance of the affected gums to over-ripe strawberries is pathognomonic of this condition and is thus highlighted. Because of the rarity of Wegener's Granulomatosis presenting initially in the oral cavity, clinicians should be alerted to the characteristic appearance of “strawberry gingivitis”.
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Affiliation(s)
- Hoe Kit Chee
- Department of Restorative Dentistry, National Dental Centre Singapore
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Bae KM, Lee WJ, Jeong YJ, Kim YS, Kim HS. A Case of Wegener's Granulomatosis Presenting as a Diplopia. JOURNAL OF RHEUMATIC DISEASES 2012. [DOI: 10.4078/jrd.2012.19.5.270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Kyung-Min Bae
- Department of Internal Medicine, College of Medicine, Chosun University, Gwangju, Korea
| | - Woo Jin Lee
- Department of Internal Medicine, College of Medicine, Chosun University, Gwangju, Korea
| | - Yu-Jin Jeong
- Department of Internal Medicine, College of Medicine, Chosun University, Gwangju, Korea
| | - Yun Sung Kim
- Department of Internal Medicine, College of Medicine, Chosun University, Gwangju, Korea
| | - Hyun-Sook Kim
- Department of Internal Medicine, College of Medicine, Chosun University, Gwangju, Korea
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Affiliation(s)
- Nichole Graves
- Department of Internal Medicine, Baylor University Medical Center, Dallas, Texas, USA.
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Xing X, Zhang T, Wang X. Pediatric Wegener's granulomatosis with oral ulcers and progressive periodontitis: a case report. ACTA ACUST UNITED AC 2011; 112:e1-5. [PMID: 21868265 DOI: 10.1016/j.tripleo.2011.05.030] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2011] [Revised: 05/23/2011] [Accepted: 05/24/2011] [Indexed: 10/17/2022]
Abstract
Wegener's granulomatosis (WG) is a rare multisystem disorder. Although it can occur at any age, it is rarely observed in children. Oral manifestations, which are present in fewer than 10% of patients, include oral ulceration, nonhealing extraction sockets, and the most common oral lesion, hyperplastic gingivitis, which is known as "strawberry gingivitis." We report the unusual case of a 6-year-old boy with WG who presented with atypical oral manifestations, including severe progressive periodontitis accompanied by oral ulcers, before the development of systemic symptoms. Although WG is rare, this case emphasizes the importance of considering the diagnosis in those who present with progressive and atypical oral disease, as prompt treatment of the systemic illness can significantly improve outcome.
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Affiliation(s)
- Xianghui Xing
- School of Stomatology, Fourth Military Medical University, Xi'an, China
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Fasunla JA, Hundt W, Lutz J, Förger F, Thürmel K, Steinbach S. Evaluation of smell and taste in patients with Wegener's granulomatosis. Eur Arch Otorhinolaryngol 2011; 269:179-86. [PMID: 21748655 DOI: 10.1007/s00405-011-1691-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2011] [Accepted: 06/18/2011] [Indexed: 01/22/2023]
Abstract
Although a reduced olfactory/gustatory function affects patients in all parts of life, this problem has not received much attention in Wegener's granulomatosis (WG). The aim of this study was to assess the smell/taste function of WG patients. Demographic data of 16 WG patients (9 males, 7 females) were obtained. They all subjectively assessed their taste/smell function on visual analogue scale. Olfactory/gustatory functions of the patients were tested with 'Sniffin' Sticks and 'Taste' strips, respectively. The results were then compared with those from sex and age-matched control group (n = 16) and normative data. WG patients subjectively assessed their olfactory (p = 0.03) and gustatory (p = 0.02) function to be lower than control group. All the olfactory scores (odour identification, odour discrimination and threshold) in both genders were significantly below the scores in the control group. WG patients were hyposmic. For taste (total taste score, as well as scores for the qualities sweet, sour, salty and bitter), WG patients did not significantly differ from controls and were normogeusic. However, the gustatory scores showed the tendency of reduction as compared to the control group. In conclusion, WG patients truly suffer from olfactory/taste dysfunction, but this is worse with olfaction. It is, therefore, imperative that physicians should make their patients to be aware of these sensory dysfunctions and educate them on methods to cope with it for better quality of life.
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Affiliation(s)
- James A Fasunla
- Department of Otorhinolaryngology, Philipps-University, Baldingerstraße, 35033 Marburg, Germany
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Figueiredo S, Leal LM, Morais A, Magalhães A, Oliveira T, Hespanhol V, Dias C, Fernandes G. [Wegener granulomatosis - otologic, nasal, tracheobronchial and pulmonary involvement]. REVISTA PORTUGUESA DE PNEUMOLOGIA 2009; 15:929-35. [PMID: 19649549 DOI: 10.1016/s0873-2159(15)30187-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Wegener granulomatosis is a rare systemic idiopathic disease characterized by involvement of small vessels - medium and small arteries, venules, arterioles and ocasionally large arteries. This disease has predilection for the upper and lower respiratory tract and the kidney, with granulomatous inflamation and necrosis. Clinical manifestations and organ involvement of the disease vary widely. Early diagnosis and treatment may lead to a full recovery. Without treatment, Wegener's granulomatosis can be fatal. The authors present a case of a 33 year-old female, with severe disease, but with good outcome, after adequate diagnosis and treatment.
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Pápulas necróticas asociadas a hemoptisis y fracaso renal agudo. ACTAS DERMO-SIFILIOGRAFICAS 2009. [DOI: 10.1016/s0001-7310(09)71261-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Santiago D, González-de Arriba A, Aragüés M. Necrotic Papules Associated With Hemoptysis and Acute Renal Failure. ACTAS DERMO-SIFILIOGRAFICAS 2009. [DOI: 10.1016/s1578-2190(09)70090-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Carter LM, Brizman E. Lingual infarction in Wegener's Granulomatosis: a case report and review of the literature. Head Face Med 2008; 4:19. [PMID: 18718013 PMCID: PMC2531096 DOI: 10.1186/1746-160x-4-19] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2007] [Accepted: 08/21/2008] [Indexed: 11/12/2022] Open
Abstract
Wegener's granulomatosis (WG) is a multi-system disease, characterised by the triad of necrotising granulomata affecting the upper and lower respiratory tracts, disseminated vasculitis and glomerulonephritis. Oral lesions are associated with up to 50% of cases, although are rare as a presenting feature. The most common oral lesions associated with WG are ulceration and strawberry gingivitis. We review the literature regarding oral manifestations of WG and present a case of lingual infarction, an extremely rare oral lesion associated with WG, in a severe, rapidly progressive and ultimately fatal form of the disease.
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Affiliation(s)
- Lachlan M Carter
- Maxillofacial Surgery, Leeds Dental Institute, Clarendon Way, Leeds, UK.
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Flores-Suárez LF, Ramírez-Anguiano J, Santillán-Doherty P. Laryngopharyngeal reflux mimicking limited wegener granulomatosis. REUMATOLOGIA CLINICA 2008; 4:123-125. [PMID: 21794514 DOI: 10.1016/s1699-258x(08)71817-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2007] [Accepted: 09/26/2007] [Indexed: 05/31/2023]
Abstract
We present a case of subglottic stenosis (SGS) in a young patient with positive ANCA but a wrong diagnosis of Wegener granulomatosis (WG). Instead, she was diagnosed as having laryngopharyngeal reflux (LPR). Pitfalls of ANCA testing in this scenario, the route to diagnosis of LPR and the contribution of this entity to subglottic stenosis (SGS) in WG are discussed. Caution when interpreting ANCA results is mandatory to avoid improper management.
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Affiliation(s)
- Luis Felipe Flores-Suárez
- Servicio de Inmunología y Reumatología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (INCMNSZ), Mexico City. Mexico
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Wegener’s granulomatosis with massive gastrointestinal hemorrhage due to jejunal and colonic involvement: Report of a case. Surg Today 2008; 38:166-9. [PMID: 18239879 DOI: 10.1007/s00595-007-3574-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2007] [Accepted: 05/01/2007] [Indexed: 02/05/2023]
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Lutt JR, Lim LL, Phal PM, Rosenbaum JT. Orbital Inflammatory Disease. Semin Arthritis Rheum 2008; 37:207-22. [PMID: 17765951 DOI: 10.1016/j.semarthrit.2007.06.003] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2007] [Revised: 06/05/2007] [Accepted: 06/17/2007] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To familiarize rheumatologists and internists with the signs, symptoms, and management of orbital inflammatory disease (OID). METHODS A comprehensive literature review related to OID was performed and reported from the perspectives of rheumatology, ophthalmology, and radiology. RESULTS OID is a general term encompassing inflammatory diseases that affect some or all of the structures contained within the orbit external to the globe. Orbital involvement as a part of the initial symptom complex is not uncommon for systemic diseases such as Graves' disease, Wegener's granulomatosis, and sarcoidosis. The management of these and other causes of OID, such as idiopathic orbital inflammation (formerly known as "orbital pseudotumor"), orbital myositis, and Tolosa-Hunt syndrome frequently involves systemic immunosuppression. Before immunosuppression is considered, however, infectious and malignant causes of inflammation must be ruled out. DISCUSSION Rheumatologists should be familiar with the differential diagnosis of OID and often need to assist colleagues in ophthalmology and internal medicine with the management of this group of diseases.
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Affiliation(s)
- Joseph R Lutt
- Department of Medicine, Oregon Health and Science University, Portland, Oregon, USA.
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Steen KS, Peters MJ, Zweegman S, de Groot PG, Voskuyl AE. Relapsing Splenic Vein Thrombosis Associated With Antiphospholipid Antibodies in a Patient With Wegener Granulomatosis. J Clin Rheumatol 2007; 13:92-3. [PMID: 17414539 DOI: 10.1097/01.rhu.0000260410.81377.b2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Relapsing splenic vein thrombosis, a very rare complication of Wegener granulomatosis (WG), is described in a female patient. Positive antiphospholipid antibodies found in this case are a rare occurrence in primary vasculitis, especially in WG. This probably caused or accentuated an effect of the WG on the splenic vein. Treatment of such patients with antiphospholipid syndrome and WG must include anticoagulation and immunosuppression and, as noted in this patient, the splenic vein thrombosis and other antiphospholipid syndrome and WG can resolve quickly.
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Affiliation(s)
- K S Steen
- Department of Rheumatology, VU University Medical Center, Amsterdam, The Netherlands.
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Song SB, Choi HS, Kim YH, Choi CW, Park MJ, Yoo JH, Kang HM, Kim YH, Park JC. A Case of Wegener's Granulomatosis with Delayed Diagnosis due to Clinical Features of Henoch-Schönlein Purpura. Tuberc Respir Dis (Seoul) 2007. [DOI: 10.4046/trd.2007.63.6.531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Se Bin Song
- Department of Pulmonary and Critical Care Medicine, Kyunghee University College of Medicine, Seoul, Korea
| | - Hye Sook Choi
- Department of Pulmonary and Critical Care Medicine, Kyunghee University College of Medicine, Seoul, Korea
| | - Yee Hyung Kim
- Department of Pulmonary and Critical Care Medicine, Kyunghee University College of Medicine, Seoul, Korea
| | - Cheon Woong Choi
- Department of Pulmonary and Critical Care Medicine, Kyunghee University College of Medicine, Seoul, Korea
| | - Myung Jae Park
- Department of Pulmonary and Critical Care Medicine, Kyunghee University College of Medicine, Seoul, Korea
| | - Jee-Hong Yoo
- Department of Pulmonary and Critical Care Medicine, Kyunghee University College of Medicine, Seoul, Korea
| | - Hong Mo Kang
- Department of Pulmonary and Critical Care Medicine, Kyunghee University College of Medicine, Seoul, Korea
| | - Yoon Hwa Kim
- Department of Pathology, Kyunghee University College of Medicine, Seoul, Korea
| | - Joo Cheol Park
- Department of Thoracic Surgery, Kyunghee University College of Medicine, Seoul, Korea
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Choopong P, Khan N, Sangwan VS, Zafirakis P, Rallatos CL, Rojas B, Baltatzis S, Foster CS. Eosinophil activation in Wegener's granulomatosis: a harbinger of disease progression? Ocul Immunol Inflamm 2006; 13:439-45. [PMID: 16321888 DOI: 10.1080/09273940591004250] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE To investigate the relation between eosinophil activation in tissue from patients with an active, limited form of Wegener's granulomatosis (WG) affecting the eye and subsequent systemic disease activity. METHODS Analysis of ocular specimens obtained from 10 patients was performed. Sections were probed with antibodies to assess the presence of major basic protein (MBP) and eosinophil cationic protein (ECP). RESULTS Four of the 10 specimens demonstrated the presence of MBP and ECP. WG progressed to the complete form in two of these patients, who received no or inadequate treatment. The other two, treated with cyclophosphamide for one year, did not progress to the complete form of WG during observation after therapy. CONCLUSIONS Activated eosinophils in sclera or conjunctiva of patients with ocular limited WG may predict progression to complete WG.
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Affiliation(s)
- Pitipol Choopong
- Department of Ophthalmology, Ocular Immunology and Uveitis Service, Massachusetts Eye and Ear Infirmary (MEEI), Boston, MA 02114, USA
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Bachmeyer C, Petitjean B, Testart F, Richecoeur J, Ammouri W, Blum L. Lingual necrosis as the presenting sign of Wegener's granulomatosis. Clin Exp Dermatol 2006; 31:321-2. [PMID: 16487139 DOI: 10.1111/j.1365-2230.2005.02053.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- C Bachmeyer
- Service de Medicine Interne, CHU Tenon, Paris, France.
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Neralić-Meniga I, Ivanovi-Herceg Z, Mazuranić I, Puljić I, Zekan M, Gorecan M, Kos M. Wegener's granulomatosis of the breast. Wien Klin Wochenschr 2006; 118:120-3. [PMID: 16703257 DOI: 10.1007/s00508-006-0536-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2005] [Accepted: 10/19/2005] [Indexed: 10/24/2022]
Abstract
Wegener's granulomatosis is a multisystem disorder characterized by necrotizing granulomatous inflammation and vasculitis of small vessels and can affect any organ system. The most common sites of involvement are upper and lower respiratory tracts, and kidneys. Breast involvement is unusual and very rare. We report a case of breast Wegener's granulomatosis in a 32-year-old woman who presented with pulmonary lesions and palpable masses in the left breast. Mammography showed multiple, sharply delineated nodules without microcalcifications. Ultrasonography revealed multiple hypoechoic solid lesions, some of them with anechoic areas of necrosis. Computed tomography showed multiple nodules. Histopathology of excision biopsy specimens of breast lesions revealed necrotizing granulomatous material consistent with Wegener's granulomatosis. Twenty reports of breast involvement in this rare disease were found in the literature; however, the respective ultrasonographic and computed tomography findings have not hitherto been described.
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Affiliation(s)
- Inja Neralić-Meniga
- Department of Radiology, Jordanovac University Hospital for Lung Diseases, Zagreb, Croatia
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Abstract
OBJECTIVES To describe the uncommon causes of cough. DESIGN/METHODOLOGY An English language literature search by MEDLINE citations from 1975 through 2004 was used to identify publications on uncommon pulmonary and nonpulmonary disorders in which cough was present as the major or presenting symptom in >50% of those persons affected by the uncommon diseases. RESULTS A substantial number of uncommon or rare pulmonary and nonpulmonary disorders were identified. The uncommon occurrence of these diseases made it difficult to develop a meaningful evidence-based guideline to the diagnosis and therapy of many of the uncommon causes of cough. As cough was the major or presenting symptom, it was usually initially attributed to common respiratory diseases (eg, asthma or bronchitis). As a result, a substantial time lag existed from the onset of cough to the diagnosis of the etiologic entity. Diagnostic tests limited to the respiratory system did not always provide clues to the diagnosis of uncommon causes of cough. CONCLUSIONS Cough is the major or presenting symptom in many uncommon pulmonary and nonpulmonary disorders. A strong index of suspicion is essential to consider and diagnose the uncommon causes of cough. The diagnosis and management of cough in patients with uncommon causes of cough is dependent on the underlying etiology.
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40
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Onal IK, Ozçakar L, Temirel K, Aran R, Kurt M. Fatal endocarditis in Wegener's granulomatosis: mitral valve involvement and an intracardiac mass. Joint Bone Spine 2005; 72:585-7. [PMID: 15922644 DOI: 10.1016/j.jbspin.2005.04.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Reported here is a 39-year-old man with Wegener's granulomatosis who had died due to endocarditis during his follow up. The concomitance of these two pathologies is discussed in the light of the pertinent literature.
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Affiliation(s)
- Ibrahim Koral Onal
- Department of Internal Medicine, Hacettepe University Medical School, Ankara, Turkey
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41
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Samarkos M, Loizou S, Vaiopoulos G, Davies KA. The Clinical Spectrum of Primary Renal Vasculitis. Semin Arthritis Rheum 2005; 35:95-111. [PMID: 16194695 DOI: 10.1016/j.semarthrit.2005.05.004] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND OBJECTIVES The vasculitides are potentially severe and often difficult to diagnose syndromes. Many forms of vasculitis may involve the kidneys. This review will focus on the clinical and histopathological aspects of renal involvement in the systemic vasculitides. METHODS We searched the MEDLINE database using as key terms the MeSH terms and textwords for different forms of vasculitis and for renal involvement, creating a database of more than 2200 relevant references. RESULTS The frequency of renal involvement in vasculitis varies among different syndromes. It is more frequent in Wegener's granulomatosis and microscopic polyarteritis, while it is uncommon to rare in other forms of vasculitis such as Behçet's disease and relapsing polychondritis. The vessels affected include the renal artery in Takayasu arteritis, medium-size renal parenchymal artery in classic polyarteritis nodosa, and glomerular involvement in Wegener's granulomatosis and microscopic polyarteritis. The clinical expression of renal vasculitis depends on the size of the affected vessels and includes renovascular hypertension, isolated nonnephrotic proteinuria, interstitial nephritis, and glomerulonephritis, which can be rapidly progressive. Diagnosis is established by a combination of history, clinical manifestations, laboratory findings (eg, urine sediment, urine protein, antineutrophil cytoplasmic antibodies), imaging techniques (renal angiography, especially when there is a suspicion of medium-to-large vessel disease, and chest radiograph), and finally, renal biopsy. Prognosis varies from unfavorable in the rapidly progressive glomerulonephritis of microscopic polyarteritis, which can lead to renal failure, chronic dialysis, and renal transplantation, to benign, as in the case of Henoch Schonlein purpura, in which the majority of patients recover. CONCLUSIONS The manifestations and prognosis of renal vasculitis range widely. Renal involvement greatly influences prognosis and dictates the need for early and prompt immunosuppressive therapy. Thus, the clinician should be alert for the timely diagnosis and treatment of renal vasculitis.
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Affiliation(s)
- Michael Samarkos
- 5th Department of Internal Medicine, Evangelismos Hospital, Athens, Greece.
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42
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Nardin R, Rutkove S. Neuropathy and Rheumatologic Disease. NEUROLOGICAL DISEASE AND THERAPY 2005. [DOI: 10.1201/b14157-17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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43
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Ríos Blanco JJ, Gómez Cerezo J, Vázquez Muñoz E, Suárez García I, López Rodríguez M, Yébenes Gregorio L, Torres Sánchez I, Barbado Hernández FJ. Estudio clínico-biológico y radiológico de la granulomatosis de Wegener en un hospital universitario. Rev Clin Esp 2005; 205:367-73. [PMID: 16143083 DOI: 10.1157/13078247] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
UNLABELLED Wegener's granulomatosis is a rare systemic vasculitis that fundamentally affects the kidney and respiratory tract. Although the histological findings are very characteristic, they do not occur in all cases, which makes diagnosis difficult. METHODS The main clinical, biological and radiological characteristics of 13 cases of Wegener's granulomatosis diagnosed in a university hospital of the center of Spain are collected in this present paper. RESULTS The majority of the patients were men in their 50's. Fever and general syndrome were usual presentations of the disease. Upper respiratory tract (10 cases) and lung involvement (9), followed by renal involvement (8), were the most common. Alveolar infiltrates and bilateral nodules were the most common findings in the X-ray and thoracic CT scan, although the latter permits a greater definition of the lesions. Measurement of antibodies against cytoplasma of the neutrophils (ANCA) was positive in 8 patients (6 cANCA and 2 pANCA). Renal biopsy was used most for the histologic diagnosis, where focal and segmental glomerulonephritis was the most common finding. The majority of the patients received steroids plus cyclophosphamide as induction treatment. CONCLUSIONS Wegener's disease is a rare systemic vasculitis. The existence of hematuria or respiratory tract involvement in a patient with fever suggests the diagnosis. Conducting a CT scan and ANCAs measurement are useful tools for its diagnosis, since the histology is not definitive.
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Affiliation(s)
- J J Ríos Blanco
- Servicios de Medicina Interna, Hospital Universitario La Paz, C/Encinar del Castillo 4, 28430 Alpedrete, Madrid, Spain.
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Rocha N, Velho G, Rodrigues M, Mendonça T, Canelhas A, Bernardo A, Massa A. Cutaneous sarcoid-like granulomas with alveolar hemorrhage and c-ANCA PR-3. Int J Dermatol 2004; 43:668-72. [PMID: 15357748 DOI: 10.1111/j.1365-4632.2004.01929.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Natividade Rocha
- Department of Dermatology, Hospital Geral de Santo António, Oporto, Portugal
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45
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Brinar VV, Cikes N, Petelin Z, Hlavati M, Poser CM. Cerebral demyelination in Wegener's granulomatosis. Clin Neurol Neurosurg 2004; 106:233-6. [PMID: 15177774 DOI: 10.1016/j.clineuro.2004.02.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
A 38-year-old woman with a history of a granulomatous lesion of the nose, developed blurred vision, ataxic gait, and spastic tetraparesis. The presence of demyelination on the brain MRI led to the diagnosis of cerebral demyelination associated with Wegener's granulomatosis. Pulse cyclophosphamide administration resulted in some clinical of improvement of her condition. Demyelinating lesions seen in Wegener's have been ascribed to multiple sclerosis, but in this case, they are much more reminiscent of disseminated encephalomyelitis (DEM). The immunological challenge of the underlying disease, may, in the genetically susceptible person, presumably trigger the appearance of MS lesions. Wegener's granulomatosis must be considered in the differential diagnosis of MS.
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Affiliation(s)
- Vesna V Brinar
- Department of Neurology, Faculty of Medicine, University of Zagreb, REBRO Hospital Centre, Kispaticeva 12, 10000 Zagreb, Croatia.
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Abstract
The treatment of interstitial lung disease in children depends on the nature of the underlying pathology. In approximately 50% of cases a specific aetiology can be found such as: chronic viral infection, an auto-immune process, sarcoidosis or alveolar proteinosis. In the remainder, the process is idiopathic and the pathological findings are based on the descriptive morphological features seen in the diagnostic lung biopsy. If a specific cause is found then targeted treatment with antivirals, steroids or other immunosuppressive agents is available. Alveolar proteinosis can be treated by bronchial lavage and GM-CSF. Idiopathic cases are treated primarily with intravenous pulsed methylprednisolone or oral prednisolone backed up hydroxychloroquine. Other immunosuppressive agents such as azathioprine, methotrexate or ciclosporin have been used successfully in individual patients. The prognosis is very variable and includes no response to any therapy, partial response with chronic long term morbidity, to virtually complete recovery. The overall mortality rate is 15%. There are no controlled therapeutic trials available because of the rarity of these conditions in childhood. Unlike in adult practice, no correlation has as yet been demonstrated between the initial pattern of chest x-ray change or the degree of pathological change on the lung biopsy and the clinical outcome. The recurrence rate within families is 1 in 8.
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Affiliation(s)
- R Dinwiddie
- Respiratory Unit, Great Ormond Street Hospital for Children, Great Ormond Street, London WC1N 3JH, UK.
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Izzedine H, Bodaghi B, Launay-Vacher V, Deray G. Oculorenal manifestations in systemic autoimmune diseases. Am J Kidney Dis 2004; 43:209-22. [PMID: 14750086 DOI: 10.1053/j.ajkd.2003.10.031] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Vasculitides form a heterogeneous group of diseases characterized by blood-vessel inflammation and necrosis. They have a wide spectrum of manifestations because of the involvement of arteries and other vessels of various sizes and locations. Early diagnosis and prompt treatment may decrease the morbidity and mortality associated with these disorders. Examination of the eye and kidney should be performed routinely in those diseases. This article reviews the major types of oculorenal manifestations in systemic autoimmune diseases.
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Affiliation(s)
- Hassane Izzedine
- Department of Nephrology, Pitie-Salpetriere Hospital, Paris, France.
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48
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Pretorius ES, Stone JH, Hellman DB, Fishman EK. Wegener's Granulomatosis: CT Evolution of Pulmonary Parenchymal Findings in Treated Disease. ACTA ACUST UNITED AC 2004. [DOI: 10.3109/10408370490430331] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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49
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Pickhardt PJ, Curran VW. Fulminant enterocolitis in Wegener's granulomatosis: CT findings with pathologic correlation. AJR Am J Roentgenol 2001; 177:1335-7. [PMID: 11717078 DOI: 10.2214/ajr.177.6.1771335] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- P J Pickhardt
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO 63110, USA
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50
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Savige J, Davies D, Falk RJ, Jennette JC, Wiik A. Antineutrophil cytoplasmic antibodies and associated diseases: a review of the clinical and laboratory features. Kidney Int 2000; 57:846-62. [PMID: 10720938 DOI: 10.1046/j.1523-1755.2000.057003846.x] [Citation(s) in RCA: 165] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
There have been a number of recent advances in this field. First, the "International Consensus Statement on Testing and Reporting of Antineutrophil Cytoplasmic Antibodies (ANCA)" has been developed to optimize ANCA testing. It requires that all sera are tested by indirect immunofluorescent (IIF) examination of normal peripheral blood neutrophils and, where there is positive fluorescence, in enzyme-linked immunosorbent assays (ELISAs) for antibodies against both proteinase 3 (PR3) and myeloperoxidase (MPO). Testing will be further improved when international standards and common ELISA units are available. Second, new diagnostic criteria for the small vessel vasculitides that take into account ANCA-positivity and target antigen specificity as well as histologic features are currently being produced. Third, we understand that the complications associated with treatment of the ANCA-associated vasculitides are often more hazardous than the underlying disease, and regimens that use effective but less toxic agents are being evaluated. The factors associated with increased risk of relapse, however, remain incompletely understood. Finally, ANCA with specificities other than PR3 and MPO are present in many nonvasculitic autoimmune diseases. Their clinical significance is still largely unclear, and some of the target antigens are present in other cells as well as neutrophils and thus are not strictly "ANCA."
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Affiliation(s)
- J Savige
- Department of Medicine, University of Melbourne, Austin, Australia.
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