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Mohankumar SP, Das S, Likitha P, Naranje P, Jana M, Gupta SK, Bagri NK. Kawasaki disease or polyarteritis nodosa: coronary involvement, a diagnostic conundrum. Rheumatol Int 2023; 43:2327-2331. [PMID: 37430128 DOI: 10.1007/s00296-023-05388-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Accepted: 06/29/2023] [Indexed: 07/12/2023]
Abstract
Polyarteritis nodosa (PAN) is a medium-vessel vasculitis presenting with cutaneous and multisystem involvement with considerable morbidity. The necrotizing vasculitis in PAN typically involves renal, celiac, and mesenteric vascular beds. Coronary artery involvement is a characteristic feature of Kawasaki disease, another medium-vessel vasculitis; however, it has been rarely reported with PAN. Here, we present 2 cases with PAN involving coronaries mimicking Kawasaki disease. A 3.5-year-old boy with classical features of Kawasaki disease with giant coronary aneurysm refractory to IVIg, methylprednisolone, infliximab presented with persistent rise in inflammatory markers and gastrointestinal bleeding. Digital subtraction angiography (DSA) revealed celiac artery branches stenosis and beading suggestive of PAN. Another 2-year-old girl presented with persistent fever, abdominal pain, and distension. She had hypertension, hepatomegaly, and splenomegaly on examination. Echocardiography revealed multiple coronary aneurysms and DSA revealed numerous renal artery aneurysms. Coronary aneurysm although is a rare presentation of childhood PAN, and can mimic Kawasaki disease. Although both are medium-vessel vasculitis differentiation between these two entities is pivotal, as there are differences in treatment modalities, duration of immunomodulatory therapy, and the outcome. This manuscript describes the salient differences which can help differentiate PAN masquerading as Kawasaki disease at initial presentation.
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Affiliation(s)
| | - Samannay Das
- Department of Paediatrics, AIIMS, New Delhi, India
| | - P Likitha
- Department of Paediatrics, AIIMS, New Delhi, India
| | - Priyanka Naranje
- Department of Radiodiagnosis and Interventional Radiology, AIIMS, New Delhi, India
| | - Manisha Jana
- Department of Radiodiagnosis and Interventional Radiology, AIIMS, New Delhi, India
| | | | - Narendra Kumar Bagri
- Division of Pediatric Rheumatology and Immunology, Department of Paediatrics, AIIMS, New Delhi, India.
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Kawamura M, Mizutani Y, Mizutani Y, Matsuyama K, Shu E, Miyazaki T, Seishima M. Clinical and pathological differences between skin‐limited IgM/IgG vasculitis and skin‐limited IgA vasculitis. JOURNAL OF CUTANEOUS IMMUNOLOGY AND ALLERGY 2021. [DOI: 10.1002/cia2.12156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
- Miho Kawamura
- Department of Dermatology Gifu University Graduate School of Medicine Gifu Japan
| | - Yuki Mizutani
- Department of Dermatology Gifu University Graduate School of Medicine Gifu Japan
| | - Yoko Mizutani
- Department of Dermatology Gifu University Graduate School of Medicine Gifu Japan
| | - Kanako Matsuyama
- Department of Dermatology Gifu University Graduate School of Medicine Gifu Japan
| | - En Shu
- Department of Dermatology Gifu University Graduate School of Medicine Gifu Japan
| | | | - Mariko Seishima
- Department of Dermatology Gifu University Graduate School of Medicine Gifu Japan
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Arterial ischemic stroke in non-neonate children: Diagnostic and therapeutic specificities. Rev Neurol (Paris) 2020; 176:20-29. [DOI: 10.1016/j.neurol.2019.03.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 03/13/2019] [Accepted: 03/14/2019] [Indexed: 12/12/2022]
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Ikeda T, Furukawa F, Kawakami T, Ishiguro N, Uzuki M, Ozaki S, Katsuoka K, Kono T, Kawana S, Kodera M, Sawai T, Sawada Y, Seishima M, Tanikawa A, Chen KR, Hasegawa M. Outline of guidelines for the management of vasculitis and vascular disorders in Japan, 2016 revised edition. J Dermatol 2017; 45:122-127. [DOI: 10.1111/1346-8138.14086] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Accepted: 09/06/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Takaharu Ikeda
- Department of Dermatology; Wakayama Medical University Graduate School of Medicine; Wakayama Japan
| | - Fukumi Furukawa
- Department of Dermatology; Wakayama Medical University Graduate School of Medicine; Wakayama Japan
| | - Tamihiro Kawakami
- Department of Dermatology; St. Marianna University School of Medicine; Kawasaki Japan
| | - Naoko Ishiguro
- Department of Dermatology; Tokyo Women's Medical University; Tokyo Japan
| | - Miwa Uzuki
- Division of Leading Pathophysiology; Department of Pathology; Iwate Medical University School of Medicine; Morioka Japan
| | - Shoichi Ozaki
- Division of Rheumatology and Allergology; Department of Internal Medicine; St. Marianna University School of Medicine; Kawasaki Japan
| | - Kensei Katsuoka
- Department of Dermatology; Kitasato University School of Medicine; Sagamihara Japan
| | - Takeshi Kono
- Department of Dermatology; Nippon Medical School Chiba Hokusoh Hospital; Inzai Japan
| | - Seiji Kawana
- Department of Dermatology; Nippon Medical School; Tokyo Japan
| | - Masanari Kodera
- Department of Dermatology; Japan Community Health care Organization Chukyo Hospital; Nagoya Japan
| | - Takashi Sawai
- Division of Leading Pathophysiology; Department of Pathology; Iwate Medical University School of Medicine; Morioka Japan
| | - Yasuyuki Sawada
- Department of Dermatology; Tokyo Metropolitan Bokutoh Hospital; Tokyo Japan
| | - Mariko Seishima
- Department of Dermatology; Gifu University Graduate School of Medicine; Gifu Japan
| | - Akiko Tanikawa
- Department of Dermatology; Keio University School of Medicine; Tokyo Japan
| | - Ko-Ron Chen
- Department of Dermatology; Saiseikai Central Hospital; Tokyo Japan
| | - Minoru Hasegawa
- Department of Dermatology; Faculty of Medical Sciences; University of Fukui; Fukui Japan
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Abstract
Cutaneous vasculitis, inflammatory destruction of blood vessels, can present with a wide range of clinical and pathologic findings across a number of heterogeneous conditions. Although some vasculitides are present in both children and adults, some important differences exist in clinical presentation, etiology, management, and prognosis in childhood vasculitis versus adult vasculitis. Cutaneous vasculitis is rare in children, and most childhood vasculitides, of which Henoch-Schönlein purpura is the most common, histologically are small vessel leukocytoclastic vasculitis. In children, infectious etiologies are more common than in adults. Childhood cutaneous vasculitis is most often self-limited with a good prognosis, and treatment is mainly supportive. © 2017 Elsevier Inc. All rights reserved.
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Affiliation(s)
- Nikita Lakdawala
- Department of Dermatology, Medical College of Wisconsin, Milwaukee, WI.
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Kawakami T, Shimosaka R, Takeuchi S, Soma Y. Importance of appropriate location and frequency of biopsy for cutaneous manifestations in eosinophilic granulomatosis with polyangiitis. Int J Dermatol 2016; 55:1388-1390. [PMID: 26749513 DOI: 10.1111/ijd.13210] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2015] [Revised: 07/29/2015] [Accepted: 09/23/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Tamihiro Kawakami
- Department of Dermatology, St. Marianna University School of Medicine, Kawasaki, Japan.
| | - Reiko Shimosaka
- Department of Dermatology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Sora Takeuchi
- Department of Dermatology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Yoshinao Soma
- Department of Dermatology, St. Marianna University School of Medicine, Kawasaki, Japan
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Matteoda MA, Stefano PC, Bocián M, Katsicas MM, Sala J, Cervini AB. Cutaneous polyarteritis nodosa. An Bras Dermatol 2016; 90:188-90. [PMID: 26312712 PMCID: PMC4540546 DOI: 10.1590/abd1806-4841.20153856] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Accepted: 08/12/2014] [Indexed: 11/22/2022] Open
Abstract
Polyarteritis nodosa is a rare vasculitis in children characterized by necrotizing inflammation in small and medium size arteries. It is classified into systemic and cutaneous PAN according to the presence of systemic symptoms or visceral involvement. We describe the case of a 14-year-old girl with cutaneous Polyarteritis nodosa with an atypical clinical presentation.
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Affiliation(s)
| | | | - Marcela Bocián
- National Hospital of Pediatrics "Prof. Dr. Juan P. Garrahan, Buenos Aires, AR
| | | | - Josefina Sala
- National Hospital of Pediatrics "Prof. Dr. Juan P. Garrahan, Buenos Aires, AR
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Goldenhar Syndrome Associated with Extensive Arterial Malformations. Case Rep Pediatr 2015; 2015:954628. [PMID: 26688769 PMCID: PMC4673332 DOI: 10.1155/2015/954628] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Accepted: 10/21/2015] [Indexed: 11/17/2022] Open
Abstract
Goldenhar Syndrome is characterized by craniofacial, ocular and vertebral defects secondary to abnormal development of the 1st and 2nd branchial arches and vertebrae. Other findings include cardiac and vascular abnormalities. Though these associations are known, the specific anomalies are not well defined. We present a 7-month-old infant with intermittent respiratory distress that did not improve with respiratory interventions. Echocardiogram suggested a double aortic arch. Cardiac CT angiogram confirmed a right arch and aberrant, stenotic left subclavian artery, dilation of the main pulmonary artery, and agenesis of the left thyroid lobe. Repeat echocardiograms were concerning for severely dilated coronary arteries. Given dilation, a rheumatologic workup ensued, only identifying few weakly positive autoantibodies. Further imaging demonstrated narrowing of the aorta below the renal arteries and extending into the common iliac arteries and proximal femoral arteries. Given a physical exam devoid of rheumatologic findings, only weakly positive autoantibodies, normal inflammatory markers, and presence of the coronary artery dilation, the peripheral artery narrowings were not thought to be vasculitic. This case illustrates the need to identify definitive anomalies related to Goldenhar Syndrome. Although this infant's presentation is rare, recognition of specific vascular findings will help differentiate Goldenhar Syndrome from other disease processes.
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Takeuchi S, Kimura S, Soma Y, Waki M, Yamaguchi M, Nakazawa D, Tomaru U, Ishizu A, Kawakami T. Lysosomal-associated membrane protein-2 plays an important role in the pathogenesis of primary cutaneous vasculitis. Rheumatology (Oxford) 2013; 52:1592-8. [PMID: 23704322 DOI: 10.1093/rheumatology/ket159] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Recent research suggests that lysosomal-associated membrane protein-2 (LAMP-2) could be one of the target antigens in the pathogenesis of vasculitides. We established a transgenic rat model, env-pX rats, with various vasculitides including cutaneous vasculitis. Human primary cutaneous vasculitis includes cutaneous polyarteritis nodosa (CPN) and Henoch-Schönlein purpura (HSP). We measured serum anti-LAMP-2 antibody levels in morbid env-pX rats and injected anti-LAMP-2 antibody into premorbid env-pX rats. We further measured serum anti-LAMP-2 antibody levels in patients with CPN and HSP. METHODS Cutaneous vasculitis was observed in ∼30% of 6-month-old morbid env-pX rats. In contrast, these findings were rare in premorbid env-pX rats under 3 months old. We also examined 85 patients with CPN and 36 adult patients with HSP. Serum anti-LAMP-2 antibody levels were determined using ELISA. Premorbid env-pX rats under 3 months old were given an i.v. injection of anti-LAMP-2 antibody at day 0 and day 7. At day 14, these rats underwent histopathological and direct immunofluorescence examination. Cell surface LAMP-2 expression of rat neutrophils was examined by flow cytometry. RESULTS Serum anti-LAMP-2 antibody levels were significantly higher in morbid env-pX rats than in wild-type normal rats. In addition, the levels in the cutaneous vasculitis group of morbid env-pX rats were significantly higher than the no cutaneous vasculitis group. Intravenous anti-LAMP-2 antibody injection into premorbid env-pX rats under 3 months old induced infiltration of neutrophils into cutaneous small vessels. Anti-LAMP-2 antibody-binding neutrophils were detected there. LAMP-2 expression on the cell surface of neutrophils in premorbid env-pX rats under PMA stimulation was higher compared with controls. Serum anti-LAMP-2 antibody levels in CPN and HSP were significantly higher than those of healthy controls. CONCLUSION These data support a positive relationship between anti-LAMP-2 antibody and cutaneous vasculitis.
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Affiliation(s)
- Sora Takeuchi
- Department of Dermatology, St Marianna University School of Medicine, Miyamae-ku, Kawasaki, Kanagawa, Japan
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