Lefèvre G, Leurs A, Gibier JB, Copin MC, Staumont-Sallé D, Dezoteux F, Chenivesse C, Lopez B, Terriou L, Hachulla E, Launay D, Etienne N, Labalette M, DeGroote P, Pontana F, Quemeneur T, Hatron PY, Schleinitz N, Viallard JF, Hamidou M, Martin T, Morati-Hafsaoui C, Groh M, Lambert M, Kahn JE; CEREO—French National Reference Center for Hypereosinophilic Syndromes. "Idiopathic Eosinophilic Vasculitis": Another Side of Hypereosinophilic Syndrome? A Comprehensive Analysis of 117 Cases in Asthma-Free Patients.
J Allergy Clin Immunol Pract 2020;
8:1329-1340.e3. [PMID:
31863912 DOI:
10.1016/j.jaip.2019.12.011]
[Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 11/28/2019] [Accepted: 12/08/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND
The absence of asthma may rule out a diagnosis of eosinophilic granulomatosis with polyangiitis in patients with hypereosinophilic syndrome (HES) and features of vasculitis.
OBJECTIVE
To describe eosinophilic vasculitis (EoV) as a possible manifestation of HES in asthma-free patients.
METHODS
We screened our hospital database and the literature for patients with HES who met the following 4 criteria: (1) histopathological or clinical features of EoV (biopsy-proven vasculitis with predominant eosinophilic infiltration of the vessel wall and/or features of vasculitis with tissue and/or blood hypereosinophilia [absolute eosinophil count >1.5 G/L]); (2) no other obvious causes of reactive eosinophilia, organ damage, and vasculitis; (3) the absence of antineutrophil cytoplasmic antibodies; and (4) the absence of current asthma.
RESULTS
Ten of our 83 (12%) asthma-free patients with HES and 107 additional cases in the literature met the criteria for EoV. After a critical analysis of the patients' clinical and laboratory characteristics and outcomes, we identified 41 cases of single-organ EoV (coronary arteritis, n = 29; temporal arteritis, n = 8; cerebral vasculitis, n = 4). Of the remaining 76 patients with EoV, the most frequent manifestations (>10%) were cutaneous vasculitis (56%), peripheral neuropathy (24%), thromboangiitis obliterans-like disease (16%), fever (13%), central nervous system involvement (13%), deep venous thrombosis (12%), and nonasthma lung manifestations (12%). Blood hypereosinophilia more than 1.5 G/L was observed in 79% of patients, and necrotizing vasculitis was observed in 44%.
CONCLUSIONS
Our results suggest that idiopathic EoV (HES-associated vasculitis) can be classified as an eosinophilic-rich, necrotizing, systemic form of vasculitis that affects vessels of various sizes in asthma-free patients.
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