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Banic M, Pavlisa G, Hecimovic A, Grzelja J, Anic B, Samarzija M, Jankovic Makek M. Refractory systemic lupus erythematosus with chylous effusion successfully treated with sirolimus: a case report and literature review. Rheumatol Int 2023; 43:1743-1749. [PMID: 37326666 DOI: 10.1007/s00296-023-05363-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 06/05/2023] [Indexed: 06/17/2023]
Abstract
Chylous effusion is a rare manifestation of systemic lupus erythematosus (SLE). When it does occur in SLE, it is generally well treated with standard pharmacologic or surgical measures. We present a decade of management in a case of SLE with lung affliction and development of refractory bilateral chylous effusion and pulmonary arterial hypertension (PAH). In the first years, the patient was treated under a Sjogren syndrome diagnose. After few years, her respiratory condition worsened due to chylous effusion and PAH. Immunosuppression therapy (methylprednisolone) was reintroduced, and vasodilator therapy commenced. With this, her cardiac function remained stable, but respiratory function continuously worsened despite several therapy trials with different combinations of immunosuppressant (glucocorticoids, resochin, cyclophosphamide and mycophenolate mofetil). On top of pleural effusion worsening, the patient developed ascites and severe hypoalbuminaemia. Even though albumin loss was stabilized with monthly octreotide applications, the patient remained respiratory insufficient and in need of continuous oxygen therapy. At that point, we decided to introduce sirolimus on top of glucocorticoids and mycophenolate mofetil therapy. Her clinical status, radiological finding, and lung function gradually improved and she became respiratory sufficient at rest. The patient remains in our follow-up and has been stable on given therapy for over 3 years despite overcoming a severe COVID-19 pneumonia in 2021. This case adds to the body of evidence of sirolimus effectiveness in patients with refractory systemic lupus and is, to our best knowledge, the first case to report its successful application in a patient with SLE and refractory chylous effusion.
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Affiliation(s)
- M Banic
- Department of Lung Diseases Jordanovac, University Hospital Centre Zagreb, Jordanovac 104, 10000, Zagreb, Croatia
| | - G Pavlisa
- Department of Lung Diseases Jordanovac, University Hospital Centre Zagreb, Jordanovac 104, 10000, Zagreb, Croatia
| | - A Hecimovic
- Department of Lung Diseases Jordanovac, University Hospital Centre Zagreb, Jordanovac 104, 10000, Zagreb, Croatia
- School of Medicine, University of Zagreb, Salata 2, 10000, Zagreb, Croatia
| | - J Grzelja
- Department of Diagnostic and Interventional Radiology, University Hospital Centre Zagreb, Kispaticeva 12, 10000, Zagreb, Croatia
| | - B Anic
- Division of Clinical Immunology and Rheumatology, Department of Internal Medicine, University Hospital Centre Zagreb, Kispaticeva 12, 10000, Zagreb, Croatia
- School of Medicine, University of Zagreb, Salata 2, 10000, Zagreb, Croatia
| | - M Samarzija
- Department of Lung Diseases Jordanovac, University Hospital Centre Zagreb, Jordanovac 104, 10000, Zagreb, Croatia
- School of Medicine, University of Zagreb, Salata 2, 10000, Zagreb, Croatia
| | - M Jankovic Makek
- Department of Lung Diseases Jordanovac, University Hospital Centre Zagreb, Jordanovac 104, 10000, Zagreb, Croatia.
- School of Medicine, University of Zagreb, Salata 2, 10000, Zagreb, Croatia.
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Hecimovic A, Kiefer C, Meindl A, Antunes R, Fantz U. Fast gas quenching of microwave plasma effluent for enhanced CO2 conversion. J CO2 UTIL 2023. [DOI: 10.1016/j.jcou.2023.102473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023]
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Kruhonja Galic Z, Jagnjic S, Bingulac-Popovic J, Planinc Peraica A, Hecimovic A, Strauss Patko M, Jukic I. Warm red blood cell autoantibodies and clinical diagnoses in patients with or without autoimmune hemolysis. Transfus Clin Biol 2019; 27:25-29. [PMID: 31708346 DOI: 10.1016/j.tracli.2019.10.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Accepted: 10/17/2019] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Red blood cell autoantibodies (RBC autoAbs) of IgG class are found in the majority of patients with warm autoimmune hemolytic anemia (wAIHA) but sometimes also during the pretransfusion testing of patients with different diagnoses but without hemolysis. The aim of the study was to identify the main differences between these two groups of patients according to age, gender, subclass and titer of IgG RBC autoAbs and diagnosis. MATERIAL AND METHODS In the 9-year retrospective study, data were collected from records of 291 patients with IgG RBC autoAbs detected by gel technique, from which 111 with wAIHA. RESULTS More than 85% of patients in both groups were over 40 years old, with male to female ratio 1:1.9 in wAIHA vs 1:1.3 in patients without hemolysis (P=0.0916). The main characteristics of patients with wAIHA vs patients without hemolysis were: IgG only 38% vs 70%, IgG+Complement 62% vs 30%, total IgG1 79% vs 55%, IgG1+IgG3 35% vs 11%, titer of 100 for IgG1+IgG3 17% vs 3% (P<0.0001), respectively, while titer of 100 for IgG1 18% vs 9% (P=0.0241). The underlying diagnosis in wAIHA vs patients without hemolysis: hematologic disorders 41% vs 22% (P=0.0006), autoimmune disorders 12% vs 13% (P=0.8033), solid tumors 5% vs 14% (P=0.0154) and surgery procedures 6% vs 26% (P<0.0001). CONCLUSION We observed more wAIHA patients with high titer of IgG1 and high prevalence of IgG1+IgG3 and consider that patients without hemolysis having identical results might be interesting to find out how they are protected from damage by RBC autoAbs.
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Affiliation(s)
- Z Kruhonja Galic
- Department of Immunohematology, Croatian Institute of Transfusion Medicine, Petrova 3, 10000 Zagreb, Croatia.
| | - S Jagnjic
- Department of Immunohematology, Croatian Institute of Transfusion Medicine, Petrova 3, 10000 Zagreb, Croatia.
| | - J Bingulac-Popovic
- Department of Molecular Diagnostics, Croatian Institute of Transfusion Medicine, Petrova 3, 10000 Zagreb, Croatia.
| | - A Planinc Peraica
- Department of Hematology, Clinical Hospital Merkur, Zajceva 19, 10000 Zagreb, Croatia; School of Medicine, University of Zagreb, Salata 3, 10000 Zagreb, Croatia.
| | - A Hecimovic
- Department of Reagents Production, Croatian Institute of Transfusion Medicine, Petrova 3, 10000 Zagreb, Croatia.
| | - M Strauss Patko
- Medical Department, Croatian Institute of Transfusion Medicine, Petrova 3, 10000 Zagreb, Croatia.
| | - I Jukic
- Medical Department, Croatian Institute of Transfusion Medicine, Petrova 3, 10000 Zagreb, Croatia; Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Cara Hadrijana 10/E, 31000 Osijek, Croatia.
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Vukic Dugac A, Hecimovic A, Jankoviç Makek M, Dzubur F, Seiwerth S, Samarzija M. Pathological fracture and osteolysis of the rib with pleural effusion - is this malignant? Neth J Med 2016; 74:369. [PMID: 27762227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- A Vukic Dugac
- Department for respiratory diseases, University Hospital Centre Zagreb, Zagreb, Croatia
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Jankovic Makek M, Pavlisa G, Jakopovic M, Redzepi G, Zmak L, Vukic Dugac A, Hecimovic A, Mazuranic I, Jaksch P, Klepetko W, Samarzija M. Early onset of nontuberculous mycobacterial pulmonary disease contributes to the lethal outcome in lung transplant recipients: report of two cases and review of the literature. Transpl Infect Dis 2016; 18:112-9. [PMID: 26556693 DOI: 10.1111/tid.12481] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Revised: 09/21/2015] [Accepted: 09/21/2015] [Indexed: 11/29/2022]
Abstract
Lung transplant (LuTx) recipients represent a population at risk of nontuberculous mycobacterial pulmonary disease (NTM-PD). Yet the risk factors, the timing of NTM-PD after transplantation, and the association with allograft dysfunction all remain poorly defined. We report 2 cases of early-onset NTM-PD and review the literature, focusing on NTM-PD in LuTx recipients not colonized with NTM prior to transplantation. In addition, we summarize the main characteristics and differences between early- and late-onset disease.
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Affiliation(s)
- M Jankovic Makek
- Department for Lung Diseases, University Hospital Centre Zagreb, Zagreb, Croatia.,School of Medicine, University of Zagreb, Zagreb, Croatia
| | - G Pavlisa
- Department for Lung Diseases, University Hospital Centre Zagreb, Zagreb, Croatia.,School of Medicine, University of Zagreb, Zagreb, Croatia
| | - M Jakopovic
- Department for Lung Diseases, University Hospital Centre Zagreb, Zagreb, Croatia.,School of Medicine, University of Zagreb, Zagreb, Croatia
| | - G Redzepi
- Department for Lung Diseases, University Hospital Centre Zagreb, Zagreb, Croatia
| | - L Zmak
- National Reference Laboratory for Mycobacteria, National Institute of Health, Zagreb, Croatia
| | - A Vukic Dugac
- Department for Lung Diseases, University Hospital Centre Zagreb, Zagreb, Croatia
| | - A Hecimovic
- Department for Lung Diseases, University Hospital Centre Zagreb, Zagreb, Croatia
| | - I Mazuranic
- School of Medicine, University of Zagreb, Zagreb, Croatia.,Department of Thoracic Radiology, University Hospital Centre Zagreb, Zagreb, Croatia
| | - P Jaksch
- Department of Surgery, Division of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
| | - W Klepetko
- Department of Surgery, Division of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
| | - M Samarzija
- Department for Lung Diseases, University Hospital Centre Zagreb, Zagreb, Croatia.,School of Medicine, University of Zagreb, Zagreb, Croatia
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Hecimovic A, Jakopovic M, Pavlisa G, Jankovic M, Vukic-Dugac A, Redzepi G, Brcic L, Samarzija M, Gupta N. SUCCESSFUL TREATMENT OF PULMONARY AND LYMPHATIC MANIFESTATIONS OF LYMPHANGIOLEIOMYOMATOSIS WITH SIROLIMUS. Lymphology 2015; 48:97-102. [PMID: 26714374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Lymphangioleiomyomatosis (LAM) is a rare, progressive, diffuse cystic lung disease predominantly affecting women of child bearing age. Recently treatment with sirolimus was shown to stabilize lung function decline and improve quality of life in patients with LAM. We treated three premenopausal women suffering from LAM manifesting as diffuse cystic lung disease, chylous effusions, and lymphangioleioyomas with sirolimus (1-3 mg a day; sirolimus trough levels 2.9-8.5 ng/ml). All three patients had a remarkable response to sirolimus, with resolution of effusions, improvement in lung function and shrinking of abdominal lymphangioleiomyomas. Our case series further complements the literature in that sirolimus is a safe and effective treatment for LAM and its lymphatic manifestations.
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