AB0786 HUGHES–STOVIN SYNDROME: A PECULIAR AUTOIMMUNE ORIGIN OF PULMONARY ANEURYSMS

Background:

Hughes-Stovin Syndrome (HSS) is a rare potentially fatal vasculitis supposedly belonging to the spectrum of Behçet disease without ocular involvement. HSS tends to play by a temporal pattern, starting with thrombosis and followed by formation of pulmonary aneurysms. Since its mortality can reach 25% of cases, the early recognition and the appropriate therapy represent the major challenges.

Objectives:

In this report, we aimed at describing a rare case of HSS successfully treated in accordance with a prompt combined management with endovascular approach and immunosuppressive treatments.

Methods:

We described a Caucasian 33-year-old man presented to the Emergency Room of our Hospital with hemoptysis associated with dyspnea and chest pain, without fever and hypotension, with a 2-year history of painful genital and oral ulcers. Blood test revealed anemia, elevated white cell count with increased C-reactive protein (77 mg/L) and D-dimer (2740 ng/mL). Doppler ultrasonography of legs showed thrombosis of the left femoral vein, while CT-angiography reported multiple aneurysms of the pulmonary arteries. An early and extensive work-up for infections and autoimmunity did not document relevant abnormalities. An appropriate genetic assessment revealed the HLA-B51 positivity. The patient immediately underwent endovascular embolization with coils and plugs of the largest pulmonary aneurysm, and inferior vena cava filter placement. Then, he started methylprednisolone (1 mg/kg/day) IV for three days in association with LMWH (6000 IU/day). Prednisone (1 mg/kg/day) in combination with cyclophosphamide (100 mg daily) were started orally, with tapering of steroids within a month. At the tight follow up (1 month and 3 months later), no genital and oral ulcers nor vascular thrombosis occurred, and acute phase reactants were in normal range. The 3-month-CT angiography showed a complete resolution of the aneurysms and no new changes.

Results:

The peculiar diagnosis of HLAB51 positive HSS with multiple pulmonary aneurysms was made. The appropriate imaging followed by a prompt endovascular embolization of aneurysms with LMWH treatment were successfully performed. Interestingly, the oral combination therapy with corticosteroid and cyclophosphamide showed a rapid efficacy with a relevant safety profile. At the tight follow up, the young man improved significantly with clinical signs and pulmonary changes (Figure 1 next page).

Conclusion:

This case is of interest because of the early recognition of such a rare disease that allowed an adequate combined radiological, vascular, and rheumatologic approach. In our case, LMWH resulted useful in preventing the pulmonary embolism, despite the use of anticoagulants is still debated in HSS. Moreover, the endovascular embolization let a less invasive approach to surgery without the need for multiple surgical procedures. For the first time, we documented that oral cyclophosphamide showed an early efficacy as a first line therapy of a HLA-B51 HSS.

References:

[1]Keskin M, Polat G, Ayranci A, et al. Insidious Hughes Stovin Syndrome: Journey From Pulmonary Embolism to Pulmonary Arterial Aneurysm. Turk Thorac J. 2020;21:350-353.

[2]Valdés-Corona LF, Kimura-Hayama E, Méndez-Cano VH, et al. Hughes-Stovin syndrome: an uncommon cause of pulmonary aneurysms. Rheumatology (Oxford). 2020;59:2183-2184.

Figure 1.

Disclosure of Interests:

None declared

AB1085 ASSESSMENT OF DIAGNOSTIC DELAY IN PATIENTS AFFECTED BY ENTEROPATHIC SPONDYLOARTHRITIS: A CROSS-SECTIONAL STUDY

Background:

Diagnostic delay of spondyloarthritis (SpA) has been established even in combination with inflammatory bowel disease and may contribute to radiographic progression and disability.

Objectives:

We aimed to evaluate diagnostic delay in enteropathic SpA (eSpA) and explore associated demographic, clinical, and radiographic characteristics.

Methods:

We analysed consecutive eSpA patients referred to the combined gastro-rheumatologic clinic of the University of Rome Tor Vergata. Diagnostic delay was defined as the time interval from the date of first symptoms to the date of diagnosis. Conventional radiography (CR) and magnetic resonance images (MRI) of sacroiliac (SI) joints and spine were performed in axial (ax)SpA patient and examined by two independent radiologists. MRI were assessed for the presence of active/chronic inflammatory lesions, disease activity by ASDAS and inflammatory markers. Statistical analyses were performed using Mann-Whitney, chi square/Fisher tests and covariance analysis (SPSS software).

Results:

190 eSpA patients (124 female, mean age 47.5±12.8 years, disease duration 72±67.4 months, 73 UC/117 CD; 118 peripheral SpA, 72 axSpA including 44 non radiographic (nr)-axSpA) were evaluated. Axial eSpA patients had a higher prevalence of men sex (p<0.0001), HLA-B27 positivity (p=0.004), uveitis (p=0.01) and pancolitis (p<0.006) compared with peripheral eSpA. AxeSpA patients displayed higher ESR, ASDAS, and VAS pain compared with peripheral ESpA (p=0.0006, p=0.001, p=0.019, respectively). A higher prevalence of csDMARDs was detected in peripheral eSpA compared with axSpA (p=0.002) while treatment with cs and bDMARDs was similar in rad-axSpA and nr-axSpA patients.

Median diagnostic delay in eSpA was 48 months (IQR 6-77) with no difference between axial and peripheral patients. Rad-ax-SpA patients displayed a higher diagnostic delay compared with nr-axSpA (median/IQR 36/17-129 vs 31/10-57 months, p=0.03). Patients with rad-axSpA were older and with longer disease duration than patients with nr-axSpA (p=0.005 and p=0.019). Low education status and high rate of employment were found in rad-axSpA compared with nr-axSpA (p=0.003 and p=0.03, respectively).

Rad-axSpA patients with sclerosis, syndesmophytes and bridge at CR had a higher diagnostic delay than those without lesions (p=0.03, p=0.043, p<0.0001, Fig. 1A-C). Men showed a higher prevalence of spine damage lesions than women as sclerosis (p=0.02), squaring (p=0.0006), syndesmophytes (p=0.0028) and bridges (p=0.007). Longer disease duration was detected in patients with radiographic damage as bridge (p<0.0001) and sacroiliitis grade 3 (p=0.04). On MRI, SI bone oedema was associated with reduced diagnostic delay (p=0.04) while bone erosions was associated with higher diagnostic delay (p=0.002) compared with that in patients without these lesions (Fig. 1D-E). Rad-axSpA women had a higher prevalence of SI damage lesions at MRI than men (p=0.001). Patients with psoriasis displayed a higher diagnostic delay compared to those without skin involvement (p=0.004).

Figure 1.

Conclusion:

Demographic and clinical factors differentiate axSpA from nr-axSpA patients. Diagnostic delay was higher in rad-axSpA compared with nr-axSpA despite the same treatment. Some lesions of spine/SI at CR and MRI, and psoriasis, were mostly associated with diagnostic delay and sex.

Disclosure of Interests:

None declared

Deposition of tetraferrocenylporphyrins on ITO surfaces for photo-catalytic O2 activation

Tetraferrocenylporphyrins have been successfully deposited on ITO electrodes for O₂ photo-catalytic activation.