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He Y, Hu L, Qiu W, Zhu L, Zhu X, Hong M. Clinical characteristics and risk factors of Helicobacter pylori infection-associated Sjogren's syndrome. Immun Inflamm Dis 2023; 11:e994. [PMID: 37904694 PMCID: PMC10614117 DOI: 10.1002/iid3.994] [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: 03/26/2023] [Revised: 08/07/2023] [Accepted: 08/16/2023] [Indexed: 11/01/2023] Open
Abstract
OBJECTIVE Although infectious pathogens are predominant factors for inducing and maintaining immune system disorders, there exist few reports establishing the significant correlation between Helicobacter pylori (H. pylori) infection and Sjogren's syndrome. This study aims to demonstrate the correlation between Sjogren's syndrome and H. pylori infection in patients, highlighting various clinical characteristics and risk factors. METHODS A single-center retrospective observational study was conducted in patients (n = 224) admitted from January 1, 2012, to February 10, 2021, in the First Affiliated Hospital of Wenzhou Medical University (Wenzhou, China). All the recruited subjects with Sjogren's syndrome and H. pylori infection were only included by validating the available medical records online. RESULTS In this study, a total of 224 patients from January 1, 2012, to February 10, 2021, were diagnosed with Sjogren's syndrome. Among them, 94 patients (41.96%) with Sjogren's syndrome were infected with H. pylori. Accordingly, the clinical manifestations, serological and immunological characteristics, as well as gastroscopic biopsy outcomes of the recruited patients with primary Sjogren's syndrome (pSS) were reported. The multivariable analysis of the dry syndrome patients infected with H. pylori displayed hypergammaglobulinemia (odds ratio [OR], 0.354; 95% confidence interval [CI], 0.189-0.663), total cholesterol (OR, 1.158; 95% CI, 0.856-1.550), hypertension (OR, 0.227; 95% CI, 0.114-0.455), Female sex (OR, 5.778; 95% CI, 1.458-22.9), anti-SSA/Ro60 positive (OR, 2.384; 95% CI, 233-4.645), γ-GT (OR, 0.99; 95% CI, 0.99-1.00) and alkaline phosphatase (ALP, OR, 1.00; 95% CI, 0.99-1.00) levels. CONCLUSION Together, our findings demonstrated that hypergammaglobulinemia could be the independent risk factors of H. pylori infection in patients with Sjogren's syndrome, requiring the physician's advice in the future.
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Affiliation(s)
- Ye He
- Department of RheumatologyTaizhou Municipal HospitalTaizhouZhejiangPeople's Republic of China
- Department of RheumatologyThe First Affiliated Hospital of Wenzhou Medical UniversityWenzhouZhejiangPeople's Republic of China
| | - Lingzhen Hu
- Department of RheumatologyThe First Affiliated Hospital of Wenzhou Medical UniversityWenzhouZhejiangPeople's Republic of China
| | - Wei Qiu
- Department of DermatologicalThe First Affiliated Hospital of Wenzhou Medical UniversityWenzhouPeople's Republic of China
| | - Lixia Zhu
- Department of RheumatologyThe First Affiliated Hospital of Wenzhou Medical UniversityWenzhouZhejiangPeople's Republic of China
| | - Xiaochun Zhu
- Department of RheumatologyThe First Affiliated Hospital of Wenzhou Medical UniversityWenzhouZhejiangPeople's Republic of China
| | - Mingzhi Hong
- Department of Burn and Plastic SurgeryTaizhou Municipal HospitalTaizhouZhejiangPeople's Republic of China
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Beuvon C, Martin M, Baillou C, Roblot P, Puyade M. Etiologies of Polyclonal Hypergammaglobulinemia: A scoping review. Eur J Intern Med 2021; 90:119-121. [PMID: 34127335 DOI: 10.1016/j.ejim.2021.05.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 05/14/2021] [Accepted: 05/16/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Clément Beuvon
- Service de Médecine Interne, Maladies infectieuses et Tropicales, Centre Hospitalier Universitaire (CHU) de Poitiers, 2, rue de la Milétrie, 86021 Poitiers cedex, France; Université de Poitiers, 6, rue de la Milétrie, TSA 51115, 86073 Poitiers cedex 9, France.
| | - Mickaël Martin
- Service de Médecine Interne, Maladies infectieuses et Tropicales, Centre Hospitalier Universitaire (CHU) de Poitiers, 2, rue de la Milétrie, 86021 Poitiers cedex, France; Université de Poitiers, 6, rue de la Milétrie, TSA 51115, 86073 Poitiers cedex 9, France
| | - Chloé Baillou
- Service de Médecine Interne, Maladies infectieuses et Tropicales, Centre Hospitalier Universitaire (CHU) de Poitiers, 2, rue de la Milétrie, 86021 Poitiers cedex, France
| | - Pascal Roblot
- Service de Médecine Interne, Maladies infectieuses et Tropicales, Centre Hospitalier Universitaire (CHU) de Poitiers, 2, rue de la Milétrie, 86021 Poitiers cedex, France; Université de Poitiers, 6, rue de la Milétrie, TSA 51115, 86073 Poitiers cedex 9, France
| | - Mathieu Puyade
- Service de Médecine Interne, Maladies infectieuses et Tropicales, Centre Hospitalier Universitaire (CHU) de Poitiers, 2, rue de la Milétrie, 86021 Poitiers cedex, France
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Palumbo CS, Wyse J. Markers of systemic and gut-specific inflammation in celiac disease. Turk J Gastroenterol 2020; 31:187-189. [PMID: 32141830 PMCID: PMC7062127 DOI: 10.5152/tjg.2020.19081] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Accepted: 03/22/2019] [Indexed: 06/10/2023]
Affiliation(s)
- Chiara Saroli Palumbo
- Division of Gastroenterology, McGill University Jewish General Hospital, Montreal, Canada
| | - Jonathan Wyse
- Division of Gastroenterology, McGill University Jewish General Hospital, Montreal, Canada
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Gardet A, Chou WC, Reynolds TL, Velez DB, Fu K, Czerkowicz JM, Bajko J, Ranger AM, Allaire N, Kerns HM, Ryan S, Legault HM, Dunstan RW, Lafyatis R, Lukashev M, Viney JL, Browning JL, Rabah D. Pristane-Accelerated Autoimmune Disease in (SWR X NZB) F1 Mice Leads to Prominent Tubulointerstitial Inflammation and Human Lupus Nephritis-Like Fibrosis. PLoS One 2016; 11:e0164423. [PMID: 27760209 PMCID: PMC5070861 DOI: 10.1371/journal.pone.0164423] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Accepted: 09/23/2016] [Indexed: 01/12/2023] Open
Abstract
Mouse models lupus nephritis (LN) have provided important insights into disease pathogenesis, although none have been able to recapitulate all features of the human disease. Using comprehensive longitudinal analyses, we characterized a novel accelerated mouse model of lupus using pristane treatment in SNF1 (SWR X NZB F1) lupus prone mice (pristane-SNF1 mice). Pristane treatment in SNF1 mice accelerated the onset and progression of proteinuria, autoantibody production, immune complex deposition and development of renal lesions. At week 14, the pristane-SNF1 model recapitulated kidney disease parameters and molecular signatures seen in spontaneous disease in 36 week-old SNF1 mice and in a traditional IFNα-accelerated NZB X NZW F1 (BWF1) model. Blood transcriptome analysis revealed interferon, plasma cell, neutrophil, T-cell and protein synthesis signatures in the pristane-SNF1 model, all known to be present in the human disease. The pristane-SNF1 model appears to be particularly useful for preclinical research, robustly exhibiting many characteristics reminiscent of human disease. These include i) a stronger upregulation of the cytosolic nucleic acid sensing pathway, which is thought to be key component of the pathogenesis of the human disease, and ii) more prominent kidney interstitial inflammation and fibrosis, which have been both associated with poor prognosis in human LN. To our knowledge, this is the only accelerated model of LN that exhibits a robust tubulointerstitial inflammatory and fibrosis response. Taken together our data show that the pristane-SNF1 model is a novel accelerated model of LN with key features similar to human disease.
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Affiliation(s)
- Agnes Gardet
- Biogen, Cambridge, Massachusetts, United States of America
- * E-mail: (DR); (AG)
| | - Wei C. Chou
- Biogen, Cambridge, Massachusetts, United States of America
| | | | - Diana B. Velez
- Biogen, Cambridge, Massachusetts, United States of America
| | - Kai Fu
- Biogen, Cambridge, Massachusetts, United States of America
| | | | - Jeffrey Bajko
- Biogen, Cambridge, Massachusetts, United States of America
| | - Ann M. Ranger
- Biogen, Cambridge, Massachusetts, United States of America
| | | | | | - Sarah Ryan
- Biogen, Cambridge, Massachusetts, United States of America
| | | | | | - Robert Lafyatis
- Division of Rheumatology and Clinical Immunology, University of Pittsburgh, Pittsburgh, United States of America
| | | | | | - Jeffrey L. Browning
- Boston University School of Medicine, Department of Microbiology, Boston, United States of America
| | - Dania Rabah
- Biogen, Cambridge, Massachusetts, United States of America
- * E-mail: (DR); (AG)
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Bouzani M, Apostolidis J, Rondogianni D, Harhalakis N, Tsatalas C, Nikiforakis E. Idiopathic Plasmacytic Lymphadenopathy with Polyclonal Gammopathy in a Patient of Western Origin. Int J Surg Pathol 2016; 13:125-6. [PMID: 15735869 DOI: 10.1177/106689690501300121] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Low JT, Hughes P, Lin A, Siebenlist U, Jain R, Yaprianto K, Gray DHD, Gerondakis S, Strasser A, O'Reilly LA. Impact of loss of NF-κB1, NF-κB2 or c-REL on SLE-like autoimmune disease and lymphadenopathy in Fas(lpr/lpr) mutant mice. Immunol Cell Biol 2016; 94:66-78. [PMID: 26084385 DOI: 10.1038/icb.2015.66] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Revised: 05/31/2015] [Accepted: 05/31/2015] [Indexed: 12/27/2022]
Abstract
Defects in apoptosis can cause autoimmune disease. Loss-of-function mutations in the 'death receptor' FAS impair the deletion of autoreactive lymphocytes in the periphery, leading to progressive lymphadenopathy and systemic lupus erythematosus-like autoimmune disease in mice (Fas(lpr/lpr) (mice homozygous for the lymphoproliferation inducing spontaneous mutation)) and humans. The REL/nuclear factor-κB (NF-κB) transcription factors regulate a broad range of immune effector functions and are also implicated in various autoimmune diseases. We generated compound mutant mice to investigate the individual functions of the NF-κB family members NF-κB1, NF-κB2 and c-REL in the various autoimmune pathologies of Fas(lpr/lpr) mutant mice. We show that loss of each of these transcription factors resulted in amelioration of many classical features of autoimmune disease, including hypergammaglobulinaemia, anti-nuclear autoantibodies and autoantibodies against tissue-specific antigens. Remarkably, only c-REL deficiency substantially reduced immune complex-mediated glomerulonephritis and extended the lifespan of Fas(lpr/lpr) mice. Interestingly, compared with the Fas(lpr/lpr) animals, Fas(lpr/lpr)nfkb2(-/-) mice presented with a dramatic acceleration and augmentation of lymphadenopathy that was accompanied by severe lung pathology due to extensive lymphocytic infiltration. The Fas(lpr/lpr)nfkb1(-/-) mice exhibited the combined pathologies caused by defects in FAS-mediated apoptosis and premature ageing due to loss of NF-κB1. These findings demonstrate that different NF-κB family members exert distinct roles in the development of the diverse autoimmune and lymphoproliferative pathologies that arise in Fas(lpr/lpr) mice, and suggest that pharmacological targeting of c-REL should be considered as a strategy for therapeutic intervention in autoimmune diseases.
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Affiliation(s)
- J T Low
- Molecular Genetics of Cancer Division, The Walter and Eliza Hall Institute of Medical Research, Parkville, Victoria, Australia
- Department of Medical Biology, University of Melbourne, Parkville, Victoria, Australia
| | - P Hughes
- Department of Nephrology, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - A Lin
- Molecular Genetics of Cancer Division, The Walter and Eliza Hall Institute of Medical Research, Parkville, Victoria, Australia
| | - U Siebenlist
- Immune Activation Section, Laboratory of Molecular Immunology, National Institute of Allergy and Infectious Diseases, NIH, Bethesda, MD, USA
| | - R Jain
- Molecular Genetics of Cancer Division, The Walter and Eliza Hall Institute of Medical Research, Parkville, Victoria, Australia
- Department of Medical Biology, University of Melbourne, Parkville, Victoria, Australia
| | - K Yaprianto
- Molecular Genetics of Cancer Division, The Walter and Eliza Hall Institute of Medical Research, Parkville, Victoria, Australia
- Department of Medical Biology, University of Melbourne, Parkville, Victoria, Australia
| | - D H D Gray
- Molecular Genetics of Cancer Division, The Walter and Eliza Hall Institute of Medical Research, Parkville, Victoria, Australia
- Department of Medical Biology, University of Melbourne, Parkville, Victoria, Australia
| | - S Gerondakis
- Department of Biochemistry and Molecular Biology, Monash University, Clayton, Victoria, Australia
| | - A Strasser
- Molecular Genetics of Cancer Division, The Walter and Eliza Hall Institute of Medical Research, Parkville, Victoria, Australia
- Department of Medical Biology, University of Melbourne, Parkville, Victoria, Australia
| | - L A O'Reilly
- Molecular Genetics of Cancer Division, The Walter and Eliza Hall Institute of Medical Research, Parkville, Victoria, Australia
- Department of Medical Biology, University of Melbourne, Parkville, Victoria, Australia
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Tanji H, Okada H, Igari R, Yamaguchi Y, Sato H, Takahashi Y, Koyama S, Arawaka S, Wada M, Kawanami T, Wakabayashi K, Kato T. Inflammatory Pseudotumor of the Brain Parenchyma with IgG4 Hypergammaglobulinemia. Intern Med 2016; 55:1911-6. [PMID: 27432102 DOI: 10.2169/internalmedicine.55.5854] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 58-year-old woman with a 1-month history of right hand clumsiness and speaking difficulty was admitted to our hospital. A neurological examination revealed sensory aphasia and right hemiparesis. Her laboratory tests showed elevated serum levels of IgG and IgG4, pancytopenia, and liver dysfunction. The results of the imaging studies of her abdomen were compatible with sclerosing cholangitis. Brain MRI showed extensive signal abnormalities in the left hemisphere on T2-weighted and fluid-attenuated inversion recovery (FLAIR) images, extending from left internal capsule to the cerebral peduncle with an irregularly enhancing lesion in the left parietal lobe. A brain biopsy revealed lymphocyte and plasma cell infiltration and reactive gliosis. Most of the plasma cells were IgG positive; however, IgG4-positive plasma cells were sparsely observed. After the initiation of betamethasone treatment, her symptoms and the brain MRI abnormalities showed significant improvement. The brain biopsy results did not meet the current criteria of IgG4-related disease. This is the first reported case of a tumefactive lesion of the brain parenchyma with serum IgG4 elevation, which was responsive to steroid treatment. The accumulation of a greater number of reports on the pathological investigation of cases of possible IgG4-related disease may help to elucidate the exact role of IgG4 in IgG4-related disorders.
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Affiliation(s)
- Haruko Tanji
- Department of Neurology, Hematology, Metabolism, Endocrinology and Diabetology (DNHMED), Yamagata University School of Medicine, Japan
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Dechavanne C, Cottrell G, Garcia A, Migot-Nabias F. Placental Malaria: Decreased Transfer of Maternal Antibodies Directed to Plasmodium falciparum and Impact on the Incidence of Febrile Infections in Infants. PLoS One 2015; 10:e0145464. [PMID: 26698578 PMCID: PMC4689360 DOI: 10.1371/journal.pone.0145464] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Accepted: 12/03/2015] [Indexed: 12/15/2022] Open
Abstract
The efficacy of mother-to-child placental transfer of antibodies specific to malaria blood stage antigens was investigated in the context of placental malaria infection, taking into account IgG specificity and maternal hypergammaglobulinemia. The impact of the resulting maternal antibody transfer on infections in infants up to the age of 6 months was also explored. This study showed that i) placental malaria was associated with a reduced placental transfer of total and specific IgG, ii) antibody placental transfer varied according to IgG specificity and iii) cord blood malaria IgG levels were similar in infants born to mothers with or without placental malaria. The number of malaria infections was negatively associated with maternal age, whereas it was not associated with the transfer of any malaria-specific IgG from the mother to the fetus. These results suggest that i) malaria-specific IgG may serve as a marker of maternal exposure but not as a useful marker of infant protection from malaria and ii) increasing maternal age contributes to diminishing febrile infections diagnosed in infants, perhaps by means of the transmission of an effective antibody response.
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Affiliation(s)
- Celia Dechavanne
- Institut de Recherche pour le Développement (IRD), UMR 216 Mère et enfant face aux infections tropicales, Université Paris Descartes, Paris, France
- COMUE Sorbonne Paris Cité, Université Paris Descartes, Faculté des Sciences Pharmaceutiques et Biologiques, Paris, France
- * E-mail:
| | - Gilles Cottrell
- Institut de Recherche pour le Développement (IRD), UMR 216 Mère et enfant face aux infections tropicales, Université Paris Descartes, Paris, France
- COMUE Sorbonne Paris Cité, Université Paris Descartes, Faculté des Sciences Pharmaceutiques et Biologiques, Paris, France
| | - André Garcia
- Institut de Recherche pour le Développement (IRD), UMR 216 Mère et enfant face aux infections tropicales, Université Paris Descartes, Paris, France
- COMUE Sorbonne Paris Cité, Université Paris Descartes, Faculté des Sciences Pharmaceutiques et Biologiques, Paris, France
| | - Florence Migot-Nabias
- Institut de Recherche pour le Développement (IRD), UMR 216 Mère et enfant face aux infections tropicales, Université Paris Descartes, Paris, France
- COMUE Sorbonne Paris Cité, Université Paris Descartes, Faculté des Sciences Pharmaceutiques et Biologiques, Paris, France
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Coloma-González I, Ceriotto A, Flores-Preciado J, Corredor-Casas S, Salcedo-Casillas G. [Comparative study of clinical features between unilateral and bilateral orbital IgG4-related disease]. Arch Soc Esp Oftalmol 2015; 90:407-413. [PMID: 25865652 DOI: 10.1016/j.oftal.2015.02.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Revised: 02/09/2015] [Accepted: 02/24/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE Descriptive and comparative study of patients with orbital IgG4-related disease. MATERIAL AND METHODS A review and analysis of the cases diagnosed with inflammatory orbital lesion related to IgG4 by the Ophthalmic Pathology Service in the Dr. Luis Sánchez Bulnes Hospital. RESULTS A total of 9 cases were found, in which 66% were women, and with a mean age of 48 years and time to diagnosis of 2 years. Unilateral involvement was observed in 56% of cases. All the females experienced pain, and there was an optimal response to corticosteroid treatment in 100% of patients who required medical treatment (one case showed spontaneous resolution). In bilateral cases (44%), only 25% were female, and none had pain as a presenting symptom. Furthermore, 25% of these patients required a combination with immunosuppressants to control inflammation. CONCLUSIONS Clinical presentation of patients with unilateral orbital IgG4-related disease differs from those with bilateral involvement.
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Affiliation(s)
- I Coloma-González
- Servicio de Órbita, Párpados y Vía Lagrimal, Hospital Dr. Luis Sánchez Bulnes, Asociación para Evitar la Ceguera IAP, México D.F. México.
| | - A Ceriotto
- Servicio de Órbita, Párpados y Vía Lagrimal, Hospital Dr. Luis Sánchez Bulnes, Asociación para Evitar la Ceguera IAP, México D.F. México
| | - J Flores-Preciado
- Servicio de Órbita, Párpados y Vía Lagrimal, Hospital Dr. Luis Sánchez Bulnes, Asociación para Evitar la Ceguera IAP, México D.F. México
| | - S Corredor-Casas
- Servicio de Órbita, Párpados y Vía Lagrimal, Hospital Dr. Luis Sánchez Bulnes, Asociación para Evitar la Ceguera IAP, México D.F. México
| | - G Salcedo-Casillas
- Servicio de Órbita, Párpados y Vía Lagrimal, Hospital Dr. Luis Sánchez Bulnes, Asociación para Evitar la Ceguera IAP, México D.F. México
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Affiliation(s)
- D Vieluf
- Department of Dermatology, University of Munich, FRG
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Affiliation(s)
- J Ring
- Dermatologische Klinik und Poliklinik, Ludwig-Maximilians University, Munich, FRG
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van Es LA, van den Wall Bake AW, Stad RK, van den Dobbelsteen ME, Bogers MJ, Daha MR. Enigmas in the pathogenesis of IgA nephropathy. Contrib Nephrol 2015; 111:169-75; discussion 175-6. [PMID: 7758338 DOI: 10.1159/000423893] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- L A van Es
- Department of Nephrology, Leiden University, The Netherlands
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Abstract
Autoimmune pancreatitis is a benign fibroinflammatory disease of the pancreas of probable autoimmune origin, which includes 2 different phenotypes: type 1 (lymphoplasmacytic sclerosing pancreatitis) and type 2 (idiopathic duct-centric pancreatitis). Its clinical presentation as obstructive jaundice in patients with a pancreatic mass is common and therefore it must be included in the differential diagnosis of pancreatic neoplasia. Many diagnostic criteria have been described throughout history. The most famous are the HISORT criteria of the Mayo Clinic and the international consensus criteria of 2011. One of the main features of autoimmune pancreatitis is its dramatic response to steroid therapy, without the need for surgical treatment. Knowledge of this disease can dramatically change the management of patients with obstructive jaundice, who would otherwise be subjected to a pancreaticoduodenectomy.
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Affiliation(s)
- Carla Senosiain Lalastra
- Servicio de Aparato Digestivo, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, España.
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Alba MA, Milisenda J, Fernández S, García-Herrera A, Hernández-Rodríguez J, Grau JM, Campo E, Cid MC. Small-vessel vasculitis with prominent IgG4 positive plasma cell infiltrates as potential part of the spectrum of IgG4-related disease: a case report. Clin Exp Rheumatol 2015; 33:S-138-41. [PMID: 26016765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Accepted: 10/03/2014] [Indexed: 06/04/2023]
Abstract
IgG4-related disease (IgG4-RD) is a systemic entity characterised by multiorgan inflammatory lesions with abundant IgG4+ plasma cells, obliterative phlebitis, and storiform fibrosis. Involvement of several organs such as the pancreas, gastrointestinal tract, salivary glands, periorbital tissue and lymph nodes has been described. Up to now, vascular involvement by IgG4-RD has been thought to be essentially confined to large vessels. We present a patient with small-vessel systemic vasculitis involving muscle, peripheral nerve and kidney (glomerulonephritis) in the context of IgG4-RD diagnosed on the basis of elevated serum IgG4+ concentrations and histologically consistent signs in all biopsied tissues. Thoracic and abdominal aortic aneurysms in addition to aortitis, suggestive of large-vessel involvement, were also present. This observation expands the spectrum of vascular involvement in the context of IgG4-RD and supports the inclusion of IgG4-RD in the category of vasculitis associated with systemic disorder.
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Affiliation(s)
- M A Alba
- Vasculitis Research Unit, Department of Autoimmune Diseases, Hospital Clínic, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Barcelona, Spain
| | - J Milisenda
- Department of Internal Medicine, Hospital Clínic, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Barcelona, Spain
| | - S Fernández
- Department of Internal Medicine, Hospital Clínic, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Barcelona, Spain
| | - Ad García-Herrera
- Department of Anatomic Pathology, Hospital Clínic, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Barcelona, Spain
| | - J Hernández-Rodríguez
- Vasculitis Research Unit, Department of Autoimmune Diseases, Hospital Clínic, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Barcelona, Spain
| | - J M Grau
- Department of Internal Medicine, Hospital Clínic, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Barcelona, Spain
| | - E Campo
- Department of Anatomic Pathology, Hospital Clínic, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Barcelona, Spain
| | - M C Cid
- Vasculitis Research Unit, Department of Autoimmune Diseases, Hospital Clínic, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Barcelona, Spain
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Golesic EA, Sheidow TG. An otherwise healthy young man presents with bilateral CRVO as the first sign of hyperviscosity syndrome in the setting of new multiple myeloma. Retin Cases Brief Rep 2015; 9:38-40. [PMID: 25383860 DOI: 10.1097/icb.0000000000000071] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
PURPOSE To report a case of bilateral central retinal vein occlusion as the presenting feature of new onset multiple myeloma in an otherwise healthy man. METHODS A 44-year-old man presented with painless visual changes in his left eye. Ophthalmic examination revealed what appeared to be bilateral central retinal vein occlusion and hematologic assessment resulted in the diagnosis of immunoglobulin G multiple myeloma. RESULTS Initial management was plasma exchange followed by a chemotherapy regimen of cyclophosphamide, bortezomib, and dexamethasone, and subsequent plans for bone marrow transplant. CONCLUSION Hyperviscosity syndrome seems similar to central retinal vein occlusion and may be associated with systemic conditions such as diabetes and atherosclerosis; however, alternative etiologies should be considered in young otherwise healthy individuals. This case underscores the need for diligent and thorough investigations for less common systemic conditions associated with retinal vein occlusions by primary care ophthalmologists.
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Affiliation(s)
- Elizabeth A Golesic
- Department of Ophthalmology, Ivey Eye Institute, Western University, London, Canada
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Abstract
OBJECTIVE Immunoglobulin (Ig) G4-related disease is systemic, and it has been reported that patients with IgG4-related disease complain of symptoms involving numerous organs. However, there are few reports concerning the otologic manifestations of IgG4-related disease. The purpose of this study is to investigate the clinical features of the otologic manifestations in IgG4-related disease. METHODS We recruited 39 consecutive patients diagnosed with IgG4-related disease. Otologic symptoms, laboratory data, and audiogram findings were retrospectively examined. Mucosal tissues from the inferior turbinate were obtained from subjects before treatment. The serum IgG4 and eosinophil levels together with clinical features were analyzed. RESULTS Five of the 39 cases had some otologic symptoms. Otitis media with effusion was present in 2 patients. Sensorineural hearing loss was also present in I patient. Eosinophilic otitis media was present in 2 patients with bilateral rhinosinusitis and bronchial asthma, and elevated serum eosinophil levels. Oral prednisolone was effective in the treatment of IgG4-related disease. CONCLUSION We revealed a new clinical entity associated with the otologic manifestations of IgG4-related disease.
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Malheiro L, Lazzara D, Xerinda S, Pinheiro MD, Sarmento A. Cryptococcal meningoencephalitis in a patient with hyper immunoglobulin M (IgM) syndrome: a case report. BMC Res Notes 2014; 7:566. [PMID: 25155248 PMCID: PMC4152563 DOI: 10.1186/1756-0500-7-566] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Accepted: 08/21/2014] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Cryptococcal meningoencephalitis is an opportunistic infection that predominantly affects immunocompromised patients. Hyper immunoglobulin M syndrome is a primary immunodeficiency syndrome that increases susceptibility to several opportunistic infections. Here, we report a case of cryptococcal meningoencephalitis in the context of hyper immunoglobulin M syndrome, a situation that has been reported very few times and whose management is not clearly defined. We describe our management of this case and the outcome of the patient to help in future similar situations. CASE PRESENTATION The patient is a 19-year-old Caucasian male student diagnosed with X-linked hyper immunoglobulin M syndrome and treated chronically with weekly intravenous immunoglobulin and daily sulfamethoxazole-trimethoprim. He was admitted to the infectious diseases ward because of headache, diplopia and a cerebral-spinal fluid analysis revealing cryptococcal meningoencephalitis. The patient was treated with liposomal amphotericin and flucytosine with a favorable outcome. Maintenance therapy with fluconazole has continued and will be sustained for 6 months following his upcoming bone marrow transplantation. CONCLUSION Monitoring for cryptococcal meningoencephalitis should be considered in patients with primary immunodeficiencies, as clinical manifestations may go unnoticed. In these patients, it is expected that chronic treatment with fluconazole will be the only treatment that will prevent reinfection or reactivation, and therefore should be kept at least until bone marrow transplant, the only curative treatment, is performed. It may, however, lead to intolerable side effects and hepatic toxicity.
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Affiliation(s)
- Luís Malheiro
- />Infectious Disease Department–Nephrology Research Development Unit (FCT-725), Faculty of Medicine, University of Porto, Centro Hospitalar São João, Porto, Portugal
| | - Daniela Lazzara
- />Serviço de Patologia Clínica, Centro Hospitalar São João, Porto, Portugal
| | - Sandra Xerinda
- />Infectious Disease Department–Nephrology Research Development Unit (FCT-725), Faculty of Medicine, University of Porto, Centro Hospitalar São João, Porto, Portugal
| | | | - António Sarmento
- />Infectious Disease Department–Nephrology Research Development Unit (FCT-725), Faculty of Medicine, University of Porto, Centro Hospitalar São João, Porto, Portugal
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Okazaki K. Current concept, diagnosis and pathogenesis of autoimmune pancreatitis as IgG4-related disease. Minerva Med 2014; 105:109-119. [PMID: 24727875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Recently, autoimmune pancreatitis, a pancreatic manifestation of IgG4-related disease (IgG4-RD) has been recognized as a novel clinical entity associated with massive infiltration of IgG4-positive cells. The first international symposium on IgG4-RD endorsed the comprehensive nomenclature as IgG4-RD, which the Japanese research committee supported by the Ministry of Health, Labor and Welfare of Japan proposed in 2009, and proposed the individual nomenclatures for each organ system manifestations and the international pathologic consensus in 2011. In addition to the pathological consensus, the Japanese comprehensive diagnostic criteria (CDC) for IgG4-RD for general use, and several organ specific criteria for the organ specified physicians have been proposed; the International Consensus Diagnostic Criteria and the revised clinical diagnostic criteria in 2011 by Japan Pancreas Society (JPS-2011) for type1 AIP, the Clinical Diagnostic Criteria 2012 for IgG4-sclerosing cholangitis (IgG4-SC-2012), the diagnostic criteria for IgG4-positive Mikulicz's disease by the Japanse Society for Sjogren's syndrome, and Diagnostic criteria for IgG4-related kidney disease by the Japanese Society of Nephrology. Although the pathogenic mechanism still remains unclear, we have proposed a hypothesis of the pathogenic mechanism; abnormal innate and acquired immunity, regulatory T cells, and B cells on abnormal genetic backgrounds may be involved in the development of IgG4-cholangiopathy. Further studies are necessary to clarify the pathogenesis including genetic backgrounds, disease specific antigens, and the role of IgG4.
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Affiliation(s)
- K Okazaki
- Division of Gastroenterology and Hepatology Third Department of Internal Medicine Kansai Medical University, Osaka, Japan -
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Ubetagoyena M, Fernandez Martin M, Gondra Sangroniz L. Xantogranulomatous Pyelonephritis in children. ARCH ESP UROL 2014; 67:214-217. [PMID: 24691047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVE Xanthogranulomatous Pyelonephritis (XP) is a renal chronic inflammatory disease infrequent during childhood produced by the association of long-term urinary tract obstruction with chronic infection. We report the cases of two children diagnosed of XP. METHODS One of them consulted for cloudy urine. Hypergammaglobulinemia with the presence of a homogeneous band in the gamma fraction of the proteinogram stood out among laboratory findings. The other case was diagnosed while performing a urologic ultrasound in the follow up of kidney stone disease. In the latter, the renal inflammation was adhered to the perirenal capsule, colonic splenic flexure and descending colon. Both presented mild proteinuria and hematuria. None of them showed clinical sings of affectation of the general status and their renal function laboratory data as well as the infection markers were normal. RESULTS All the alterations disappeared after performing a nephrectomy of the affected kidney. CONCLUSIONS We present two cases of XP in a group of age rarely affected by this disease that also showed an uncommon presentation for their age. A high rate of suspicion must be held to diagnose and correctly treat this disease because the grade of renal and extra renal damage is closely related with the extension and duration of the disease.
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Affiliation(s)
- M Ubetagoyena
- Seccion de Nefrologia Pediatrica y radiolofia Pediatrica. Hospital Universitario Donostia. San Sebastian.Spain
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Abstract
IgG4-related orbital disease (IgG4-ROD) is a recently described condition that may account for a significant proportion of idiopathic lymphoplasmacytic or sclerotic orbital lesions. This study is the first meta-analysis of published cases and reveals several differences between IgG4-related disease affecting the orbit and that affecting the pancreas. IgG4-ROD affects a slightly younger group of patients, affects men and women approximately equally, is commonly associated with salivary gland lesions, is associated with a relatively higher serum IgG4 and may confer an increased risk of non-Hodgkin Lymphoma. Its pathogenesis may involve an immune response to antigen exposure in the upper aerodigestive tract.
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Affiliation(s)
- Nicholas Andrew
- South Australian Institute of Ophthalmology and Department of Ophthalmology and Visual Sciences, University of Adelaide, Adelaide, South AustraliaInstitute of Medical and Veterinary Science, Department of Surgical Pathology, Adelaide, South Australia
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Ma Z, Xie Y, Wang Y, Ma L, He Y, Zhang Y, Lian J, Guo Y, Jia Z. [Peripheral blood CD4⁺;CXCR5⁺; follicular helper T cells are related to hyperglobulinemia of patients with chronic hepatitis B]. Xi Bao Yu Fen Zi Mian Yi Xue Za Zhi 2013; 29:515-521. [PMID: 23643274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
OBJECTIVE To detect cell frequency and surface markers of peripheral blood CD4⁺;CXCR5⁺;follicular helper T cells (Tfh cells) and analyze the correlation between CD4⁺;CXCR5⁺;Tfh cells and hyperglobulinemia of patients with chronic hepatitis B. METHODS We collected blood samples of 20 HBV infected patients with hyperglobulinemia, 10 chronic HBV infected patients and 10 health volunteers and isolated plasma and peripheral blood mononuclear cells (PBMCs). The percentage of CD4⁺;CXCR5⁺;Tfh cells and the expressions of PD-1, ICOS and CD40L on CD4⁺;CXCR5⁺;Tfh cells were detected by flow cytometry. The levels of CXCL13, IFN-γ and IL-21 in plasma were measured by ELISA. RESULTS Compared with the percentage of CD4⁺;CXCR5⁺;Tfh cells in chronic HBV infected patients (11.9 ± 3.9) and health controls (6.8 ± 3.9), it was higher in HBV infected patients with hyperglobulinemia (22.6 ± 4.7, P<0.05). And in the hyperglobulinemia patients, the expressions of PD-1 and CD40L on CD4⁺;CXCR5⁺;Tfh cells and the levels of CXCL13 and IL-21 in plasma increased, whereas the level of IFN-γ significantly declined (P<0.05). CONCLUSION The results suggest that CD4⁺;CXCR5⁺;Tfh cells may participate in the pathogenesis of hyperglobulinemia during HBV infection.
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Affiliation(s)
- Zhiyuan Ma
- PLA Center for Diagnosis and Treatment of Infectious Diseases, Tangdu Hospital, Fourth Military Medical University, Xi'an 710038, China.
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Mohammadzadeh I, Shahbaznejad L, Wang N, Farhadi E, Aghamohammadi A, Hammarström L, Rezaei N. A novel CD40 ligand mutation in a patient with pneumonia, neutropenia, and hyperimmunoglobulin M phenotype. J Investig Allergol Clin Immunol 2013; 23:50-51. [PMID: 23653974] [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: 06/02/2023] Open
Affiliation(s)
- I Mohammadzadeh
- Non-Communicable Pediatric Diseases Research Center, Babol University of Medical Sciences, Babol, Iran
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Arıkan-Ayyıldız Z, Yuce A, Uslu-Kızılkan N, Demir H, Gürakan F. Hyperimmunoglobulinemia in pediatric patients with Gaucher disease in Southern Brazil. Pediatr Blood Cancer 2012; 59:340. [PMID: 22431267 DOI: 10.1002/pbc.24098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2012] [Accepted: 01/09/2012] [Indexed: 11/11/2022]
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Vairo F, Alegra T, Dornelles A, Mittelstadt S, Netto CBO, Schwartz IVD. Hyperimmunoglobulinemia in pediatric Gaucher patients in Southern Brazil. Pediatr Blood Cancer 2012; 59:339. [PMID: 22457220 DOI: 10.1002/pbc.24091] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2011] [Accepted: 12/29/2011] [Indexed: 11/06/2022]
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Nagai K, Hara Y, Shinkai M, Goto H, Hoshino M, Watanabe K, Yamaguchi N, Kawana A, Ishigatsubo Y, Kaneko T. [A case of IgG4-related disease with deterioration in pulmonary and pituitary involvements during a 10-year clinical course of inflammatory pseudotumor]. Nihon Kokyuki Gakkai Zasshi 2011; 49:922-928. [PMID: 22352054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
A 71-year-old man underwent pleural biopsy due to left pleural effusion and pleural thickening in August, 2001. An inflammatory pseudotumor (IPT) was diagnosed, and therefore systemic oral steroid therapy (prednisolone [PSL] 30 mg/day) was initiated. However, after tapering PSL to 7.5 mg/day, a complication of secondary central diabetes insipidus due to hypophysitis developed in 2008. As his pulmonary condition deteriorated over time and he began to experience exertional dyspnea, he was admitted to our hospital for re-evaluation of the disease in October, 2010. High-resolution CT (HRCT) revealed pulmonary involvements distributed in the interstitium and a high serum IgG4 level (240 mg/dl). Upon re-evaluating the pleural biopsy specimens of the first visit, we found lymphoplasmacytic-type IPT with approximately 10% IgG4-positive plasma cells in the affected areas. After increasing the PSL dose up to 0.6 mg/kg/day, his serum IgG4 levels decreased, his dyspnea improved, and the radiological findings of his pulmonary and pituitary involvements improved. This case was diagnosed as lymphoplasmacytic type IPT which appeared to be highly homologous with IgG4-related disease due to high serum levels of IgG4, pituitary involvements and the observed efficacy of PSL.
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Affiliation(s)
- Kenjiro Nagai
- Respiratory Disease Center, Yokohama City University Medical Center
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Wakamatsu R, Watanabe H, Suzuki K, Suga N, Kitagawa W, Miura N, Nishikawa K, Yokoi T, Banno S, Imai H. Hypocomplementemic urticarial vasculitis syndrome is associated with high levels of serum IgG4: a clinical manifestation that mimics IgG4-related disease. Intern Med 2011; 50:1109-12. [PMID: 21576837 DOI: 10.2169/internalmedicine.50.4515] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 58-year-old Japanese woman presented with recurrent abdominal pain, chronic urticaria, and petechiae on her extremities, and hypocomplementemia, findings that were consistent with hypocomplementemic urticarial vasculitis syndrome (HUVS). A laboratory examination revealed that she had markedly elevated IgG levels (4,448 mg/dL; normal range, 870-1,700 mg/dL) with particularly high IgG4 levels (1,050 mg/dL; normal range, 48-105 mg/dL) and a high IgG4/total IgG ratio (0.22; normal range, 0.02-0.05). A skin biopsy demonstrated leukocytoclastic vasculitis with IgG4 deposition in the vascular lumen and vascular walls. A lymph node biopsy revealed reactive lymphoid hyperplasia with numerous IgG4-positive cells in the perifollicular area, but no sclerotic findings. A chromosomal analysis of an enlarged lymph node, without phytohemagglutinin (PHA) stimulation, demonstrated that one in every three analyzed cells had abnormalities, such as 44, XX, -13, add(15)(p11), -17, -17, and mar.
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Affiliation(s)
- Ryo Wakamatsu
- Department of Internal Medicine, Department of Clinical Pathology, Aichi Medical University School of Medicine, Japan
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Kramer AB, Lebbink HR, van Dijk MCRF, Franssen CFM, Stegeman CA. [From 'malignancy' to IgG4-related systemic disease]. Ned Tijdschr Geneeskd 2011; 155:A3603. [PMID: 22108460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
IgG4-related systemic disease is a new clinical entity with a large variety of clinical symptoms that can affect almost all organs. The best known manifestations are retroperitoneal fibrosis and autoimmune pancreatitis. We present 3 patients aged 71, 83 and 70 years, with malaise, fatigue and swellings suggestive of a malignancy. However, histopathology of these swellings showed infiltration with plasma cells. Increased serum IgG4-levels confirmed the diagnosis 'IgG4-related systemic disease'. All patients responded well to treatment with glucocorticoids. IgG4-related systemic disease is often mistaken for malignancy because of similar presenting symptoms. The diagnosis can easily be confirmed by high serum protein levels, high serum IgG4-levels and infiltrates of IgG4-positive plasma cells. Response to treatment with glucocorticoids is good, as is the prognosis. IgG4-related systemic disease should be part of the differential diagnosis when patients present with malaise, high protein-levels and multi-organ involvement. Rapid diagnosis can prevent unnecessary surgical procedures for malignancy.
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Affiliation(s)
- Andrea B Kramer
- Universitair Medisch Centrum Groningen, Afd. Nefrologie, Groningen, the Netherlands.
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29
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Urbina F, Sudy E. Unilateral and distal subcorneal pustular dermatosis and persistent polyclonal immunoglobulin M hyperimmunoglobulinemia. J Dermatol 2010; 37:907-9. [PMID: 20860743 DOI: 10.1111/j.1346-8138.2010.00889.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Lorenz EC, Sethi S, Poshusta TL, Ramirez-Alvarado M, Kumar S, Lager DJ, Fervenza FC, Leung N. Renal failure due to combined cast nephropathy, amyloidosis and light-chain deposition disease. Nephrol Dial Transplant 2010; 25:1340-3. [PMID: 20061318 DOI: 10.1093/ndt/gfp735] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Elizabeth C Lorenz
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA
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Breda L, Nozzi M, Di Marzio D, De Sanctis S, Gattorno M, Chiarelli F. Recurrent pericarditis in hyper-IgD syndrome. Clin Exp Rheumatol 2009; 27:695. [PMID: 19772809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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Abstract
We report a patient with IgM gammapathy, cryoglobulinemia, Raynaud's phenomena, purpura hyperglobulinemica of the legs and polyneuropathy. Endoneural vasculitis with infiltrations of eosinophilic and neutrophilic granulocytes and an extensive loss or Wallerian degeneration of myelinated nerve fibers were seen on histopathologic examination of a sural nerve biopsy specimen. The microscopic picture differed somewhat from that observed previously in cryoglobulinemic vasculitis. Although vasculitis is most often believed to represent an immunologically mediated lesion, we propose an alternate explanation, namely, that the disease manifestations in the present case were secondary to cold-induced effects of the cryoglobulin on the microcirculation.
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Abstract
Adult Fanconi syndrome has been described as a manifestation of a latent form of myeloma. Since benign monoclonal gammopathy (BMG) is a latent form of myeloma we studied ten patients with this disease with respect to the adult Fanconi syndrome. These patients were selected from a larger group with BMG because of urinary excretion of monoclonal light chains. In no instance could a complete Fanconi syndrome be shown, but one patient, who also had a diabetic nephropathy, had very high levels of urinary beta 2-microglobulins. Two additional patients showed minor features included in the adult Fanconi syndrome. BMG does not seem to be associated with an increased risk of developing adult Fanconi syndrome.
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Forssman O, Björkman G, Hollender A, Englund NE. IgM-producing lymphocytes in peripheral nerve in a patient with benign monoclonal gammopathy. Scand J Haematol 2009; 11:332-5. [PMID: 4777833 DOI: 10.1111/j.1600-0609.1973.tb00137.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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36
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Larsen RA, Solheim BG. Family studies in systemic lupus erythematosus. V. Presence of antinuclear factors (ANTFs) in relatives and spouses of selected SLE probands. Acta Med Scand Suppl 2009; 543:55-64. [PMID: 4124132 DOI: 10.1111/j.0954-6820.1972.tb03617.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Matsui T, Hidaka M, Kawakita T, Inoue Y, Sakai T, Harada N, Takemoto S, Nagakura S, Tsukamoto A, Kiyokawa T, Kawano F. [Serum sickness induced by rituximab infusion; report of two cases with hematological malignancies]. Rinsho Ketsueki 2009; 50:304-308. [PMID: 19404025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
We report 2 cases of serum sickness after rituximab infusion. Case 1 is a patient with Waldenström's macroglobulinemia, and case 2 is a patient with marginal-zone B-cell lymphoma of mucosa-associated lymphoid tissue (MALT) type and Sjögren's syndrome. Both patients had polyclonal hypergammaglobulinemia, were treated with rituximab monotherapy, developed serum sickness between 9 and 17 days after the first rituximab infusion, developed fever and arthralgia, and improved soon after corticosteroid treatment. Serum sickness after rituximab treatment for hematological malignancies is very rare as far as we know. We identified three risk factors of serum sickness after rituximab infusion from previous reports and our cases; administration of rituximab alone, the existence of Sjögren's syndrome, and polyclonal hypergammaglobulinemia.
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Affiliation(s)
- Takahiro Matsui
- Department of Internal Medicine, National Hospital Organization Kumamoto Medical Center, Kumamoto
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Tsuji T, Yamasaki H, Arima N, Tsuda H. [Lymphoplasmacytic lymphoma with a breast tumor and IgG+IgA type biclonal gammopathy]. Rinsho Ketsueki 2009; 50:309-312. [PMID: 19404026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
An 88-year-old female was admitted to our hospital due to a right breast tumor and biclonal gammopathy (IgG-lambda and IgA-lambda). CT scan showed systemic lymphadenopathy. Tumor specimens were comprised of medium-sized atypical lymphocytes. Lymphoepithelial lesions and plasmacytic differentiation were observed. The atypical lymphocytes were positive for CD20, CD79a, Bcl-2, CD5 and negative for CD10, Cyclin D1. Moreover, the cells expressed IgG-lambda or IgA-lambda. We diagnosed the patient's disease as lymphoplasmacytic lymphoma (LPL). Although biclonal gammopathy with IgM elevation has been reported in LPL patients, this is the first case of IgG+IgA type biclonal gammopathy.
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Affiliation(s)
- Takahiro Tsuji
- Division of Hematology and Oncology, Kumamoto City Hospital
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Sugimoto T, Morita Y, Isshiki K, Yamamoto T, Uzu T, Kashiwagi A, Horie M, Asai T. Constrictive pericarditis as an emerging manifestation of hyper-IgG4 disease. Int J Cardiol 2008; 130:e100-1. [PMID: 17727980 DOI: 10.1016/j.ijcard.2007.06.111] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2007] [Accepted: 06/23/2007] [Indexed: 11/28/2022]
Abstract
A 68-year-old Japanese man was admitted for evaluation of right pleural effusion and bilateral leg edema that had progressively worsened over 6 months. As chest computed tomography revealed marked pericardial thickening, we performed a pericardiectomy, resulting in the remarkable improvement of his clinical manifestations. However, pleural fibrosis associated with fever of unknown origin soon developed. An elevated serum level of serum IgG4 and infiltration of IgG4-positive plasma cell in the resected pericardium were identified; thus, our patient might have hyper-IgG4 disease. Our case is the first report describing constrictive pericarditis as an initial manifestation of hyper-IgG4 disease.
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Barge S, Bouchachi A, Bechara C, Lazure T, Assayag P, Lambotte O. Eosinophilia with stroke in a Chinese patient: Kimura's disease complicated with fibroblastic endocarditis, first report. Am J Hematol 2008; 83:432. [PMID: 18418903 DOI: 10.1002/ajh.21121] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Abstract
BACKGROUND Because the tongue is an organ known for its excellent blood supply, ischaemic lingual necrosis is extremely rare within clinical everyday life. Acute lingual circulatory disturbances can result from impairment of venous drainage or more often from ischaemic arterial occlusion. Due to permanent function loss of the tongue, apparent lingual necrosis may lead to severe mutilation of the patient. While vasculitis of the lingual arteries in temporal arteritis is said to be the most frequent causation of tongue necrosis, diagnosing the underlying disease of lingual ischaemia may sometimes be challenging for the clinician. PATIENTS AND METHODS We present the first reported case of a spontaneous lingual necrosis in a patient with rheumatoid arthritis, due to polyclonal gammopathy with extensive hyperviscosity syndrome and local vasculitis. RESULTS Clinical symptoms, diagnosis and therapy of tongue necrosis are presented in a case report. Besides an overview on the disorder of hyperviscosity syndrome, the discussion will illustrate pathogenetic, diagnostic and therapeutic considerations of lingual ischaemia. The international medical literature is reviewed to summarize the causes of tongue necroses that are described up to now. The particular importance of temporal arteritis Horton for the otolaryngologist in general and for the development of lingual necrosis in particular is highlighted. CONCLUSIONS Apart from the presentation of the first reported case of lingual necrosis in rheumatoid hyperviscosity syndrome, the intention of this article is to draw the clinician's attention on the fundamental aspects of lingual ischaemia and of temporal arteritis.
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Affiliation(s)
- J Pfeiffer
- Universitätsklinik für Hals-, Nasen- und Ohrenheilkunde und Poliklinik, Universitätsklinikum Freiburg, Freiburg.
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Arai H, Rino Y, Fujii K, Yamada T, Suganuma N, Yukawa N, Wada N, Nakagishi Y, Imagawa T, Yamanaka S, Nakayama H, Masuda M. [Surgical treatment for pulmonary aspergillosis with hyper immunoglobulin-E syndrome; report of a case]. Kyobu Geka 2007; 60:1122-1125. [PMID: 18018659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
A 6-year-old girl who had been diagnosed as hyper immunoglobulin-E syndrome, was admitted to the department of pediatrics of our institute in May 2006, because of pulmonary aspergillosis. The chest X-ray showed bilateral cavities with niveau and fungus ball in the left middle lung field. In spite of medical treatment by antibiotics and antimycotics, the lesions did not improve. Therefore, bilateral lobectomy was done. After surgery, she needed re-operation twice, because of prolonged air leakage. There are few reports of lung surgery for the patient with the hyper immunoglobulin-E syndrome, and we present our case and review previous 2 case reports in the Japanese literature.
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Affiliation(s)
- Hiromasa Arai
- Department of Surgery, Yokohama City University, Yokohama, Japan
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Abstract
BACKGROUND Childhood interstitial lung disease (ILD) is a spectrum of diseases including many different rare lung conditions. We present a family with an unusual presentation of ILD in association with rheumatologic and immunologic abnormalities. METHODS Eight children with a common father were evaluated for evidence of lung disease in association with rheumatologic findings. All underwent routine history and physical examination, hematologic evaluation, and chest radiography and/or CT scan of the chest. Seven children underwent a more extensive immunologic evaluation. Those who were able underwent pulmonary function testing, and four children underwent lung biopsy. RESULTS Six of eight children with a common father were found to have radiographic findings consistent with ILD. These children also had evidence of autoimmune disease with joint symptoms, alopecia, rheumatoid factor production, and hypergammaglobulinemia. Open-lung biopsy in four children revealed a spectrum of pulmonary lymphoid proliferations ranging from reactive lymphoid hyperplasia to lymphoid interstitial pneumonia. CONCLUSION The findings of ILD and autoimmunity in a kindred of children suggest a novel genetic disorder of autosomal dominant pattern and variable penetrance. Although the precise pathogenesis remains unclear, these cases provide valuable insight into childhood ILD.
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Affiliation(s)
- Heather Thomas
- Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Cincinnati, OH 45267-0564, USA
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Young TY, Jerome D, Gupta S. Hyperimmunoglobulinemia E syndrome associated with coronary artery aneurysms: deficiency of central memory CD4+ T cells and expansion of effector memory CD4+ T cells. Ann Allergy Asthma Immunol 2007; 98:389-92. [PMID: 17458437 DOI: 10.1016/s1081-1206(10)60887-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Hyperimmunoglobulinemia E syndrome is a primary immunodeficiency disorder characterized by elevated IgE levels, recurrent infections, pruritic rash, and skeletal and dental abnormalities. Autosomal dominant, autosomal recessive, and sporadic forms have been described. Coronary artery aneurysms and analysis of central (TCMs) and effector (TEMs) memory T cells have not been previously reported with this syndrome. OBJECTIVE To describe a 30-year-old woman with hyperimmunoglobulinemia E syndrome who was found to have coronary artery aneurysms, deficiency in CD4+ TCMs, and expansion of CD4+ TEMs expressing CD45RA antigen (TEMRAs). METHODS The patient presented to the clinic after hospitalization for chest pain. Coronary angiogram performed during the hospitalization revealed aneurysms in multiple coronary arteries with thrombus formation. In addition, she had a history of recurrent pneumonia, staphylococcal skin abscesses, and a pruritic facial rash. An extensive immunologic evaluation was performed. RESULTS Immunologic studies revealed increased serum IgE levels (13,434 IU/dL), decreased proliferative responses to the soluble recall antigens tetanus toxoid and Candida albicans, and normal responses to mitogens. Analysis of lymphocyte subsets showed a deficiency of CD4+ TEMs and an increase in CD4+ TEMRAs. In addition, a decreased proportion and number of memory B cells and a deficiency in antibody response to pneumococcal antigens were observed. CONCLUSION Hyperimmunoglobulinemia E syndrome may be associated with coronary artery aneurysms and with deficiency in CD4+ TEMs and expansion of CD4+ TEMRAs. Comprehensive immunologic evaluation should be performed in patients with this syndrome.
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Affiliation(s)
- Ted Y Young
- Division of Basic and Clinical Immunology, University of California, Irvine, California, USA
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46
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Nualart Grollmus ZC, Morales Chávez MC, Silvestre Donat FJ. Periodontal disease associated to systemic genetic disorders. Med Oral Patol Oral Cir Bucal 2007; 12:E211-5. [PMID: 17468717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/15/2023] Open
Abstract
A number of systemic disorders increase patient susceptibility to periodontal disease, which moreover evolves more rapidly and more aggressively. The underlying factors are mainly related to alterations in immune, endocrine and connective tissue status. These alterations are associated with different pathologies and syndromes that generate periodontal disease either as a primary manifestation or by aggravating a pre-existing condition attributable to local factors. This is where the role of bacterial plaque is subject to debate. In the presence of qualitative or quantitative cellular immune alterations, periodontal disease may manifest early on a severe localized or generalized basis--in some cases related to the presence of plaque and/or specific bacteria (severe congenital neutropenia or infantile genetic agranulocytosis, Chediak-Higiashi syndrome, Down syndrome and Papillon-Lefévre syndrome). In the presence of humoral immune alterations, periodontal damage may result indirectly as a consequence of alterations in other systems. In connective tissue disorders, bacterial plaque and alterations of the periodontal tissues increase patient susceptibility to gingival inflammation and alveolar resorption (Marfan syndrome and Ehler-Danlos syndrome). The management of periodontal disease focuses on the control of infection and bacterial plaque by means of mechanical and chemical methods. Periodontal surgery and even extraction of the most seriously affected teeth have also been suggested. There are variable degrees of consensus regarding the background systemic disorder, as in the case of Chediak-Higiashi syndrome, where antibiotic treatment proves ineffective; in severe congenital neutropenia or infantile genetic agranulocytosis, where antibiotic prophylaxis is suggested; and in Papillon-Lefévre syndrome, where an established treatment protocol is available.
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Rigante D, Capoluongo E, Bertoni B, Ansuini V, Chiaretti A, Piastra M, Pulitanò S, Genovese O, Compagnone A, Stabile A. First report of macrophage activation syndrome in hyperimmunoglobulinemia D with periodic fever syndrome. ACTA ACUST UNITED AC 2007; 56:658-61. [PMID: 17265501 DOI: 10.1002/art.22409] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
We describe for the first time a case of macrophage activation syndrome in a child with hyperimmunoglobulinemia D with periodic fever syndrome who required intensive care support. Up-regulated monokine production, high serum levels of triglycerides and ferritin, clotting abnormalities with hypofibrinogenemia, and rapidly evolving pancytopenia should alert the clinician to the possible diagnosis of macrophage activation syndrome, even in autoinflammatory diseases characterized basically by the periodic recurrence of unprovoked inflammatory attacks. Bone marrow aspiration showing well-differentiated macrophages phagocytosing hematopoietic elements remains the main tool for a final diagnosis, and cyclosporine is the best strategy for treatment.
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Affiliation(s)
- Donato Rigante
- Department of Pediatric Sciences, Università Cattolica Sacro Cuore, Rome, Italy.
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48
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Affiliation(s)
- Rosa Ramos
- Department of Nephrology, Hospital Universitari de Bellvitge, Dos de Maig 279, 08025 Barcelona.
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49
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Cailliez M, Garaix F, Rousset-Rouvière C, Bruno D, Kone-Paut I, Sarles J, Chabrol B, Tsimaratos M. Anakinra is safe and effective in controlling hyperimmunoglobulinaemia D syndrome-associated febrile crisis. J Inherit Metab Dis 2006; 29:763. [PMID: 17103011 DOI: 10.1007/s10545-006-0408-7] [Citation(s) in RCA: 85] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2006] [Revised: 09/06/2006] [Accepted: 09/19/2006] [Indexed: 11/28/2022]
Abstract
Hyper-IgD and periodic fever syndrome (HIDS) is a hereditary autoinflammatory syndrome, characterized by recurrent inflammatory attacks. Treatment of HIDS is difficult. Recently, the IL-1ra analogue anakinra was reported to be successful in aborting the IgD inflammatory attacks in a vaccination model. We report a clinical case of spectacular reduction of febrile attacks in a severe HIDS patient.
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Affiliation(s)
- M Cailliez
- AP-HM Timone-Enfants, F-13385, Marseilles Cedex 05, France
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50
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Ling JC, Freeman AF, Gharib AM, Arai AE, Lederman RJ, Rosing DR, Holland SM. Coronary artery aneurysms in patients with hyper IgE recurrent infection syndrome. Clin Immunol 2006; 122:255-8. [PMID: 17098478 PMCID: PMC6588833 DOI: 10.1016/j.clim.2006.10.005] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2006] [Revised: 09/22/2006] [Accepted: 10/08/2006] [Indexed: 01/28/2023]
Abstract
Hyper IgE recurrent infection syndrome (HIES, or Job's syndrome) is a primary immunodeficiency characterized by recurrent skin and lung infections, eczema, elevated serum immunoglobulin E (IgE) levels, and various connective tissue and skeletal system abnormalities including characteristic facies, scoliosis, joint hyperextensibility, retained primary dentition, craniosynostosis, osteopenia, and pathologic fractures. We have identified two patients with aneurysmal coronary artery disease. One was a forty-three-year-old man with HIES and coronary artery aneurysms and ectasia identified on cardiac catheterization following myocardial infarction. The other was a 48-year-old man with coronary artery ectasia-aneurysm identified after cardiac catheterization for evaluation of chest pain. Although connective tissue abnormalities are common in HIES, this is the first report of coronary artery aneurysms in HIES. Further studies are necessary to determine the incidence, pathogenesis, and optimal therapy of these arterial abnormalities in HIES.
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Affiliation(s)
- Jennifer C Ling
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892, USA
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