ABSTRACT
We present two cases of patients with systemic autoimmune diseases (one with dermatomyositis and one with CREST syndrome) who presented with a worsening of calcinosis cutis after treatment of osteoporosis with teriparatide. To our knowledge, this association is not described in the literature and might be considered in the spectrum of adverse reactions to teriparatide.
Subject(s)
Bone Density Conservation Agents/adverse effects , Calcinosis/chemically induced , Osteoporosis/drug therapy , Skin Diseases/chemically induced , Teriparatide/adverse effects , Aged , CREST Syndrome/complications , Dermatomyositis/complications , Female , Humans , Middle Aged , Osteoporosis/complicationsABSTRACT
AIM: The aim of this study was to describe a case series of patients with primary or secondary antiphospholipid syndrome (APS) treated with direct oral anticoagulants (DOACs). PATIENTS AND METHODS: Clinical charts of eight patients with thrombotic primary or secondary APS treated with direct oral anticoagulants (DOACs) between January 2012 and May 2015 were reviewed. RESULTS: The mean age was 45 ± 14.36 (range 27-69 years). Four patients had secondary APS (50%). All patients were initially treated with warfarin by a mean time of 70.87 ± 57.32 months (range 17-153 months). Changes in anticoagulation were defined by recurring thrombosis in five patients (62.5%) and life-threatening bleeding in the other three cases. Seven patients (87.5%) received rivaroxaban treatment and one patient (12.5%) apixaban. The mean follow-up period with DOACs was 19 ± 10.06 months (range 2-36 months). There was no recurrence of thrombosis by the time of data collection. CONCLUSIONS: Despite not being the standard treatment in APS, we propose DOACs as a rational alternative for the management of patients with this diagnosis. Further interventional clinical studies are necessary for possible standardization of this therapy in APS patients.
Subject(s)
Anticoagulants/therapeutic use , Antiphospholipid Syndrome/drug therapy , Hemorrhage/chemically induced , Thrombosis/prevention & control , Administration, Oral , Adult , Aged , Anticoagulants/administration & dosage , Anticoagulants/adverse effects , Antiphospholipid Syndrome/complications , Female , Follow-Up Studies , Hemorrhage/epidemiology , Humans , Middle Aged , Pyrazoles/adverse effects , Pyrazoles/therapeutic use , Pyridones/adverse effects , Pyridones/therapeutic use , Recurrence , Retrospective Studies , Rivaroxaban/adverse effects , Rivaroxaban/therapeutic use , Thrombosis/etiology , Treatment Outcome , Warfarin/adverse effects , Warfarin/therapeutic useABSTRACT
Rheumatoid arthritis (RA) is a complex autoimmune disease of recent evolutionary origin. Genetic drift determines diverse polymorphisms implicated in the susceptibility to RA including the major histocompatibility complex (MHC) class II genes in the so-called shared epitope. These genes originated after the divergence between Homo and Pan from their common ancestry Ardipithecus ramidus about 5 million years ago. Natural selection determined the particular changes in the legs (bipedal position), hands, neck, brain and eusociality in humans which influence the clinical presentation of RA. In this article, we hypothesized that the origin and course of RA may be explainable in the light of evolution.
Subject(s)
Arthritis, Rheumatoid/genetics , Arthritis, Rheumatoid/pathology , Chromosomes, Human, Pair 6/genetics , Evolution, Molecular , Genes, MHC Class II/genetics , Models, Biological , Atlanto-Axial Joint/pathology , Genetic Drift , Hand/pathology , Hip/pathology , Humans , Selection, GeneticABSTRACT
New cases of Pneumocystis jirovecii pneumonia (PJP) have recently been reported in patients with systemic lupus erythematosus (SLE) after rituximab therapy. Several factors may contribute to susceptibility to P. jirovecii infection in this type of patients, including the immunological characteristics of the disease, the mechanisms of rituximab action, environmental factors, and the biological characteristics of the fungus. We report two patients with SLE who developed PJP after rituximab therapy.
Subject(s)
Antibodies, Monoclonal, Murine-Derived/adverse effects , Lupus Erythematosus, Systemic/drug therapy , Pneumocystis carinii/isolation & purification , Pneumonia, Pneumocystis/etiology , Anti-Bacterial Agents/therapeutic use , Antibodies, Monoclonal, Murine-Derived/therapeutic use , Fatal Outcome , Female , Humans , Lupus Erythematosus, Systemic/complications , Pneumonia, Pneumocystis/drug therapy , Rituximab , Treatment Outcome , Young AdultABSTRACT
We report an adult female patient with Takayasu arteritis (TA) receiving conventional medical treatment and anti-TNF therapy, which developed progressive thoracic and abdominal aortic aneurysms. She developed imminent rupture of the thoracic aneurysm and an endovascular stent-graft (EVSG) was emergency implanted and a year after this procedure the abdominal aneurysm increased in size requiring reoperation and placement of another EVSG. Both procedures had a very good outcome. This case shows the effectivity and security of multiple EVSG implantations in multiple aortic aneurisms in patients with TA.
Subject(s)
Aortic Aneurysm, Abdominal/surgery , Aortic Aneurysm, Thoracic/surgery , Blood Vessel Prosthesis Implantation/instrumentation , Blood Vessel Prosthesis , Endovascular Procedures/instrumentation , Stents , Takayasu Arteritis/complications , Takayasu Arteritis/drug therapy , Adult , Aortic Aneurysm, Abdominal/diagnosis , Aortic Aneurysm, Abdominal/etiology , Aortic Aneurysm, Thoracic/diagnosis , Aortic Aneurysm, Thoracic/etiology , Aortography/methods , Biological Products/therapeutic use , Female , Humans , Reoperation , Takayasu Arteritis/diagnosis , Takayasu Arteritis/immunology , Tomography, X-Ray Computed , Treatment Outcome , Tumor Necrosis Factor-alpha/antagonists & inhibitorsABSTRACT
Several clinical cases have shown the association of primary hyperparathyroidism and immune conditions related to B-cell hyperactivity. In some of these cases the treatment of hyperparathyroidism led to the resolution of the autoimmune phenomena. Thus, this paper hypothesizes that high levels of parathyroid hormone (PTH) may modify B lymphocytes function and induce the development of autoimmunity mediated by B-cell hyperactivity.
Subject(s)
B-Lymphocytes/immunology , Hyperparathyroidism, Primary/immunology , Humans , Models, Theoretical , Parathyroid Hormone/physiologyABSTRACT
Paracoccidioidomycosis is an endemic South American systemic mycosis caused by the dimorphic fungus Paracoccidioides brasiliensis (P. brasiliensis). The main clinical form of disease is pulmonary, but all organs may be involved. We report a case of overinfection by P. brasiliensis in chronic gouty arthritis affecting the proximal phalanx of the right hallux. The patient required proximal amputation and long-term antifungal therapy.
ABSTRACT
The psychiatric manifestations of three patients with systemic lupus erythematosus (SLE) and neuropathic dysautonomic processes are described. All patients had a severe form of SLE with neurological, renal, articular, pulmonary or haematological manifestations. All three have two types of psychiatric manifestations: (1) a chronic and progressive depression and (2) a complex dissociative disorder during the acute episodes of postural hypotension. A provocative test with SPECT with 99mTc-HmPAO to be done during the episode of orthostatic hypotension may contribute to clinical assessment of complex changes in cerebral regional perfusion.
Subject(s)
Autonomic Nervous System Diseases/etiology , Autonomic Nervous System Diseases/psychology , Lupus Erythematosus, Systemic/complications , Lupus Erythematosus, Systemic/psychology , Adolescent , Autoimmune Diseases of the Nervous System/diagnostic imaging , Autoimmune Diseases of the Nervous System/etiology , Autoimmune Diseases of the Nervous System/psychology , Autonomic Nervous System Diseases/diagnostic imaging , Brain/blood supply , Brain/diagnostic imaging , Cerebrovascular Circulation , Depression/diagnostic imaging , Depression/etiology , Depression/psychology , Dissociative Disorders/diagnostic imaging , Dissociative Disorders/etiology , Dissociative Disorders/psychology , Female , Humans , Hypotension, Orthostatic/diagnostic imaging , Hypotension, Orthostatic/etiology , Hypotension, Orthostatic/psychology , Lupus Erythematosus, Systemic/diagnostic imaging , Radiopharmaceuticals , Technetium Tc 99m Exametazime , Tomography, Emission-Computed, Single-Photon , Young AdultABSTRACT
We report a female patient with rheumatoid arthritis which was refractory to methotrexate, leflunomide, and anti-TNF therapy. She was treated with anti-IL-6 tocilizumab (TCZ), with an early appearance of sterile pustules on erythematous swollen skin of trunk, back, and abdominal area. The lesions were consistent with the diagnosis of acute drug-related generalized exanthematous pustulosis (AGEP). This adverse event was controlled with medical treatment without requiring removal of TCZ.
