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vasculitis in the elderly

Zaw Min, Raquel R Garcia, Monika Murillo, Jeffrey M Uchin, Nitin Bhanot
Intravenous vancomycin is a widely used antibiotics, but it causes different types of cutaneous hypersensitivity reactions, ranging from maculopapular rash, red-man syndrome, drug rash with eosinophilia and systemic symptoms, IgA bullous dermatosis, leukocytoclastic vasculitis, Stevens-Johnsons syndrome, to IgE-mediated anaphylaxis. We report an elderly patient with the end-stage renal disease presented with diffuse palpable purpura while receiving IV vancomycin therapy for methicillin-resistant Staphylococcus aureus septicemia...
September 25, 2016: Journal of Infection and Chemotherapy: Official Journal of the Japan Society of Chemotherapy
Konstantinos Thomas, Dimitrios Vassilopoulos
PURPOSE OF REVIEW: To review recent evidence for infection rates in patients with systemic vasculitides, the role of specific infectious agents in the pathogenesis of vasculitis and recent breakthroughs in the treatment of virus-associated vasculitides. RECENT FINDINGS: In well designed recent studies, infections were found to be common during the first 6-12 months in patients with anti-neutrophil cytoplasmic antibodies (ANCA)-associated vasculitides (AAV) and giant cell arteritis (GCA) and to contribute significantly to increased mortality during this period...
September 21, 2016: Current Opinion in Rheumatology
Huifang Liu, Jiachuan Xiong, Jun Zhang, Ying Zhang, Ling Nie, Yiqin Wang, Jinghong Zhao
Anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is a life-threatening condition that causes renal failure. Multiple myeloma (MM) is a malignant proliferation of monoclonal plasma cells in the blood that can also cause renal failure. The two diseases have high morbidity and mortality rates in the elderly, with a poor prognosis. A 64-year-old female presented to Xinqiao Hospital (Chonqing, China) with fatigue and a poor appetite that had been apparent for 6 weeks. Laboratory tests revealed a serum creatinine level of 10...
September 2016: Oncology Letters
Yue Chen, Ping Li, Chunli Cui, Aihong Yuan, Kun Zhang, Chen Yu
OBJECTIVE: To explore the clinical characteristics, renal histopathological spectrum and prognostic factors of biopsy-proven kidney diseases in the elderly. METHODS: A retrospective observational study was conducted in elderly patients who had received renal biopsies. Demographic, clinical and pathological data at the time of the biopsy were collected from the medical records. Follow-up records and prognostic factors were studied. RESULTS: The elderly (≥60 years) accounted for 74 of 434 (17...
September 5, 2016: Journal of International Medical Research
Anish Lawrence, Madhu Nagappa, Anita Mahadevan, Arun B Taly
OBJECTIVE: To describe clinical, electrophysiological, and histopathological profile of vasculitic neuropathy in elderly subjects aged 65 years or more. DESIGN: Retrospective chart review. SETTING: Departments of Neurology and Neuropathology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India. PATIENTS AND METHODS: Elderly subjects, diagnosed vasculitic neuropathy by nerve biopsy over one decade, were studied...
July 2016: Annals of Indian Academy of Neurology
Juliana Bordignon Draibe, Xavier Fulladosa, Josep Maria Cruzado, Joan Torras, Alan David Salama
Anti-neutrophil cytoplasm antibody (ANCA)-associated vasculitis (AAV) is characterized by a variable disease course, with up to 50% of patients having one relapse within 5 years and many progressing to end-stage organ damage despite modern treatment strategies. Moreover, complications arising from treatment dominate the causes of mortality and morbidity both early and late during disease, especially in the elderly and those with severe renal involvement, and there is additional uncertainty as to how long treatment should be continued...
August 2016: Clinical Kidney Journal
Liwei Jia, Marta Couce, Jill S Barnholtz-Sloan, Mark L Cohen
Temporal arteritis peaks during the 8th decade, affecting patients with frequent comorbidities who are especially prone to adverse effects of corticosteroid therapy. Perivascular inflammation involving small periadventitial vessels is not uncommon in otherwise normal temporal artery biopsies (TAB). As ischemic events occur in patients with non-temporal artery based inflammation, it has been recommended any vascular inflammation within temporal artery biopsies be treated with corticosteroids. We sought to determine whether such patients are at increased risk for temporal arteritis-like adverse events compared with age-matched controls devoid of inflammatory infiltrates...
July 18, 2016: Human Pathology
Parminder K Judge, Michael E Reschen, Richard Haynes, Edward J Sharples
BACKGROUND/AIMS: Anti-neutrophil cytoplasmic autoantibody-associated vasculitis (AAV) is a cause of biopsy-proven acute kidney injury, more common in the elderly. Treatment requires immunosuppression, which can have significant toxic effects. The aim of this study was to assess whether morbidity and mortality that are associated with immunosuppression for AAV varied with age. METHODS: A retrospective review of 232 patients given induction therapy with prednisolone and cyclophosphamide was conducted...
2016: Nephron
Jem Ninan, Susan Lester, Catherine Hill
Giant cell arteritis (GCA) is the most common vasculitis of the elderly. The diagnosis can be challenging at times because of the limitation of the American Rheumatology Association (ARA) classification criteria and the significant proportion of biopsy-negative patients with GCA. We discuss the role of advanced imaging techniques, including positron emission tomography (PET) scanning, in establishing diagnosis and improved histopathology techniques to improve the sensitivity of temporal artery biopsy. There have been significant advances in the understanding of the pathogenesis of GCA, particularly the role of cytokine pathways such as the interleukins, IL-6-IL-17 axis, and the IL-12-interferon-γ axis and their implication for new therapies...
February 2016: Best Practice & Research. Clinical Rheumatology
Kornelia Böhler
Venous disorders causing a permanent increase in venous pressure are by far the most frequent reason for ulcers of the lower extremity. With a prevalence of 1 % in the general population rising to 4 % in the elderly over 80 and its chronic character, 1 % of healthcare budgets of the western world are spent on treatment of venous ulcers. A thorough investigation of the underlying venous disorder is the prerequisite for a differenciated therapy. This should comprise elimination of venous reflux as well as local wound management...
June 2016: Wiener Medizinische Wochenschrift
Yoshiyuki Abe, Naoto Tamura, Kwang-Seok Yang, Joe Matsuoka, Takayuki Kon, Ken Yamaji, Hiroshi Hashimoto, Hiroshi Tsuda, Yoshinari Takasaki
PURPOSE: To determine mortality and its predictive factors in elderly Japanese patients with severe microscopic polyangiitis (MPA). METHOD: This retrospective single-center study determined the mortality of 52 patients with MPA who were admitted to our geriatric medical center from 2002 to 2014. The variables at baseline, including patient demographics, clinical characteristics, and treatment, were analyzed for their association with mortality. RESULT: Mean age at onset of MPA was 73...
July 11, 2016: Modern Rheumatology
C A Moura, M Santiago, J Neto, V H Gomes de Souza, C Geraldo Moura
The relationship between primary hematologic disease and rheumatologic manifestations is well known, especially acute lymphocytic leukemia, lymphomas, plasma cell dyscrasias and myelodysplastic syndrome (MDS). Currently, more has been described about autoimmune manifestations in chronic myelomonocytic leukemia (CMML). Many different clinical scenarios may lead a patient with MDS/CMML initially to seek a rheumatological unit. Autoimmune features such as polymyalgia rheumatic symptoms, myositis, neutrophilic dermatosis, cutaneous vasculitis and positive antinuclear antibodies (ANA) are some examples of clinical presentation of MDS/CMML...
June 30, 2016: Lupus
Qi Wang, Mirjan M van Timmeren, Arjen H Petersen, Jun Yuan, Jill Moser, Elisabeth Brouwer, Johanna Westra, AnneMieke M H Boots, Peter Heeringa
BACKGROUND: Anti-neutrophil cytoplasmic antibody associated vasculitis (AAV) is a typical disease of the elderly. In AAV, there is an age-specific increase in disease incidence with age being a predictor of disease outcome. In this study, we aimed to determine the contribution of age to the development of AAV employing a mouse model of anti-myeloperoxidase (MPO) antibody-mediated glomerulonephritis. METHODS: Anti-MPO IgG and lipopolysaccharide (LPS)-mediated glomerulonephritis was induced in 3- and 18-month-old C57Bl6 mice...
May 26, 2016: Nephrology, Dialysis, Transplantation
Don Gilden, Maria A Nagel
PURPOSE OF REVIEW: Giant cell arteritis (GCA) is a severe form of vasculitis in the elderly. The recent discovery of varicella zoster virus (VZV) in the temporal arteries and adjacent skeletal muscle of patients with GCA, and the rationale and strategy for antiviral and corticosteroid treatment for GCA are reviewed. RECENT FINDINGS: The clinical features of GCA include excruciating headache/head pain, often with scalp tenderness, a nodular temporal arteries and decreased temporal artery pulsations...
July 2016: Current Opinion in Rheumatology
Ukamaka Nwadibia, Eric Larson, Joseph Fanciullo
Polymyalgia rheumatic (PMR) and giant cell arteritis (GCA) are two rheumatological conditions with significant overlap that typically affect the older white population. PMR is the most common inflammatory rheumatic disease of the elderly and shares many pathogenetic and epidemiological features with GCA. Diagnosis is made primarily on clinical grounds with supporting laboratory evidence. Typical symptoms of PMR are bilateral aching of the shoulders and pelvic girdle associated with stiffness. PMR is associated with GCA and is considered to be on a disease continuum...
March 2016: South Dakota Medicine: the Journal of the South Dakota State Medical Association
David A Cabral, Debra L Canter, Eyal Muscal, Kabita Nanda, Dawn M Wahezi, Steven J Spalding, Marinka Twilt, Susanne M Benseler, Sarah Campillo, Sirirat Charuvanij, Paul Dancey, Barbara A Eberhard, Melissa E Elder, Aimee Hersh, Gloria C Higgins, Adam M Huber, Raju Khubchandani, Susan Kim, Marisa Klein-Gitelman, Mikhail M Kostik, Erica F Lawson, Tzielan Lee, Joanna M Lubieniecka, Deborah McCurdy, Lakshmi N Moorthy, Kimberly A Morishita, Susan M Nielsen, Kathleen M O'Neil, Andreas Reiff, Goran Ristic, Angela B Robinson, Angelyne Sarmiento, Susan Shenoi, Mary B Toth, Heather A Van Mater, Linda Wagner-Weiner, Jennifer E Weiss, Andrew J White, Rae S M Yeung
OBJECTIVE: To uniquely classify children with microscopic polyangiitis (MPA), to describe their demographic characteristics, presenting clinical features, and initial treatments in comparison to patients with granulomatosis with polyangiitis (Wegener's) (GPA). METHODS: The European Medicines Agency (EMA) classification algorithm was applied by computation to categorical data from patients recruited to the ARChiVe (A Registry for Childhood Vasculitis: e-entry) cohort, with the data censored to November 2015...
October 2016: Arthritis & Rheumatology
Susan Lester, Alex W Hewitt, Carlee D Ruediger, Linda Bradbury, Elisabeth De Smit, Michael D Wiese, Rachel Black, Andrew Harrison, Graeme Jones, Geoffrey O Littlejohn, Tony R Merriman, Bain Shenstone, Malcolm D Smith, Maureen Rischmueller, Matthew A Brown, Catherine L Hill
Giant cell arteritis (GCA) is one of the commonest forms of vasculitis in the elderly, and may result in blindness and stroke. The pathogenesis of GCA is not understood, although environmental, infectious and genetic risk factors are implicated. One gene of interest is PTPN22, encoding lymphoid protein tyrosine phosphatase (Lyp), expressed exclusively in immune cells, which is proposed to be an 'archetypal non-HLA autoimmunity gene'. The minor allele of a functional PTPN22 single nucleotide polymorphism (rs2476601, R620W), which disrupts an interaction motif in the protein, was originally reported to be associated with biopsy-proven GCA in Spanish patients, with supporting data from three replicate Northern European studies...
2016: RMD Open
S Ludwig-Béal, N Vernier, L Popitean, L Levêque, S Combret, P Manckoundia
Even though digoxin causes many side effects, few cases of skin involvement are recorded in the French Pharmacovigilance Database. We report a case of leukocytoclastic vasculitis (LV) very probably due to digoxin. A 91-year-old woman, hospitalized following a fall, presented cardiac decompensation in a context of rapid atrial fibrillation requiring treatment with digoxin. Eight days later, a rash appeared on her back and trunk. It was neither itchy, nor painful and persisted despite local treatment. There were no other clinical anomalies...
May 2016: Journal des Maladies Vasculaires
Don Gilden, Maria A Nagel
PURPOSE OF REVIEW: Giant cell arteritis (GCA) is a serious disease and the most common cause of vasculitis in the elderly. Here, studies describing the recent discovery of varicella zoster virus (VZV) in the temporal arteries of patients with GCA are reviewed. RECENT FINDINGS: GCA is characterized by severe headache/head pain and scalp tenderness. Many patients also have a history of vision loss, jaw claudication, polymyalgia rheumatica, fever, night sweats, weight loss, and fatigue...
June 2016: Current Opinion in Infectious Diseases
Aishwarya Sukhdeo, James Bertouch
Gynceological involvement in antineutrophil cytoplasmic antibody (ANCA)-associated vasculitides is rare. We describe a case of ANCA-associated vasculitis in an elderly woman presenting with fevers, cough and a rash. Further investigations revealed vasculitic involvement of the ovaries, fallopian tubes, uterus and omentum with an eosinophil-rich infiltrate.
September 2016: International Journal of Rheumatic Diseases
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