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Nature Reviews. Rheumatology Sep 2017First described in the early 1980s, antiphospholipid syndrome (APS) is a unique form of acquired autoimmune thrombophilia in which patients present with clinical... (Review)
Review
First described in the early 1980s, antiphospholipid syndrome (APS) is a unique form of acquired autoimmune thrombophilia in which patients present with clinical features of recurrent thrombosis and pregnancy morbidity and persistently test positive for the presence of antiphospholipid antibodies (aPL). At least one clinical (vascular thrombosis or pregnancy morbidity) and one lab-based (positive test result for lupus anticoagulant, anticardiolipin antibodies and/or anti-β2-glycoprotein 1 antibodies) criterion have to be met for a patient to be classified as having APS. However, the clinical spectrum of APS encompasses additional manifestations that can affect many organs and cannot be explained exclusively by patients being in a prothrombotic state; clinical manifestations not listed in the classification criteria (known as extra-criteria manifestations) include neurologic manifestations (chorea, myelitis and migraine), haematologic manifestations (thrombocytopenia and haemolytic anaemia), livedo reticularis, nephropathy and valvular heart disease. Increasingly, research interest has focused on the development of novel assays that might be more specific for APS than the current aPL tests. This Review focuses on the current classification criteria for APS, presenting the role of extra-criteria manifestations and lab-based tests. Diagnostic approaches to difficult cases, including so-called seronegative APS, are also discussed.
Topics: Antibodies, Antiphospholipid; Antiphospholipid Syndrome; Diagnostic Tests, Routine; Female; Humans; Male; Needs Assessment; Sensitivity and Specificity; Severity of Illness Index
PubMed: 28769114
DOI: 10.1038/nrrheum.2017.124 -
Journal of Clinical Immunology Jul 2018Deficiency of ADA2 (DADA2) is the first molecularly described monogenic vasculitis syndrome. DADA2 is caused by biallelic hypomorphic mutations in the ADA2 gene that... (Review)
Review
Deficiency of ADA2 (DADA2) is the first molecularly described monogenic vasculitis syndrome. DADA2 is caused by biallelic hypomorphic mutations in the ADA2 gene that encodes the adenosine deaminase 2 (ADA2) protein. Over 60 disease-associated mutations have been identified in all domains of ADA2 affecting the catalytic activity, protein dimerization, and secretion. Vasculopathy ranging from livedo reticularis to polyarteritis nodosa (PAN) and life-threatening ischemic and/or hemorrhagic stroke dominate the clinical features of DADA2. Vasculitis and inflammation can affect many organs, explaining the intestinal, hepatological, and renal manifestations. DADA2 should be primarily considered in patients with early-onset fevers, rashes, and strokes even in the absence of positive family history. Hematological manifestations include most commonly hypogammaglobulinemia, although pure red cell aplasia (PRCA), immune thrombocytopenia, and neutropenia have been increasingly reported. Thus, DADA2 may unify a variety of syndromes previously not thought to be related. The first-line treatment consists of TNF-inhibitors and is effective in controlling inflammation and in preserving vascular integrity. Hematopoietic stem cell transplantation (HSCT) has been successful in a group of patients presenting with hematological manifestations. ADA2 is highly expressed in myeloid cells and plays a role in the differentiation of macrophages; however, its function is still largely undetermined. Deficiency of ADA2 has been linked to an imbalance in differentiation of monocytes towards proinflammatory M1 macrophages. Future research on the function of ADA2 and on the pathophysiology of DADA2 will improve our understanding of the condition and promote early diagnosis and targeted treatment.
Topics: Adenosine Deaminase; Animals; Combined Modality Therapy; Disease Management; Genetic Association Studies; Genetic Predisposition to Disease; Humans; Intercellular Signaling Peptides and Proteins; Mutation; Phenotype; Quantitative Trait Loci; Treatment Outcome; Vasculitis
PubMed: 29951947
DOI: 10.1007/s10875-018-0525-8 -
Dermatology (Basel, Switzerland) 2021Coronavirus disease-19 (COVID-19) is an ongoing global pandemic caused by the "severe acute respiratory syndrome coronavirus 2" (SARS-CoV-2), which was isolated for the... (Review)
Review
BACKGROUND
Coronavirus disease-19 (COVID-19) is an ongoing global pandemic caused by the "severe acute respiratory syndrome coronavirus 2" (SARS-CoV-2), which was isolated for the first time in Wuhan (China) in December 2019. Common symptoms include fever, cough, fatigue, dyspnea and hypogeusia/hyposmia. Among extrapulmonary signs associated with COVID-19, dermatological manifestations have been increasingly reported in the last few months.
SUMMARY
The polymorphic nature of COVID-19-associated cutaneous manifestations led our group to propose a classification, which distinguishes the following six main clinical patterns: (i) urticarial rash, (ii) confluent erythematous/maculopapular/morbilliform rash, (iii) papulovesicular exanthem, (iv) chilblain-like acral pattern, (v) livedo reticularis/racemosa-like pattern, (vi) purpuric "vasculitic" pattern. This review summarizes the current knowledge on COVID-19-associated cutaneous manifestations, focusing on clinical features and therapeutic management of each category and attempting to give an overview of the hypothesized pathophysiological mechanisms of these conditions.
Topics: Acrodermatitis; COVID-19; Exanthema; Humans; Livedo Reticularis; Patient Acuity; Purpura; SARS-CoV-2; Urticaria
PubMed: 33232965
DOI: 10.1159/000512932 -
Revista Brasileira de Reumatologia Feb 2016Livedoid vasculopathy is a chronic and painful skin disease that progresses to ulceration. Due to its uncertain pathogenesis, there is no single effective treatment for...
Livedoid vasculopathy is a chronic and painful skin disease that progresses to ulceration. Due to its uncertain pathogenesis, there is no single effective treatment for this condition, and current therapeutic options are based on isolated case reports, or on case series. We report a case of a female patient with livedoid vasculopathy, which achieved excellent healing of lower limb ulcers after using an anti-TNF agent.
PubMed: 26952873
DOI: 10.1016/j.rbr.2015.09.011 -
Dermatology Online Journal Dec 2013Livedo reticularis (LR) is a net-like, violaceous, hyperpigmented pattern on the skin that reflects an underlying change in cutaneous blood flow. The causes of LR are...
Livedo reticularis (LR) is a net-like, violaceous, hyperpigmented pattern on the skin that reflects an underlying change in cutaneous blood flow. The causes of LR are many and most commonly include connective tissue diseases, vasculitis, hypercoagulability, and embolic events. We describe a 49-year-old man who presented with painful LR and ulcers on the lower extremities as a manifestation of chronic natural killer cell leukemia (CNKL). There have been only a few cases previously reported in the literature. We report an additional case of a patient with both LR and CNKL and suggest a possible mechanism that explains this association.
Topics: Humans; Killer Cells, Natural; Leukemia, Lymphoid; Livedo Reticularis; Male; Middle Aged; Skin Ulcer; Vasculitis
PubMed: 24364996
DOI: No ID Found -
Arthritis and Rheumatism Apr 2002To analyze the clinical and immunologic manifestations of antiphospholipid syndrome (APS) in a large cohort of patients and to define patterns of disease expression.
OBJECTIVE
To analyze the clinical and immunologic manifestations of antiphospholipid syndrome (APS) in a large cohort of patients and to define patterns of disease expression.
METHODS
The clinical and serologic features of APS (Sapporo preliminary criteria) in 1,000 patients from 13 European countries were analyzed using a computerized database.
RESULTS
The cohort consisted of 820 female patients (82.0%) and 180 male patients (18.0%) with a mean +/- SD age of 42 +/- 14 years at study entry. "Primary" APS was present in 53.1% of the patients; APS was associated with systemic lupus erythematosus (SLE) in 36.2%, with lupus-like syndrome in 5.0%, and with other diseases in 5.9%. A variety of thrombotic manifestations affecting the majority of organs were recorded. A catastrophic APS occurred in 0.8% of the patients. Patients with APS associated with SLE had more episodes of arthritis and livedo reticularis, and more frequently exhibited thrombocytopenia and leukopenia. Female patients had a higher frequency of arthritis, livedo reticularis, and migraine. Male patients had a higher frequency of myocardial infarction, epilepsy, and arterial thrombosis in the lower legs and feet. In 28 patients (2.8%), disease onset occurred before age 15; these patients had more episodes of chorea and jugular vein thrombosis than the remaining patients. In 127 patients (12.7%), disease onset occurred after age 50; most of these patients were men. These patients had a higher frequency of stroke and angina pectoris, but a lower frequency of livedo reticularis, than the remaining patients.
CONCLUSION
APS may affect any organ of the body and display a broad spectrum of manifestations. An association with SLE, the patient's sex, and the patient's age at disease onset can modify the disease expression and define specific subsets of APS.
Topics: Adolescent; Adult; Age Distribution; Aged; Aged, 80 and over; Antiphospholipid Syndrome; Autoantibodies; Child; Child, Preschool; Cohort Studies; Diagnosis, Differential; Female; Humans; Infant; Infant, Newborn; Lupus Vasculitis, Central Nervous System; Male; Middle Aged; Prevalence; Sex Distribution
PubMed: 11953980
DOI: 10.1002/art.10187 -
Biomedical Papers of the Medical... Dec 2022Although symptoms of pancreatic diseases such as pancreatitis, acute and chronic and, carcinoma of the pancreas are mainly gastrointestinal in nature, the... (Review)
Review
Although symptoms of pancreatic diseases such as pancreatitis, acute and chronic and, carcinoma of the pancreas are mainly gastrointestinal in nature, the extra-pancreatic symptoms are also important. These include skin symptoms, such as pancreatic panniculitis, acanthosis nigricans, livedo reticularis, necrolytic migratory erythema, cutaneous signs of hemorrhage, as in persons with severe acute pancreatitis, or the finding of cutaneous metastases of pancreatic carcinoma, which may be a sign of advanced disease. The pancreas is therefore one of those organs for which diagnosis and therapy are often multidisciplinary. In this review article, we summarize current knowledge of the possible skin manifestations of pancreatic disorders.
Topics: Humans; Acute Disease; Pancreatitis; Pancreatic Diseases; Skin Diseases; Skin; Pancreatic Neoplasms
PubMed: 35938387
DOI: 10.5507/bp.2022.035 -
International Journal of Women's... Sep 2020Coronaviridae (CoV) is a large family of zoonotic viruses linked to a range of diseases from the common cold to severe acute and Middle East respiratory syndrome CoV... (Review)
Review
Coronaviridae (CoV) is a large family of zoonotic viruses linked to a range of diseases from the common cold to severe acute and Middle East respiratory syndrome CoV epidemics. In 2019, a novel virus emerged from Wuhan, China, and resulted in a marked worldwide outbreak of respiratory illness. Prevention and containment became the prioritized intervention against COVID-19, coupled with a continued search for hallmarks of the disease that would allow early detection and provide insight into management and triage. Cutaneous findings associated with COVID-19 include diffuse maculopapular rashes, livedo reticularis, and acro-ischemic "COVID toes." These skin findings occurred anywhere from days before respiratory symptom onset to weeks after recovery, and predominantly in child and adolescent populations. The role of dermatologists can be expanded during this COVID-19 pandemic to help identify disease through cutaneous presentations.
PubMed: 32838013
DOI: 10.1016/j.ijwd.2020.06.006 -
The Israel Medical Association Journal... Feb 2015Livedo reticularis is a common cutaneous manifestation of APS and may be a prognostic marker of more severe disease. It is associated with arterial and venous thrombosis... (Review)
Review
Livedo reticularis is a common cutaneous manifestation of APS and may be a prognostic marker of more severe disease. It is associated with arterial and venous thrombosis and pregnancy morbidity irrespective of the presence of antiphospholipid antibodies. Recent results suggest the possibility of an association with accelerated atherosclerosis in patients with livedo. Given the similarities between APS and livedo (aPL negative), experts in this field believe that livedo may represent the so-called seronegative antiphospholipid syndrome, although the exact relationship of livedo with seronegative APS remains to be elucidated. LV may present as painful cutaneous ulcers that are often difficult to treat. The underlying pathology involves prothrombotic as well as immunological processes with some overlap with APS. Treatment remains challenging and results are often variable.
Topics: Adult; Antibodies, Anticardiolipin; Antibodies, Antiphospholipid; Antiphospholipid Syndrome; Atherosclerosis; Diagnosis, Differential; Disease Management; Female; Humans; Livedo Reticularis; Pregnancy; Pregnancy Complications; Prognosis; Thrombosis
PubMed: 26223086
DOI: No ID Found