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Pregled bibliografske jedinice broj: 462135

Reactive macrophage activation syndrome in a patient with parvovirus B19 infection, lymphocytic lichenoid vasculitis, urticaria and angioedema


Soldo-Jureša, Dragica; Radman, Maja; Pejša, Vlatko; Božikov, Velimir
Reactive macrophage activation syndrome in a patient with parvovirus B19 infection, lymphocytic lichenoid vasculitis, urticaria and angioedema // Annals of Saudi medicine, 30 (2010), 1; 88-89 doi:10.4103/0256-4947.59371 (podatak o recenziji nije dostupan, prikaz, stručni)


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Naslov
Reactive macrophage activation syndrome in a patient with parvovirus B19 infection, lymphocytic lichenoid vasculitis, urticaria and angioedema

Autori
Soldo-Jureša, Dragica ; Radman, Maja ; Pejša, Vlatko ; Božikov, Velimir

Izvornik
Annals of Saudi medicine (0256-4947) 30 (2010), 1; 88-89

Vrsta, podvrsta i kategorija rada
Radovi u časopisima, prikaz, stručni

Ključne riječi
reactive macrophage activation syndrome; parvovirus B19 infection; lymphocytic lichenoid vasculitis; urticaria; angioedema

Sažetak
47-year-old woman had a history of episodic acute intermittent angioedema and urticaria with moderate pruritus for one month. She was on 10 mg of loratadine daily. She had a fever of 39ºC, arthralgia, fatigue, and angioedema of the upper respiratory tract. Laboratory results are shown in [Table 1]. She had elevated IgE (206 kU/L). The immunoassay for C1-esterase inhibitor was normal. She was treated with H1- and H2-blocking antihistamines, and methylprednisolone intravenously (1 mg/kg/day). Culture results and viral titers were negative except for a high positive titer of specific IgG antibody to parvovirus B19 of 11.1 (positive titer >1). On the third week of hospitalization, she deteriorated rapidly and developed a macular rash on the trunk and extremities with generalised lymphadenpathy, liver dysfunction and disseminated intravascular coagulopathy (DIC) [Figure 1]. A skin biopsy specimen was compatible with lymphocytic lichenoid vasculitis. An inflammatory pattern centered on the basal layer of the epidermis and upper dermis in a dense band-like distribution. Direct immunofluorescence showed no IgG, IgA, IgM, C3, C1q and fibrinogen deposits. A bone marrow aspirate showed hemophagocytosis [Figure 2]. Parvovirus B19 DNA was detected by the polymerase chain reaction (PCR) in bone marrow [Figure 3]. Macrophage activation syndrome was confirmed. The patient was treated with methylprednisolone 250 mg/day intravenously and intravenous immunoglobulin (IVIG) 0.55 g/kg BW/day for five consecutive days, followed by methylprednisolone 1 mg/kg daily. Fresh frozen plasma and enoxaparin were administered. Two days after treatment, she improved. Monthly infusions of IVIG were continued for 6 months. Corticosteroids were tapered gradually to 8 mg of methylprednisolone daily. On periodic follow-up, the patient was quite well without episodes of angioedema and no new skin lesions were seen. Our patient met all criteria for reactive macrophage activation syndrome (rMAS) outlined by Imashuku. [1] Acute parvovirus B19 infection can be diagnosed by demonstrating a four-fold rise in serum B19-specific IgG antibody titers, as in our case. B19 specific DNA or antigens can be detected for months or even years after infection. [2], [3] We speculate that the presence of acute parvovirus B19 infection was a trigger for rMAS. [4] Lymphocytic vasculitis is a reactive process. [5], [6] Purpura pigmentosa chronica, fixed drug eruption, urticarial vasculitis, allergic vasculitis, and the vasculitis of Sjogren syndrome are known to have lymphocytic vasculitis. We conclude that rMAS might represent a subgroup of patients with systemic inflammatory response amenable to IVIG treatment. Given early, IVIG may interrupt the processes that lead to macrophage overactivation.

Izvorni jezik
Engleski



POVEZANOST RADA


Projekti:
198-1980955-0953 - Imunobiologija kronične B-limfocitne leukemije i mikrookoliš (Jakšić, Ozren, MZOS ) ( CroRIS)
198-1980955-0954 - Novi klinički pristupi kroničnim mijelo i limfoproliferacijama (Pejša, Vlatko, MZOS ) ( CroRIS)

Ustanove:
Klinička bolnica "Dubrava"

Poveznice na cjeloviti tekst rada:

doi www.saudiannals.net www.saudiannals.net

Citiraj ovu publikaciju:

Soldo-Jureša, Dragica; Radman, Maja; Pejša, Vlatko; Božikov, Velimir
Reactive macrophage activation syndrome in a patient with parvovirus B19 infection, lymphocytic lichenoid vasculitis, urticaria and angioedema // Annals of Saudi medicine, 30 (2010), 1; 88-89 doi:10.4103/0256-4947.59371 (podatak o recenziji nije dostupan, prikaz, stručni)
Soldo-Jureša, D., Radman, M., Pejša, V. & Božikov, V. (2010) Reactive macrophage activation syndrome in a patient with parvovirus B19 infection, lymphocytic lichenoid vasculitis, urticaria and angioedema. Annals of Saudi medicine, 30 (1), 88-89 doi:10.4103/0256-4947.59371.
@article{article, author = {Soldo-Jure\v{s}a, Dragica and Radman, Maja and Pej\v{s}a, Vlatko and Bo\v{z}ikov, Velimir}, year = {2010}, pages = {88-89}, DOI = {10.4103/0256-4947.59371}, keywords = {reactive macrophage activation syndrome, parvovirus B19 infection, lymphocytic lichenoid vasculitis, urticaria, angioedema}, journal = {Annals of Saudi medicine}, doi = {10.4103/0256-4947.59371}, volume = {30}, number = {1}, issn = {0256-4947}, title = {Reactive macrophage activation syndrome in a patient with parvovirus B19 infection, lymphocytic lichenoid vasculitis, urticaria and angioedema}, keyword = {reactive macrophage activation syndrome, parvovirus B19 infection, lymphocytic lichenoid vasculitis, urticaria, angioedema} }
@article{article, author = {Soldo-Jure\v{s}a, Dragica and Radman, Maja and Pej\v{s}a, Vlatko and Bo\v{z}ikov, Velimir}, year = {2010}, pages = {88-89}, DOI = {10.4103/0256-4947.59371}, keywords = {reactive macrophage activation syndrome, parvovirus B19 infection, lymphocytic lichenoid vasculitis, urticaria, angioedema}, journal = {Annals of Saudi medicine}, doi = {10.4103/0256-4947.59371}, volume = {30}, number = {1}, issn = {0256-4947}, title = {Reactive macrophage activation syndrome in a patient with parvovirus B19 infection, lymphocytic lichenoid vasculitis, urticaria and angioedema}, keyword = {reactive macrophage activation syndrome, parvovirus B19 infection, lymphocytic lichenoid vasculitis, urticaria, angioedema} }

Časopis indeksira:


  • Current Contents Connect (CCC)
  • Web of Science Core Collection (WoSCC)
    • Science Citation Index Expanded (SCI-EXP)
    • SCI-EXP, SSCI i/ili A&HCI
  • Scopus
  • MEDLINE


Uključenost u ostale bibliografske baze podataka::


  • EMBASE (Excerpta Medica)
  • MEDLINE
  • Pubmed


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