Journal articles on the topic 'Autoimmune oral lesion'
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1
Pinheiro, Juliana Barchelli, Camila Tirapelli, Claudia Helena Lovato da Silva, Marilena Chinali Komesu, Flávio Calil Petean, Paulo Louzada Junior, Jorge Esquiche León, and Ana Carolina Fragoso Motta. "Oral Nodular Lesions in Patients with Sjögren’s Syndrome: Unusual Oral Implications of a Systemic Disorder." Brazilian Dental Journal 28, no. 3 (June 2017): 405–12. http://dx.doi.org/10.1590/0103-6440201601013.
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Abstract Sjögren’s syndrome (SS) is a systemic chronic autoimmune disorder affecting the lacrimal and salivary glands. SS may manifest as primary SS (pSS) or secondary SS (sSS), the latter occurring in the context of another autoimmune disorder. In both cases, the dry eyes and mouth affect the patient’s quality of life. Late complications may include blindness, dental tissue destruction, oral candidiasis and lymphoma. This paper reports two cases of SS, each of them presenting unusual oral nodular lesion diagnosed as relapsed MALT lymphoma and mucocele. The importance of the diagnosis, treatment and management of the oral lesions by a dentist during the care of SS patients is emphasized, as the oral manifestations of SS may compromise the patient’s quality of life.
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Tarakji, Bassel. "Pemphigus Vulgaris in Old Patient." Case Reports in Dentistry 2021 (August 23, 2021): 1–3. http://dx.doi.org/10.1155/2021/3946161.
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Pemphigus vulgaris (PV) is a chronic, autoimmune, intraepidermal blistering disease of the skin and mucous membranes. The first clinical manifestation is often the development of intraoral lesions, and later, the lesions involve the other mucous membranes and skin. The etiological factors of this disease still remain unknown, although the presence of autoantibodies is consistent with an autoimmune disease. A 73-year-old man had bullous lesions on gingiva, oral mucosa first, then scalp, trunk, and face. An oral medicine specialist suspects the lesion in differential diagnosis in the first presentation of oral lesions and follows up the patient, and then these bullous lesions presented on the skin. In this article, a patient had received oral prednisolone (80 mg/kg/day) and azathioprine, then tapered oral prednisolone to 40 mg/day, with a reduction of 5 mg/day every three weeks. The patient shows remission of these lesions, and complication of this treatment includes osteoporosis, hyperglycemia, and hypertension.
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Kitakawa, Dárcio, Gabriela Máximo, Maria Clara Ferreira Coelho, Felipe da Silva Peralta, Dárcio Kitakawa, and Luis Felipe das Chagas e Silva de Carvalh. "Erythema multiforme: A case report with oral manifestations." International Journal of Case Reports and Images 13, no. 2 (August 12, 2023): 61–65. http://dx.doi.org/10.5348/101328z01gm2022cr.
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Introduction: Erythema multiforme (EM) is an acute, immune-mediated mucocutaneous disease, which may be related to herpes simplex virus, use of certain medications, autoimmune disease, radiation, immunization, pregnancy, period, and food additives or chemicals. It is a condition that occurs predominantly in young adults, with a slight female preponderance and no predilection. Clinically, EM presents erosive and erythematous plaques, affecting mainly the lips and oral mucosa, called target lesions, which may progress to vesiculobullous lesions. The aim of this study is to report a case shown as a positive response to treatment. Case Report: This is a case of EM in a 50-year-old female patient with a persistent ulcer on the lower lip. The clinical presentation showed an ulcerated lesion that extended through the right labial vermilion, semi-mucosa and jugal mucosa, in addition to painful symptoms. Although the diagnostic hypothesis of EM, an incisional biopsy was performed, that confirmed the clinical diagnosis of EM. As treatment, topical use of 0.05% clobetasol propionate for 15 days was prescribed on the lesion. The patient returned in seven days with significant improvement of the site. It was decided to do only the follow-up and not to intervene with systemic corticosteroid therapy. The patient is followed up for 15 months without recurrence of the lesion. The histopathological analysis of this type of lesion is essential for the diagnosis of the lesion. In this way, we can rule out differential diagnoses, especially pemphigus vulgaris and in children, hands, feet, and mouths disease. In this work, it was observed how important the histopathological analysis is necessary in more complex cases, because in this way the therapeutic approach was effective. Conclusion: The present case report represents how important the histopathological analysis is necessary in more complex cases to conclude the diagnosis, therefore is possible conduce the best choose of treatment for patient.
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Anitua, Eduardo, Mohammad H. Alkhraisat, Asier Eguia, and Laura Piñas. "Oral Pemphigoid Recalcitrant Lesion Treated with PRGF Infiltration. Case Report." Dentistry Journal 9, no. 11 (November 19, 2021): 137. http://dx.doi.org/10.3390/dj9110137.
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Mucous membrane pemphigoid (MMP) is a heterogeneous group of chronic autoimmune subepithelial blistering diseases. Oral involvement is present in almost all patients, may represent the onset of the disease, and causes different degrees of pain, dysphagia, soreness, and bleeding. Treatment is based on systemic and/or oral corticoids, or other immunosuppressants. Occasionally, oral lesions can show a poor response to standard treatments. We present the case of a 61-year-old female patient with a painful extensive MMP oral ulcerative lesion recalcitrant to previous systemic azathioprine and local triamcinolone treatment, which was successfully treated in a novel way using PRGF infiltrations as adjuvant. After four weekly infiltrations, pain was reduced from 10 to 0 in a VAS and the lesion was completely healed. The patient continued with a low dose maintenance immunosuppressive treatment (prednisone 5 mg/day PO), and after 13 months of follow-up, there was no relapse of the lesion and no side effects. Although future research is necessary to confirm these observations, PRGF could be a useful adjuvant for the management of extensive mucous membrane pemphigoid oral lesions.
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Cai, Q., and T. Yoo. "Oral Administration Decreases Autoimmune Hearing Loss Lesion in the Mice." Journal of Allergy and Clinical Immunology 117, no. 2 (February 2006): S18. http://dx.doi.org/10.1016/j.jaci.2005.12.073.
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Sadat, SM Anwar, and Akhter Imam. "Pemphigus Vulgaris as Oral Mucosal Ulcer Progressive to Skin Lesion:." Update Dental College Journal 3, no. 2 (February 18, 2014): 43–47. http://dx.doi.org/10.3329/updcj.v3i2.17999.
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Among all the life threatening diseases, autoimmune diseases are among most notorious and complicated diseases. As these diseases have no specific cause or responsible organism, it is therefore very difficult to distinguish and diagnose and thus stands as a major threat for public health. It is assumed that the reason for these diseases may be from genetic to environmental factors, from stress to idiopathic origin. Pemphigus Vulgaris(PV) is such an autoimmune blistering disease that frequently affects the mucous membrane and skin. Very often it starts from oral cavity and Dentists therefore the first to recognize. This paper describes the case of a patient presenting with a one-year history of painful ulcerated gingiva, tongue, floor of the mouth and even on GIT who is finally diagnosed as having PV spreading to generalized skin. DOI: http://dx.doi.org/10.3329/updcj.v3i2.17999 Update Dent. Coll. j: 2013; 3 (2): 43-47
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Ohki, Masafumi, and Shigeru Kikuchi. "Nasal, Oral, and Pharyngolaryngeal Manifestations of Pemphigus Vulgaris: Endoscopic Ororhinolaryngologic Examination." Ear, Nose & Throat Journal 96, no. 3 (March 2017): 120–27. http://dx.doi.org/10.1177/014556131709600311.
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Pemphigus vulgaris is an autoimmune blistering disorder that involves the skin and mucous membranes. Few reports have described nasal and oropharyngolaryngeal lesions in pemphigus vulgaris using an endoscopic ororhinolaryngologic examination. We retrospectively reviewed the clinical records of 11 patients with pemphigus vulgaris between 2001 and 2013 with respect to their symptoms, lesion sites, lesion features, and treatments received. All patients had undergone an endoscopic ororhinolaryngologic examination. Their mucosa-related symptoms were sore throat, oral pain, odynophagia, gingival bleeding, hoarseness, and epistaxis. The most frequent sites were the oral cavity (gingiva and buccal mucosa), larynx (epiglottis and vocal fold), oropharynx (soft palate), and nasal cavity (nasal septum). Lesions were typically characterized by erosion, erosion with a whitish exudate, and erythematous patches. Thus, our study findings reveal that pemphigus vulgaris involves both the nasal and oropharyngolaryngeal regions. Patients with pemphigus vulgaris should undergo an endoscopic ororhinolaryngologic examination to determine the range of their lesions.
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Serpico, R., G. Pannone, A. Santoro, E. Mezza, S. Piccolo, V. Esposito, M. Busciolano, D. Ciavarella, L. Lo Muzio, and P. Bufo. "Report of a Case of Discoid Lupus Erythematosus Localised to the Oral Cavity: Immunofluorescence Findings." International Journal of Immunopathology and Pharmacology 20, no. 3 (July 2007): 651–53. http://dx.doi.org/10.1177/039463200702000325.
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Discoid Lupus Erythematosus (DLE) is a chronic disease with a typical cutaneous involvement. This pathology rarely involves mucosa: oral cavity is interested in 20% of DLE patients. We describe a case of oral DLE in a 50-year-old woman with an anamnesis for autoimmune disorders. This study shows the helpful role of immunofluorescence in the diagnosis of autoimmune diseases. The first diagnostic step was the clinical observation of the oral mucosa: the lesion area was erythematous, athrophic and hyperkeratotic. The patient then underwent laboratory examination. We utilized human epithelial cells (Hep-2010) for Indirect Immuno-Fluorescence (IIF). Moreover, the biopsy site for Direct Immuno-Fluorescence (DIF) and histopathological analysis was the untreated oral lesion. IIF detected an increase of Anti-Nuclear Antibody (ANA) and positivity for SSA-RO. By DIF, we observed IgG/IgA/fibrinogen along basal layer. Multiple biopsies reported signs of chronic basal damage. Steroid systemic therapy induced a considerable lesion regression. We suggest the use of immunofluorescence with the integration of further data to improve diagnosis of rare diseases and to establish a suitable therapy.
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Jimenez, Antonio, Paige Hoyer, and Michael Wilkerson. "An Atypical Presentation of Pemphigus Vegetans in the Umbilicus." SKIN The Journal of Cutaneous Medicine 4, no. 5 (August 26, 2020): 452–55. http://dx.doi.org/10.25251/skin.4.5.12.
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Pemphigus is a chronic, autoimmune bullous disease that affects the skin and mucous membranes. Pemphigus vegetans is a rare variant of pemphigus and presents as oral ulcerations with associated verrucous lesions in intertriginous or flexural areas. A 38-year-old African American woman presented to the clinic with a chief complaint of oral ulcers. She carried a diagnosis of Behcet’s disease and was referred by rheumatology for evaluation of treatment-resistant mucosal ulcerations. At the time of her dermatology visit, she also reported an enlarging umbilical mass that had been present for several months. Further examination of the umbilical lesion identified an exophytic, vegetative mass. Histologic assessment of the lesion identified acanthosis and acantholysis with dermal eosinophils consistent with pemphigus vegetans. A pemphigus antibody panel was done and resulted positive for IgG desmoglein-3 antibodies. The patient was treated with prednisone and rituximab with improvement of her lesions. We present an atypical presentation of pemphigus vegetans involving the umbilicus. This diagnosis should be considered in patients who present with oral erosions and concomitant vegetative lesions, regardless of location or prior diagnoses.
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Setiadhi, Riani, and Kosterman Usri. "Oral Lesion Caused by Improper Removable Partial Denture." Jurnal Material Kedokteran Gigi 7, no. 1 (May 1, 2018): 12. http://dx.doi.org/10.32793/jmkg.v7i1.275.
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Oral lesions are relatively common findings in clinical practice, can occur due to various factors such as trauma, systemic diseases, autoimmune disorders, malignancies. Local trauma as one of the cause of oral lesions majority due to poor dentures, fractured restorations and sharp edges of teeth. The lesions are commonly found on the mucosa that is subjected to the source of trauma such as buccal mucosa, lateral border of the tongue or lips. Removable partial denture is a denture that can be removed and reinserted without professional help. Poor removable denture which is an ill-fitting denture, rough/sharp/overextended flanges, or lack of retention/stability could cause oral lesions. This case report describes a 76 old year man complained of pain on his right lateral tongue since 6 months ago. He was wearing a removable upper right denture which cannot be remove for about a year. It was a rough and sharp self-curing acrylic denture. There was erythematous and pain on his lateral right of the tongue but no induration on palpation. Triamcinolone acetonide 0,1% in orabase was the given treatment for the right lateral of the tongue and referred him to the prosthodontic department for replacing the denture. The oral lesion was healed after one week of treatment and the poor denture was removed. As a conclusion dentures should be made properly by the expert in order to prevent oral lesions.
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Raffaele, Regina Maria, Mario Eduardo Baldo, Pamela Ferreira de Sá Queiroz, Ricardo Yudi Tateno, Luiz Felipe Palma, and Luana Campos. "Phototherapies in the management of an ulcerative lip lesion in a patient taking multiple medications for rheumatoid arthritis." Research, Society and Development 10, no. 8 (July 9, 2021): e50210817538. http://dx.doi.org/10.33448/rsd-v10i8.17538.
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The treatment of rheumatoid arthritis (RA), an inflammatory autoimmune disease of chronic nature, consists of medications, exercises, patient education on the disease, and rest. Unfortunately, many drugs used for RA have been recently recognized to induce oral manifestations due to either immunosuppression or antiproliferative effects. Thus, the present study reports a case of a patient who was receiving multiple medications (methotrexate, leflunomide, and sodium risedronate) for RA and developed an extensive lip ulcerative lesion not responsive to previous treatments. The lesion management was performed using only a combination of photobiomodulation therapy (PBMT) and antimicrobial photodynamic therapy (aPDT), totalizing three laser sessions. Within 4 days, the patient no longer complained of pain and the lesion presented an advanced healing aspect. According to the current case, the combination of PBMT and aPDT seems to be a suitable alternative for the management of oral lesions in patients taking medications for RA.
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Leone, Corolina, Norberto Sugaya, and Dante Migliari. "An Intriguing Case of Ectopic Benign Migratory Glossitis Resembling Secondary Syphilis: A Case Report." Case Reports in Dermatology 12, no. 3 (November 26, 2020): 262–65. http://dx.doi.org/10.1159/000510776.
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Oral mucosal lesions presenting as erythematous patches usually pose difficulties for a clinical diagnosis. They elicit an array of differential diagnosis that mainly includes oral candidosis, contact mucosal reaction, oral lichenoid lesion, oral psoriasiform, autoimmune disease, and, not to forget, secondary syphilis. In this present case, all those above-mentioned possibilities were ruled out, while secondary syphilis stood as the main diagnosis. As this was also later excluded by a negative serological treponemal test, the final diagnosis rested on an ectopic manifestation of benign migratory glossitis (BMG), whose diagnosis was based on the clinical aspects of the lesions, along with their spontaneous disappearance in a short period of time (a hallmark of this condition) and the presence of fissured tongue, a manifestation that occurs very often in concomitance with BMG.
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Olisova, Olga Yu, and Natalia P. Teplyuk. "Photogallery of diseases of the oral mucosa. Part II." Russian Journal of Skin and Venereal Diseases 25, no. 6 (February 17, 2023): 83–86. http://dx.doi.org/10.17816/dv113013.
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Nowadays there are more than 300 types of diseases of the oral mucosa and the red fringe of the lips. The etiology of these lesions is extremely diverse and includes primary and secondary infectious diseases of bacterial, fungal and viral origin, autoimmune diseases, etc. In addition, there are a number of features associated with the age of manifestation of a particular lesion. For example, in childhood, primary rashes with herpes simplex often appear precisely on the oral mucosa. In adults, along with widespread rashes on the skin, it is possible to damage the oral mucosa in Kaposi's sarcoma with predominant localization on the hard palate. In primary and secondary syphilis, rashes on the oral mucosa can often be observed: primary hard chancre, syphilitic tonsillitis, syphilitic papules.
This photo gallery presents images with various lesions of the oral mucosa.
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Gurumoorthi, Ragesh, Saranya Ramasamy, and Sindhiya Kulandaisamy. "A Case of Bullous Pemphigoid - Potentially Fatal Condition." International Journal of Health Sciences and Research 12, no. 10 (October 17, 2022): 150–53. http://dx.doi.org/10.52403/ijhsr.20221019.
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Bullous pemphigoid is a rare autoimmune skin disorder characterized by enormous, fluid – filled blisters that appear on skin lower belly, upper thighs and armpits. It occurs when the body’s immune system targets the tissue layer beneath the top layer of skin. The cause of this attack is not known. A 48 years old male patient received in the ward with the complaints of fluid filled lesions all over the body including oral cavity, history of rupture of lesions spontaneously to form raw areas, itching before the onset of lesions since 3 days. The incisional biopsy was done and the lesion was clinically confirmed to be a bullous pemphigoid. After the medical treatment with steroids, the patient was symptomatically better and was discharged with medications. Key words: Autoimmune, blisters, lesions, erosions, paronychia
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Wahyuni, Indah Suasani, Tenny Setiana Dewi, Erna Herawati, and Dewi Zakiawati. "Profil lesi oral pada penderita penyakit autoimun." Majalah Kedokteran Gigi Indonesia 2, no. 3 (December 30, 2016): 147. http://dx.doi.org/10.22146/majkedgiind.11311.
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Oral lesion’s profi le in autoimmune disease. Oral lesions are commonly found in patients with autoimmune diseases as manifestations of the disease or a side effect of the treatment. Oral lesions must be handled properly to prevent secondary infection, relieve pain and improve the patient’s quality of life. The aim of this study is to describe oral lesions profile in patients with autoimmune diseases, including clinical characteristics and location of oral lesions as well as the distribution of age and sex of the patient. The methods were retrospective observation by describing the secondary data from patients with autoimmune handled by Oral Medicine Specialist, Faculty of Dentistry, University of Padjadjaran in dr. Hasan Sadikin Hospital Dental Clinic. Patient files from August 2010 untill August 2014 (n = 66) were used, with the most often diagnosis were Systemic Lupus erythematosus (SLE), Oral lichen planus (OLP) and Pemphigus vulgaris (PV). It is revealed that, the age of patients varied between 9 to 68 years old and there was predominance of female patients. Patients diagnosed with SLE were 26 (39.4%), 12 patients with OLP (18.2%) and 28 patients with PV (42.4%). Based on the clinical feature, the most commonly found type of oral lesion was erosion (n=52/78,8%), while the most commonly predilection was in the buccal mucosa (n = 46/69,7%). In conclusion, intra-oral examination should be used as a routine procedure in the comprehensive management of patients with autoimmune diseases. Dentist have a professional role in the diagnosis of oral lesions and provide appropriate therapy in order to improve the quality of life of patients with autoimmune diseases.ABSTRAKLesi oral biasa ditemukan pada penderita penyakit autoimun sebagai manifestasi penyakit atau efek samping pengobatan kortikosteroid jangka panjang. Lesi oral harus ditangani dengan baik untuk mencegah terjadinya infeksi sekunder, mengatasi rasa sakit dan meningkatkan kualitas hidup penderita. Pengumpulan data gambaran profil lesi oral penderita penyakit autoimun, meliputi karakteristik klinis dan lokasi lesi oral serta distribusi usia dan jenis kelamin penderita belum pernah dilakukan. Metode yang digunakan adalah non eksperimen, retrospektif dan deskripsi data sekunder penderita autoimun yang ditangani oleh bagian Ilmu Penyakit Mulut FKG Universitas Padjadjaran di SMF Gigi dan Mulut RS dr. Hasan Sadikin Bandung. Data pasien yang dipergunakan antara bulan Agustus 2010 sampai Agustus 2014 (n=66), dengan diagnosis penyakit autoimun yang paling sering adalah Sistemic Lupus Erythematous (SLE), Oral Lichen Planus (OLP) dan Pemphigus Vulgaris (PV). Semua pasien memberikan persetujuan pada saat dilakukan pemeriksaan dan pengumpulan data melalui informed consent. Hasil penelitian ini menunjukkan usia penderita bervariasi antara 9 hingga 68 tahun dan jumlah penderita wanita lebih banyak daripada pria. Penderita yang didiagnosis SLE 26 orang (39,4%), OLP 12 orang (18,2%) dan PV 28 orang (42,4%). Berdasarkan gambaran klinisnya jenis lesi oral yang banyak ditemukan adalah erosi (n = 52/ 78,8%) dan berdasarkan lokasi lesi oral banyak ditemukan pada mukosa bukal (n = 46/69,7% penderita). Kesimpulannya, pemeriksaan intra oral disarankan menjadi prosedur rutin dalam tatalaksana komprehensif penderita penyakit autoimun. Dokter gigi diharapkan dapat berperan dalam mendiagnosis lesi oral dan memberikan terapi yang tepat sehingga dapat meningkatkan kualitas hidup penderita penyakit autoimun.
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Sugerman, P. B., N. W. Savage, L. J. Walsh, Z. Z. Zhao, X. J. Zhou, A. Khan, G. J. Seymour, and M. Bigby. "The Pathogenesis of Oral Lichen Planus." Critical Reviews in Oral Biology & Medicine 13, no. 4 (July 2002): 350–65. http://dx.doi.org/10.1177/154411130201300405.
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Both antigen-specific and non-specific mechanisms may be involved in the pathogenesis of oral lichen planus (OLP). Antigen-specific mechanisms in OLP include antigen presentation by basal keratinocytes and antigen-specific keratinocyte killing by CD8+ cytotoxic T-cells. Non-specific mechanisms include mast cell degranulation and matrix metalloproteinase (MMP) activation in OLP lesions. These mechanisms may combine to cause T-cell accumulation in the superficial lamina propria, basement membrane disruption, intra-epithelial T-cell migration, and keratinocyte apoptosis in OLP. OLP chronicity may be due, in part, to deficient antigen-specific TGF-β1-mediated immunosuppression. The normal oral mucosa may be an immune privileged site (similar to the eye, testis, and placenta), and breakdown of immune privilege could result in OLP and possibly other autoimmune oral mucosal diseases. Recent findings in mucocutaneous graft- versus-host disease, a clinical and histological correlate of lichen planus, suggest the involvement of TNF-α, CD40, Fas, MMPs, and mast cell degranulation in disease pathogenesis. Potential roles for oral Langerhans cells and the regional lymphatics in OLP lesion formation and chronicity are discussed. Carcinogenesis in OLP may be regulated by the integrated signal from various tumor inhibitors (TGF-β1, TNF-α, IFN-γ, IL-12) and promoters (MIF, MMP-9). We present our recent data implicating antigen-specific and non-specific mechanisms in the pathogenesis of OLP and propose a unifying hypothesis suggesting that both may be involved in lesion development. The initial event in OLP lesion formation and the factors that determine OLP susceptibility are unknown.
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Baral, Radha, Bidhata Ojha, and Dipshikha Bajracharya. "ORAL PEMPHIGUS VULGARIS: A CASE REPORT." Journal of Chitwan Medical College 10, no. 1 (March 14, 2020): 91–93. http://dx.doi.org/10.54530/jcmc.137.
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Pemphigus vulgaris is an autoimmune blistering disease clinically presenting as vesicles, bullae and erosion on the skin and mucous membrane. Histopathologically, it is characterized by acantholysis and supra basilar split. The underlying mechanism causing intra epithelial split in pemphigus vulgaris is binding of IgG autoantibodies to desmoglin 3 which belongs to a transmembrane glycoprotein adhesion molecule. Here we present a case of 27 years old male patient suffering from pemphigus vulgaris. This Case report highlights the importance of detailed case history, thorough clinical examination and appropriate investigation to reach a diagnosis of vesiculobullous lesion.
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Baral, Radha, Bidhata Ojha, and Dipshikha Bajracharya. "Oral Pemphigus Vulgaris: A case report." Journal of Chitwan Medical College 10, no. 1 (March 15, 2020): 91–93. http://dx.doi.org/10.3126/jcmc.v10i1.28082.
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Pemphigus vulgaris is an autoimmune blistering disease clinically presenting as vesicles, bullae and erosion on the skin and mucous membrane. Histopathologically, it is characterized by acantholysis and supra basilar split. The underlying mechanism causing intra epithelial split in pemphigus vulgaris is binding of IgG autoantibodies to desmoglin 3 which belongs to a transmembrane glycoprotein adhesion molecule. Here we present a case of 27 years old male patient suffering from pemphigus vulgaris. This Case report highlights the importance of detailed case history, thorough clinical examination and appropriate investigation to reach a diagnosis of vesiculobullous lesion.
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Cichońska, Dominika, Dominika Komandera, Magda Mazuś, and Aida Kusiak. "Chronic Ulcerative Stomatitis (CUS) as an Interdisciplinary Diagnostic Challenge: A Literature Review." International Journal of Molecular Sciences 23, no. 22 (November 9, 2022): 13772. http://dx.doi.org/10.3390/ijms232213772.
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Chronic ulcerative stomatitis (CUS) is a rarely reported disease affecting the oral cavity, most often affecting middle-aged Caucasian females. The aim of the present study is to present the diagnosis, differentiation, and interdisciplinary treatment of this rare disease. CUS is characterized by the presence of an oral erosive or ulcerative lesion. The autoimmune pathogenesis of CUS includes affecting the antigen’s activity by DNA-breaking and protein-hydrolyzing enzymes. The stratified epithelium-specific antinuclear antibodies (SES-ANA) are associated with CUS development. Clinically, the lesions presented in oral mucosa might resemble an erosive form of oral lichen planus, whereas gingival lesions seem to be similar to desquamative gingivitis related to dermatological diseases manifested in the oral cavity. Patients often report subjective symptoms related to oral mucosa and general symptoms. Histopathological presentation of CUS is often non-specific and includes sub-epithelial separation from underlying connective tissue, atrophic epithelium, and inflammatory infiltrate with an increased number of plasma cells and lymphocytes. Direct immunofluorescence (DIF) might be used in CUS diagnostics. CUS generally remains nonsusceptible to corticosteroid treatments; however, antimalarial drugs and calcineurin inhibitors are more effective. Further research should be conducted in order to implement a diagnostic protocol and observe the long-term results of CUS management.
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Shenoy, Santhosh, Madhurya N. Kedlaya, Sajna H. R., and Amitha Ramesh. "Oral Mucous Membrane Pemphigoid with Contact Dermatitis - A Rare Clinical Entity." Journal of Health and Allied Sciences NU 08, no. 03 (September 2018): 041–44. http://dx.doi.org/10.1055/s-0040-1708763.
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AbstractMucous membrane pemphigoid (MMP) is a rare inflammatory, autoimmune, subepithelial vesiculobullous lesion. Oral mucosa is affected in almost 90% of cases. Its development is chronic with a possible involvement of ocular, laryngeal and genital mucosa. Spontaneous remission is rare. Currently, improving oral hygiene, topical corticosteroid treatment is used to control the oral lesions of MMP. In the present case report, a 53 year old female patient with a known history of hypothyroidism reported to the department of Periodontology with a complaint of burning sensation and tenderness in the gums on intake of spicy food for the past one week .The patient had also noticed the formation of blisters on the gums which would break off on their own. Hence provisional diagnosis of MMP was considered based on the clinical and histopathological examination which was later confirmed with immunofluorescent interpretations. The treatment objective is to suppress extensive blister formation, to promote healing, and to prevent scarring. The above objectives were met in our case by thorough periodontal maintenance and steroid therapy. She also presented with skin lesions due to contact dermatitis caused by occupational exposure to tobacco which makes this case report unique.
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Lee, Yi-Chieh, Hsueh-Yu Li, and Wan-Ni Lin. "Isolated Epiglottic Manifestations of HIV Infection: Two Cases Reports." Microorganisms 10, no. 12 (December 5, 2022): 2404. http://dx.doi.org/10.3390/microorganisms10122404.
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Diagnosis of the Human Immunodeficiency Virus (HIV) remains challenging due to non-specific clinical presentations and mostly flu-like symptoms, e.g., fever, headache, sore throat, and general weakness. Oral lesions, such as oral candidiasis and Kaposi sarcoma, are also frequently associated with HIV infection, whereas laryngeal manifestations are rare. We report two cases of newly diagnosed HIV patients with clinical presentations of sore throat, and endoscopy revealed an epiglottic ulcerative tumor-like lesion. A laryngomicrosurgical biopsy of the lesions was performed for persistent symptoms and suspicion of malignancy. The result revealed acute and chronic inflammation without a conclusive pathology diagnosis. Further laboratory analysis was arranged in consideration of autoimmune diseases, Epstein–Barr virus (EBV), and HIV infection due to their persistent and atypical symptoms. The results were positive for HIV infection. These patients were treated successfully with antiviral treatment and the laryngeal symptoms improved within weeks. In patients with idiopathic and persistent epiglottitis or an epiglottic ulcer after medical treatment, HIV infection needs to be considered as a potential etiology in order to institute proper treatment.
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Lunge, Snehal, Pallavi Singh, and Arvind Rajbhog Ashwin. "Paraneoplastic pemphigus: Diagnosing with a modified criteria – A case report." Our Dermatology Online 14, e (January 8, 2023): e15-e15. http://dx.doi.org/10.7241/ourd.2023e.15.
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Paraneoplastic pemphigus is a rare autoimmune blistering disorder which presents with polymorphous cutaneous lesions and recalcitrant stomatitis. The disorder has a 100% association with an underlying neoplasia, primarily lymphoproliferative disorders. We report a patient who presented with oral mucosal lesions resistant to treatment with bullous cutaneous lesion and an underlying NHL-B cell lymphoma. The condition since its inception has been diagnosed using the criteria by Anhalt et al, which still is the most standard one. The criterion has been revised and updated every now and then. A current update has been proposed by Svoboda SA et al, which is a more relaxed one making diagnosis easier in a patient of Paraneoplastic pemphigus. Our patient was confidently diagnosed with Paraneoplastic pemphigus using this criterion. A quick diagnosis with fewer investigations allowed early and aggressive institution of treatment, to which patient responded well.
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Nidhi Ojha and Om Prakash Yadav. "Benign Mucous Membrane Pemphigoid: A Case Report." International Healthcare Research Journal 4, no. 2 (May 21, 2020): 34–37. http://dx.doi.org/10.26440/ihrj/0402.05333.
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Benign Mucous Membrane Pemphigoid (MMP) is a vesiculobullous (VB) lesion that affects oral and nasal mucosa, oropharynx, conjunctiva, and genital mucosa. It is considered an autoimmune disease. Autoantibodies are produced due to several external factors or genetic factors. It creates many complications, such as defects in vision, voice alteration (hoarseness), airway obstruction, and dyspareunia. The subepithelial blisters form due to these antibodies. Treatment modalities differ from topical steroids to systemic steroid therapy based on the nature and severity of clinical symptoms.
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Raybaud, H., C. V. Olivieri, L. Lupi-Pegurier, S. Pagnotta, R. Marsault, N. Cardot-Leccia, and A. Doglio. "Epstein-Barr Virus–Infected Plasma Cells Infiltrate Erosive Oral Lichen Planus." Journal of Dental Research 97, no. 13 (July 13, 2018): 1494–500. http://dx.doi.org/10.1177/0022034518788282.
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Epstein-Barr virus (EBV), in addition to its transforming properties, contributes to the pathogenesis of several inflammatory diseases. Here, we investigated its involvement in oral lichen planus (OLP), a common autoimmune-like disease of unknown etiopathogenesis that can display a malignant potential. EBV-infected cells (EBV+ cells) were sought in a large series of clinically representative OLPs ( n = 99) through in situ hybridization to detect small noncoding EBV-encoded RNAs. Overall, our results demonstrated that EBV was commonly found in OLP (74%), with significantly higher frequency (83%) in the erosive form than in the reticular/keratinized type mild form (58%). Strikingly, many erosive OLPs were massively infiltrated by large numbers of EBV+ cells, which could represent a large part of the inflammatory infiltrate. Moreover, the number of EBV+ cells in each OLP section significantly correlated with local inflammatory parameters (OLP activity, infiltrate depth, infiltrate density), suggesting a direct relationship between EBV infection and inflammatory status. Finally, we characterized the nature of the infiltrated EBV+ cells by performing detailed immunohistochemistry profiles ( n = 21). Surprisingly, nearly all EBV+ cells detected in OLP lesions were CD138+ plasma cells (PCs) and more rarely CD20+ B cells. The presence of EBV+ PCs in erosive OLP was associated with profound changes in cytokine expression profile; notably, the expression of key inflammatory factors, such as IL1-β and IL8, were specifically increased in OLP heavily infiltrated with EBV+ PCs. Moreover, electron microscopy–based experiments showed that EBV+ PCs actively produced EBV viral particles, suggesting possible amplification of EBV infection within the lesion. Our study thus brings conclusive evidence showing that OLP is commonly infiltrated with EBV+ PCs, adding a further puzzling element to OLP pathogenesis, given that PCs are now considered to be major regulatory immune cells involved in several autoimmune diseases (ClinicalTrials.gov NCT02276573).
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Robinson, Carly J., Neil K. Jairath, Jon C. Davis, and Hongyu H. Yang. "A rare case of infliximab induced myeloperoxidase-cytoplasmic antineutrophil cytoplasmic autoantibody positive cutaneous vasculitis." International Journal of Research in Dermatology 8, no. 6 (October 27, 2022): 574. http://dx.doi.org/10.18203/issn.2455-4529.intjresdermatol20222730.
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<p>Drug-induced cutaneous vasculitis is a known autoimmune complication of tumor necrosis factor (TNF) inhibitors with many instances resulting in the production of newly formed antibodies. We report a 21-year-old female with a past medical history of Crohn’s disease controlled with infliximab who presented to dermatology with a purpuric rash and crusted plaques of her distal lower extremities. Biopsy of a lesion revealed perivascular lymphocytes, neutrophils and eosinophils, vessel wall damage, and dermal eosinophils consistent with a drug-induced vasculitis. Follow up labs assessing for antibodies revealed unusual findings of an elevated cytoplasmic-antineutrophil cytoplasmic autoantibody (C-ANCA) titer and myeloperoxidase (MPO) antibody level making this patient MPO-C-ANCA positive. The patient’s lesions were treated with both oral and topical steroids, colchicine, and transition of her infliximab to ustekinumab with subsequent improvement of her lesions and normalization of antibody titers.</p>
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Abbas, Zaheer, Zahra Safaie Naraghi, and Elham Behrangi. "Pemphigus Vulgaris Presented with Cheilitis." Case Reports in Dermatological Medicine 2014 (2014): 1–3. http://dx.doi.org/10.1155/2014/147197.
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Background. Pemphigus vulgaris is an autoimmune blistering disease affecting the mucous membrane and skin. In 50 to 70% of cases, the initial manifestations of pemphigus vulgaris are oral lesions which may be followed by skin lesions. But it is unusual for the disease to present with initial and solitary persistent lower lip lesions without progression to any other location.Main Observations. We report a 41-year-old woman with dry crusted lesions only on the lower lip, clinically resembling actinic cheilitis and erosive lichen planus, but histopathological evaluation showed unexpected results of suprabasal acantholysis and cleft compatible with pemphigus vulgaris. We treated her with intralesional triamcinolone 10 mg/mL for 2 sessions and 2 g cellcept daily. Patient showed excellent response and lesions resolved completely within 2 months. In one-year follow-up, there was no evidence of relapse or any additional lesion on the other sites.Conclusion. Cheilitis may be the initial and sole manifestation of pemphigus vulgaris. Localized and solitary lesions of pemphigus vulgaris can be treated and controlled without systemic corticosteroids.
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Sukekava, Flavia, Luiz Carlos Carmo Filho, Julia Helena Luiz, and Jaques Luiz. "Utilização do Blue®m no tratamento do líquen plano oral – relato de caso." Full Dentistry in Science 12, no. 46 (2021): 44–48. http://dx.doi.org/10.24077/2021;1246-cj4448.
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Oral lichen planus (OLP) is an autoimmune disease, one of the most prevalent in the mouth, which mainly affects women, leukoderma, between the third and sixth decades of life. Of unknown etiology, it may present with bilateral/symmetrical lesions, occurring throughout the mouth. The clinical characteristics range from white keratotic lesions to painful erosions and ulcerations, with reticular, atrophic, papular, erosive, bullous, and erythematous forms, depending on the time of evolution and location. Oxygen-releasing products are gaining ground in the dental market with the promise of aid in wound healing. The purpose of this case report was to associate these products in the treatment of a patient with OLP. The leukoderma female patient, 56 years old, sought dental care with a complaint of bleeding gums for years. On clinical examination, spontaneous gingival bleeding was observed in the anterior teeth region, excellent plaque control, and erythematous lesions in the cheek mucosa and anterior gingiva. Basic periodontal treatment and mouthwash with Blue®m was proposed for 2 weeks. In the reassessment, improvement was reported for 2 weeks and return to the bleeding condition. At this moment, an incisional biopsy was performed, and fragments were sent for laboratorial analysis, which found structures characteristic of OLP. The patient was instructed to maintain the standard of oral hygiene, to keep the mouthwash twice a day, associated with Blue®m oral gel over the lesions. After one-year follow-up, the patient continues to have no lesion return, no side effects, with significant improvement in quality of life.
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Iuliano, Stefano, Maria Carmela Zagari, Margherita Vergine, Alessandro Comi, Michele Andreucci, Gemma Patella, Stefania Giuliano, et al. "Autoimmune Hypophysitis with Late Renal Involvement: A Case Report." Endocrines 2, no. 2 (June 17, 2021): 160–66. http://dx.doi.org/10.3390/endocrines2020016.
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We report a case of a 50-year-old male admitted to the Endocrinology Unit because of persistent headaches, nausea, feeling tired, sudden weight loss, cold intolerance, decreased appetite, and lack of sex interest. Diagnostic workup showed a 6-millimeter pituitary tumor without signs of compression, and a condition of progressive panhypopituitarism. After 12 months of hormone replacement therapy, the patient was hospitalized because of sudden weight gain, periorbital-peripheral edema, severe dyslipidemia, hypertension, and proteinuria. Corticosteroid therapy was shifted from oral to continuous intravenous infusion, and once the diagnosis of “immune complex-mediated glomerulonephritis with mesangial deposits suggestive for membranoproliferative glomerulonephritis type IIIIgG4-positive” was made, the immunosuppressant mycophenolate (1500 mg/day) was started. After a 6-month follow-up, the complete resolution of renal symptoms was accompanied by the disappearance of a pituitary lesion and the patient was back to prior hormone replacement therapy. Autoimmune hypophysitis (AH) is a rare autoimmune inflammatory disease of the pituitary gland that can impair hormone secretion and function. IgG4-hypophysitis is rare and is usually associated with other IgG4-related diseases. Herein, we describe a rare case of AH associated with late renal disease, and without any other organ involvement.
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Arellano, Janetta, and Michael Sy. "Treatment-Refractory Autoimmune Glial Fibrillary Acidic Protein Meningoencephalomyelitis in a Young Adult Female." Neurology 99, no. 23 Supplement 2 (December 5, 2022): S55.1—S55. http://dx.doi.org/10.1212/01.wnl.0000903444.16135.69.
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ObjectiveTo describe a case of autoimmune glial fibrillary acidic protein (GFAP) astrocytopathy refractory to immunotherapy without evidence of malignancy or coexisting autoimmunity.BackgroundAutoimmune GFAP astrocytopathy is an autoimmune disease of the central nervous system associated with the presence of GFAP-IgG in the CSF. Patients may present with acute or subacute onset of headache, encephalopathy, seizures, abnormal vision, weakness or numbness, postural tremor and cerebellar ataxia. GFAP astrocytopathy is usually corticocorticosteroid-responsive in the acute setting but may rarely require maintenance immunotherapy to prevent relapse. Treatment refractory cases should trigger work up for coexisting autoimmunity or malignancy.Design/MethodsA 35-year-old female patient presented with subacute meningoencephalomyelitis with prodromal symptoms.ResultsHer cerebrospinal fluid revealed lymphocytic pleocytosis and elevated protein. Brain magnetic resonance imaging (MRI) with and without contrast showed perivascular radial enhancement and periventricular T2 FLAIR hyperintensity. Spinal MRI with and without contrast demonstrated longitudinal T2 FLAIR hyperintensity from T1-T2 to T7-T8. Despite high dose steroid treatment, her disease progressed with an enlarging periventricular lesion and worsening visual acuity. Biopsy of the enhancing periventricular lesion showed perivascular inflammation. After five cycles of plasma exchange along with a five-day course of intravenous methylprednisolone 1 gram daily, her symptoms stabilized. The CSF autoimmune encephalopathy panel (Mayo Clinic Laboratories) came back positive for GFAP-IgG antibody on tissue immunofluorescence assay, and was confirmed positive by GFAP cell-based assay. No neoplastic disease was identified using high resolution PET/CT scans. Based on the aggressiveness of her disease, she received one cycle of cyclophosphamide, and was discharged home on an oral corticosteroid taper. Even one year after addition of both mycophenolate mofetil and rituximab, MRI imaging continued to reveal new enhancing lesions.ConclusionsAutoimmune GFAP astrocytopathy may sometimes require long-term immunosuppression even without presence of malignancy or other coexisting autoimmune disease.
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Guryevskaya, Olga, Irina Usmanova, Zuhra Hismatullina, Al'bina Bulgakova, Yigal Granot, Konstantin Mochalov, and Yuri Novikov. "CLINICAL MANIFESTATIONS OF ORAL MUCOSAL LESIONS IN VERIOUS DERMATOSIS." Actual problems in dentistry 16, no. 1 (May 14, 2020): 5–13. http://dx.doi.org/10.18481/2077-7566-20-16-1-5-13.
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Subject. This review presents a modern literature review on the clinical manifestations of severe autoimmune disease — pemphigus vulgaris, chronic genetic determinate dermatosis — by the example of epidermolysis bullosa, dermatosis — lichen planus, acute immuno-mediated disease — multiforme exudative erythema.
The goal is to conduct a systematic analysis of modern domestic and foreign literature to determine some features of the clinical manifestations of chronic dermatoses with lesions of the oral mucosa.
Methodology. A review of the studies allows us to consider the etiology and pathogenesis of the development of these nosologies, approaches to modern classification, as well as an analysis of their clinical features with an emphasis on differential diagnosis.
Results. It was noted that with combined damage to the skin and oral mucosa, the diagnosis of these dermatoses in patients does not present any particular difficulties. However, the significance of determining pathognomonic signs of damage to the oral mucosa with a particular dermatosis increases significantly with an isolated lesion of the oral mucosa, and when it is the primary and only manifestation of skin disease.
Conclusions. Undoubtedly, the principle of continuity of the interested specialties among which are undoubted - dermatovenerologists, dentists, gastroenterologists, gynecologists, neuropsychiatrists, has great prospects in both diagnosis and complex treatment. Nevertheless, for their widespread use, the local and general treatment of these patients needs to be verified, solving urgent problems of introducing and adapting modern technologies for rapid prototyping them into practical healthcare, which together will allow significant progress in their diagnosis and prevention.
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Memar, Elmira Hajiesmaeil, Moeinadin Safavi, Mohammad-Hassan Moradinejad, and Vahid Ziaee. "The First Presentation of Localized Scleroderma at Birth: Scleroderma as a Differential Diagnosis of Congenital Skin Lesion." Journal of Child Science 12, no. 01 (January 2022): e1-e4. http://dx.doi.org/10.1055/s-0041-1741055.
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Abstract Localized scleroderma is an uncommon autoimmune disease characterized by fibrosis of the skin and underlying tissue without involvement of blood vessels or internal organs. It usually affects children during later childhood, and early presentation of localized scleroderma during infancy is rare. In the current study, we report a child with localized scleroderma-related presentations occurring at birth. A 2-day-old male neonate presented with a firm, erythematous, and slightly pigmented plaque on his left thigh, leading to a change in the diameter of the affected foot and contracture of the left knee. At the age of 7 months, he was referred to our rheumatology clinic with normal growth and development. Laboratory studies, including urine and blood high-performance liquid chromatography assay, antinuclear antibodies, antitopoisomerase I, and rheumatic factor, were in the normal range. No signs of ocular involvement were noted during ophthalmological consultation. Skin biopsy showed mild acanthosis and collagen bundles, which replaced the fat around the sweat glands. A final diagnosis of localized scleroderma was made. Treatment was started with oral prednisolone, oral methotrexate (MTX), and colchicine. The skin lesion stopped progressing after 3 months of treatment. Steroid was then tapered over 6 months, while MTX and colchicine were continued for 2 years. Localized scleroderma during early infancy is a rare disease, but it should be considered as a differential in infants with erythematous and firm lesions on their body at birth because early treatment can prevent future complications.
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Odani, Kentaro, Akane Itoh, Soshi Yanagita, Yasuhito Kaneko, Mitsuhiro Tachibana, Takashi Hashimoto, and Yutaka Tsutsumi. "Paraneoplastic Pemphigus Involving the Respiratory and Gastrointestinal Mucosae." Case Reports in Pathology 2020 (June 29, 2020): 1–8. http://dx.doi.org/10.1155/2020/7350759.
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Paraneoplastic pemphigus (PNP), an autoimmune mucocutaneous disorder involving the oral and bronchial mucosae, is a rare complication of hematologic malignancy. Serologically, serum autoantibodies against varied desmosome-related proteins are of notice. PNP is often lethal due to bronchiolitis obliterans and opportunistic infection. A 70-year-old Japanese male complained of dry cough, stomatitis, and sore throat. The lips and oral mucosa were severely eroded, and skin eruptions were seen on the chest and abdomen. The biopsy features were consistent with PNP, and the deposition of IgG and IgM was shown on the plasma membrane of the involved keratinocytes. Serological studies demonstrated autoantibodies to desmoglein-3, desmocollins-2 and -3, bullous pemphigoid antigen-1, envoplakin and periplakin. Systemic evaluation disclosed mantle cell lymphoma, stage 4B. After chemotherapy, partial remission was reached. PNP was treated with methylprednisolone and intravenous immunoglobulins, and the oral lesion only temporarily responded. He died of respiratory failure two months after onset. Autopsy revealed residual indolent lymphoma and systemic opportunistic infections. Aspergillus colonized the eroded bronchial/bronchiolar mucosa, associated with extensive vascular invasion. Coinfection of cytomegalovirus (CMV) and Pneumocystis jirovecii caused interstitial pneumonia. The oropharyngeal, respiratory, esophageal, and gastrointestinal mucosae were diffusely infected by CMV. Bronchiolitis obliterans was observed in the peripheral lung. PNP-related acantholysis-like lesions were microscopically identified in the bronchial and gastrointestinal mucosa. IgG deposition and cleaved caspase-3-immunoreactive apoptotic cell death were proven in the involved mucosal columnar cells. Pathogenesis of the mucosal involvement is discussed.
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Kartika Sari, Rina, Kus Harijanti, Adiastuti Endah P, and Hening Tuti H. "MANAGEMENT OF ULCERATIVE ORAL LICHEN PLANUS PREDISPOSED BY PSYCHOLOGICAL STRESS." Dentino : Jurnal Kedokteran Gigi 7, no. 2 (October 28, 2022): 204. http://dx.doi.org/10.20527/dentino.v7i2.14632.
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Background: Oral lichen planus (OLP) is a chronic inflammatory autoimmune oral mucosa disease. The ulcerative type of OLP presents as erythematous ulceration with mucosal erosions surrounding whitish striae. The aetiology of OLP is unknown, but can be predisposed by psychological factors. Purpose: Reporting ulcerative oral lichen planus predisposed by psychological stress. Case: A 36 years old woman complained very painful ulcer in the right buccal mucosa and a grey-purple lower lip lesion for a year. It had been treated with topical corticosteroids, antibiotics, tretinoin, and vitamins but did not heal. Extraoral examination on the lower vermillion showed bluish-purple macules, diffuse and irregular borders, rough and painful. Intraoral examination in the right buccal mucosa showed an irregular yellowish-white ulcer with an erythematous area and white striae. Case Management: Screening for psychological stress by DASS 42 showed moderate stress and severe anxiety. Autofluorescence examination showed no malignant transformation sign. A complete blood count test showed low neutrophil and lymphocyte count. ANA test was normal. Systemic Methyl Prednisolone 8 mg was prescribed 2 tabs twice a day and tapered off after the lesion resolved within 1 week. Supportive treatments include Benzydamine HCl and multivitamins. Discussion: Stress, anxiety, and depression were possible factors of OLP mediated by the Hypothalamic-pituitary-adrenal (HPA) axis system and the Sympathetic-adrenal-medullary (SAM) system. Specific mechanisms are mediated by Antigen-specific CD8+ (CTLs) that are activated with the help of CD4+ T-cells. Non-specific mechanism mediated by MMP-9 activation. They led to the apoptosis of keratinocytes. Systemic corticosteroids are an important treatment for oral lichen planus that do not responded to topical steroids. Conclusion: Oral Lichen Planus is a chronic inflammatory disease that affects the oral mucosa and can be predisposed by psychological stress. Corticosteroid is very effective to treat oral lichen planus, especially the erosive-ulcerative type. Keywords: Oral Lichen Planus, Psychological Stress, Ulcerative
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Destek, Sebahattin, Vahit Onur Gul, Serkan Ahioglu, and Kursat Rahmi Serin. "Pituitary Adenoma and Hyperprolactinemia Accompanied by Idiopathic Granulomatous Mastitis." Case Reports in Endocrinology 2017 (2017): 1–4. http://dx.doi.org/10.1155/2017/3974291.
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Idiopathic granulomatous mastitis (IGM) is a rare chronic inflammatory disease of the breast, and its etiology remains not fully elucidated. IGM is observed more often in patients with autoimmune disease. Hyperprolactinemia is observed during pregnancy, lactation, and a history of oral contraceptive use. A 39-year-old patient with no history of oral contraceptive use presented with complaints such as redness, pain, and swelling in her left breast. Ultrasound and magnetic resonance imaging (MRI) revealed a suspicious inflamed mass lesion. Core biopsy was performed to exclude breast cancer and to further diagnose. The breast abscess was drained and steroids were given for treatment. In order to monitor any progression during the three months of treatment, hormone levels were routinely examined. Prolactin level was above the reference range, and pituitary MRI revealed a pituitary prolactinoma. After treatment with prolactin inhibitors, IGM also improved with hyperprolactinemia. This report emphasizes attention to hyperprolactinemia in cases of IGM diagnosis and treatment.
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Oematan, Willy, Syeben Hezer Epatah Hietingwati, and Robertus Arian Datusanantyo. "A Rare Case of Recurrent Pyoderma Gangrenosum." International Journal of Research and Review 10, no. 1 (January 23, 2023): 409–12. http://dx.doi.org/10.52403/ijrr.20230145.
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Introduction: Pyoderma gangrenosum (PG) is a rare non-infectious disorder, and presents as solitary or multiple, fragile papules that progresses to ulcer and necrotic tissue. Autoimmune is the favored pathophysiology associated with this chronic inflammatory skin disease. Systemic disease such as inflammatory bowel disease, rheumatoid arthritis, and haematological disorders often accompany PG. We report a case of recurred PG in 60 year old male with no evidence of associated systemic condition. Case Presentation: A 60 year-old male complained of 1 month-long painful ulceration on his left chest. The lesion started as a pustule which gradually increased in size and broke into painful ulcer. The patient had similar skin lesion, five and three years prior to this admission on the lower abdomen and lower limbs respectively. Both episodes healed more than a year. The diagnosis of ulcerative PG was established based on the physical and histopathological examination. The patient was treated with prednisone and moist wound care. The ulceration responded rapidly. Discussion: Pyoderma gangrenosum is associated with underlying disease in up to two-thirds of case. It occurs typically in adults between 40 and 60 years of age. Although PG predilection is typically lower extremities, any body site can be affected, especially following a trauma. Our patient presented with recurred PG but showed no other systemic condition. Autoinflammatory disease are clinically characterized by recurrent episode and the treatment is quite challenging for its tendency to become chronic, relapsing, or reversible ulcer. Conclusion. We report a rare case of recurred ulcerative PG with no symptom of associated systemic disease who responded rapidly with oral steroid treatment and moist wound care. Keywords: Pyoderma gangrenosum, ulcerative, autoimmune, case report, steroid.
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Chen, Sheng-An, Lan-Ting Wang, Zi-Hua Chen, Fan-Ping Yang, Qin-Yuan Zhu, Hu-Yan Chen, and Xiao-Qun Luo. "Extensive cutaneous iatrogenic Kaposi’s sarcoma after bullous pemphigoid treatment with oral methylprednisolone: a rare Chinese case report." Journal of International Medical Research 49, no. 1 (January 2021): 030006052098282. http://dx.doi.org/10.1177/0300060520982829.
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Bullous pemphigoid (BP) is an autoimmune disease that requires immunosuppressive therapy. Systemic corticosteroids are considered the standard treatment for moderate-to-severe BP. Kaposi’s sarcoma (KS) is a rare multifocal endothelial tumour that affects the skin, mucosa and viscera. As an angioproliferative disease of obscure aetiopathogenesis and histogenesis, KS is associated with human herpesvirus 8 (HHV-8). This current case report describes a rare occurrence of extensive cutaneous KS in a 60-year-old Chinese male patient after oral methylprednisolone treatment for BP with an emphasis on its pathological characterization. A total of more than 40 nodules were found on his trunk and lower limbs covering more than 20% of his body surface area. Immunohistochemical staining of biopsy samples from the lesion showed the patient was positive for HHV-8, CD31, CD34, XIIIa, ERG and Ki-67. The Epstein–Barr virus test showed the patient tested negative for immunoglobulin (Ig)A and IgM, but was positive for IgG. Immunosuppression associated with the treatment for BP may activate a latent HHV-8 infection and induce the development of KS.
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Kohli, Pankaj, Komal Sharma, and Akshay Tolani. "A study of cutaneous manifestations of systemic lupus erythematosus in Malwa region of India." International Journal of Research in Dermatology 4, no. 2 (April 25, 2018): 230. http://dx.doi.org/10.18203/issn.2455-4529.intjresdermatol20181825.
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<p class="abstract"><strong>Background:</strong> Systemic lupus erythematosus (SLE) is an autoimmune disease. SLE is the most common connective tissue disease. Its prevalence varies according to geographical and racial background from 3/10 000 in Caucasians to 20/10 000 in Afro-Caribbeans. Around 90% of affected individuals are women, and the peak age at onset is between 20 and 30 years. Limited studies are available in India which have documented the frequency of cutaneous manifestations of SLE, so, this study was planned to evaluate the frequency of skin manifestations of SLE, in a tertiary care centre of Malwa region of India.</p><p class="abstract"><strong>Methods:</strong> All demographic data including age, sex, weight was collected on a pre-designed proforma. All the patients were evaluated for cutaneous manifestations of SLE i.e. malar rash, discoid rash, oral ulcers, photosensitivity etc. All the information was recorded in designed proforma.<strong></strong></p><p class="abstract"><strong>Results:</strong> Among 100 SLE subjects, 82 (82%) patients had skin manifestations, 18 (18%) patients had oral ulcer and 12 (12%) patients had raynaud’s phenomenon at the time of presentation. Among dermatological manifestations, 42% patients had photosensivity, 35% patients had malar rash, 30% patients had discoid rash, 10% patients had alopecia and 2% patients had bullous lesion.</p><p class="abstract"><strong>Conclusions:</strong> Skin lesions in patients with lupus may be specific or nonspecific. This study covers the SLE-specific cutaneous changes: malar rash, discoid rash, photosensitivity, and oral mucosal lesions as well as SLE nonspecific skin manifestations. A deeper thorough understanding of the cutaneous manifestations of SLE is essential for diagnosis, prognosis, and efficient management. Thus, dermatologists should be involved with other specialties to provide optimal care of SLE patient.</p>
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Ranabhat, S., R. Byanju, and S. Khadka. "Behcet’s Disease with Absent HLA Serotyping and Pathergy Test." Kathmandu University Medical Journal 19, no. 4 (December 31, 2021): 519–21. http://dx.doi.org/10.3126/kumj.v19i4.49789.
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Behcet’s disease is a multisystemic vasculitis of unknown etiopathogenesis characterized by recurrent acute inflammation. A 30-year male presented with progressive blurred vision in both eye for one month associated with photophobia, redness and ocular pain. On presentation best corrected visual acuity was 6/9 both eyes. Bilateral ocular examination of anterior segment demonstrated occasional cells. Treatment history of multiple joint pain along with oral aphthous ulcers. Erythematous papulopustular lesion over face, neck, trunk and genital ulcers were being treated. Irrespective of negative human leucocyte antigen B51 and pathergy, patient was diagnosed as Behcet’s disease on the basis of clinical criteria and started with topical steroid and cycloplegic. At one-month, ocular symptoms were relieved. Behcet’s disease is a rare, autoimmune disease, which lacks universal pathognomonic test and investigations, therefore diagnosis is primarily done with international criteria for Behcet’s disease. Multidisciplinary approach certainly helps in early diagnosis and eliminating morbidity.
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Jocic, Ivana, Dragana Dakovic, Lidija Kandolf-Sekulovic, Ljubomir Novakovic, and Zeljko Mijuskovic. "Mucous membrane pemphigoid - a report of four cases." Vojnosanitetski pregled, no. 00 (2021): 98. http://dx.doi.org/10.2298/vsp210801098j.
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Introduction. Mucous membrane pemphigoid (MMP) is a rare autoimmune, chronic inflammatory disease which affects mucous membranes, most commonly the eyes and 3 mouth, with or without skin involvement. It is a complex disease with several complications including scarring, especially on conjunctival mucosa that can lead to visual loss. Case report. We report four patients (two men and two women) with MMP. In all patients the disease started in their seventies. The diagnosis was confirmed on the basis of clinical appearance, histology, direct and indirect immunofluorescence studies, indirect split skin technique and ELISA test. The majority of lesions were on the gums and buccal mucosa, one patient had laryngeal involvement and a lesion on the umbilicus. No ocular involvement and no malignancy were detected. Direct immunofluorescence tests revealed continuous linear IgG deposition in the basal membrane zone in two patients, and they were treated with oral nicotinamide and tetracycline hydrochloride. In two patients we detected IgG along with IgA linear deposition; they received treatement with methylprednisolone. Complete remission was achieved in all patients. Conclusion. Early diagnosis as well as a multidisciplinary therapeutic approach is necessary for the MMP treatment in long term disease control and reduction of the disease-related complications.
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Li, Ye, James McKelvie, Cliff Fairley, and Cameron McLintock. "Scedosporium scleritis following pterygium excision with conjunctival autograft." Malaysian Journal of Ophthalmology 3, no. 4 (December 6, 2021): 230–35. http://dx.doi.org/10.35119/myjo.v3i4.210.
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A 67-year-old female presented 6 months following left pterygium surgery with autoconjunctival graft with presumed episcleritis. Following a trial of topical dexamethasone, she returned with pain, reduced vision, and a donor-site scleral nodule. MRI orbits demonstrated scleritis; oral prednisolone was commenced for presumed immune-mediated scleritis. Ten days later, vision reduced to light-perception with significant vitritis overlying a subretinal lesion associated with the donor site. Vitreous tap cultured Scedosporium aurantiacum. Treatment consisted of vitrectomy, scleral debridement with corneal patch graft, with both systemic and intravitreal voriconazole. Further scleral debridement was attempted but unable to be completed due to its posterior extent. As repeat MRI orbits showed persistent active scleritis in proximity to the optic nerve which posed a risk of meningitis, a decision was made for enucleation. This case highlights the difficulties in distinguishing between infectious and autoimmune scleritis, and the importance of excluding infection, particularly in eyes with prior surgery.
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Nammour, Samir, Marwan El Mobadder, Aldo Jr Brugnera, Melanie Namour, Saad Houeis, Daniel Heysselaer, Alain Vanheusden, and Amaury Namour. "Photobiomodulation Therapy vs. Corticosteroid for the Management of Erosive/Ulcerative and Painful Oral Lichen Planus. Assessment of Success Rate during One-Year Follow-Up: A Retrospective Study." Healthcare 9, no. 9 (August 31, 2021): 1137. http://dx.doi.org/10.3390/healthcare9091137.
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Photobiomodulation (PBM) therapy is a promising approach for the management of inflammatory conditions and autoimmune lesions, such as oral lichen planus (OLP). The aim of this retrospective study was to assess the effectiveness of PBM in the management of painful and erosive/ulcerative OLP and to compare it with the standard of care that is the topical application of corticosteroids. 96 patients were included with erosive and painful OLP. 48 patients received PBM therapy and 48 received corticosteroids. Data was collected retrospectively on pain using the visual analogue scale; clinical aspects of lesions were assessed with the REU score, and the recurrence rate was noted. One session of PBM therapy with a helium-neon red light (635 nm) was carried out every 48 h for 6 weeks. Treatments were mainly made in contact mode, using a fiber with a diameter of 600 µm (0.6 mm). The output power of the laser beam was calibrated by a power meter. A delivered power of 0.1 W was used for 40 s in a continuous wave (CW), corresponding to a delivered energy of 4 J. The delivered energy density related to the fiber diameter was 1415 J/cm2. Each treated point was considered as 1 cm2 of diameter. PBM therapy within these parameters was carried out on each point until the totality of the lesion was covered, including the non-erosive OLP area. Furthermore, healthy mucosa within 5 mm of the lesion was also irradiated with the same conditions. This PBM treatment was performed during 6 consecutive weeks. The topical corticosteroid treatment consisted of cortisone application to cover the OLP 3 times/day for 6 weeks. Follow-up was made at 6 weeks and at 3, 6 and 12 months. After 6 weeks, both groups showed complete absence of pain, and a complete disappearance of ulcerative/erosive areas. No significant difference was found for both groups concerning the recurrence rate of erosive OLP during the follow-up period; values were 0% at 6 weeks for both groups and 79% and 87.5% for the corticosteroid and PBM group, respectively, at 12 months of follow-up. PBM is effective for managing OLP and is significantly similar to topical corticosteroids without any need for the use of medication and with no reported side effects.
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Stępień, Katarzyna, Ewa Żabska, Mansur Rahnama-Hezavah, and Adam Reich. "Lichen Planus Activity and Damage Index (LiPADI)–Creation of the Questionnaire." Journal of Clinical Medicine 11, no. 1 (December 22, 2021): 23. http://dx.doi.org/10.3390/jcm11010023.
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Introduction: Lichen planus (LP) is a chronic autoimmune disease that affects skin, oral and genital mucosa, and other sites. Basic difficulties in assessment of LP are multitude of disease forms and diverse locations of lesions. Moreover, there is lack of objective and consolidated tool for assessment of disease severity and LP progression. Objective: The aim of the study was to develop a valid evaluation tool of LP severity, which will enable disease assessment in a repetitive way. Materials and methods: A combined tool called Lichen Planus Activity and Damage Index (LiPADI) was developed to assess the severity of LP skin, mucosal, and nail lesions as well as hair loss/scaring alopecia to provide an integrative scoring for LP activity and damage caused by the disease. Skin lesions were assessed in nine locations: scalp, face, chest, abdomen, back and buttocks, arms, hands, legs, and feet. The assessment of lesion activity included erythema, hypertrophy, and scaling, while the damage was reflected by the assessment of hyperpigmentation and scaring/atrophy. In addition, mucosal lesions, nail abnormalities, hair loss, and scarring alopecia were evaluated as well. LiPADI scoring was compared with quality of life assessed with the Dermatology Life Quality Index, EQ-5D calculator, pain and pruritus intensity assessed with the Numerical Rating Scale as well as with the patient and physician global assessment. Results: Our results show that LiPADI well reflects the LP patient’s clinical condition. The obtained results were in line with other indicators assessed. In addition, it was possible to evaluate patients with various forms and locations of LP, what indicates its versatility. Conclusions: LiPADI seems to be a useful tool for measurement the severity of the LP and its progress over time, which could help to monitor the effectiveness of the patients’ treatment.
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Balaban, Jagoda. "The Use of Methotrexate in Dermatology / Upotreba metotreksata u dermatologiji." Serbian Journal of Dermatology and Venerology 3, no. 4 (December 1, 2011): 137–44. http://dx.doi.org/10.2478/v10249-011-0045-5.
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Abstract Methotrexate is a cytotoxic antimetabolite agent and a folic acid antagonist. Except for its use in oncology and rheumatology, it is widely used in dermatology. The most important indications include severe forms of psoriasis, but also a wide range of autoimmune diseases and dermatoses with different etiology and pathophysiology such as: bullous pemphigoid, dermatomyositis, pityriasis rubra pilaris, sarcoidosis, T-cell lymphomas, Behcet’s disease, adult atopic eczema, scleroderma, Reiter’s syndrome and many others. For dermatological indications methotrexate is usually taken in low oral doses, 5-25 mg once a week. In certain diseases it can be applied to the lesion itself, or in the form of local preparations. Considering the fact that numerous drugs affect various metabolic phases of methotrexate and may increase its toxicity, it is of utmost importance to consider other prescribed drugs, especially certain antibiotics, nonsteroidal antiinflammatory drugs, antiepileptic drugs, retinoids, proton pump inhibitors and so on. If the selection of patients is correct, if drugs are taken regularly and laboratory monitoring is included, methotrexate is a truly efficient and safe drug that can be taken for months or years if necessary.
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Farag, Mena, Beverley Hunt, and Thomasin Andrews. "100 Antiphospholipid-related chorea." Journal of Neurology, Neurosurgery & Psychiatry 93, no. 9 (August 12, 2022): e2.51. http://dx.doi.org/10.1136/jnnp-2022-abn2.144.
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Chorea of subacute onset is a movement disorder that typically has a monophasic course. Chorea can be associated with autoimmune diseases such as antiphospholipid syndrome and has been associated with the isolated presence of antiphospholipid antibodies (aPL). Here, we report a patient with isolated aPL-related chorea that unusually followed a relapsing-remitting course.A female in her forties developed chorea gravidarum during her first pregnancy, eight years previously, and again during her second pregnancy five years ago. Investigations showed high titre triple positivity of aPL. No basal ganglia lesion or signal change was identified on MRI brain. There was no history of arterial or venous thromboembolism or pregnancy morbidity. Her symptoms continued post-partum and she received treatment with low-molecular-weight-heparin, prednisolone and intravenous immunoglobulin, while breastfeeding. Tetrabenazine was trialled, which helped to suppress chorea, though lowered her mood. The chorea remitted. She developed a recurrence of chorea three years later, when she was not pregnant or taking hormone therapy. She had significant irritability. Olanzapine was trialled with benefit and her movements and mood improved. She relapsed with a fourth recurrence of chorea two years later and recommenced olanzapine, with no symptomatic benefit. She is currently trialling pulsed oral methylprednisolone followed by azathioprine.
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de Souza, Erik Friedrich Alex, Guilherme Almeida Rosa da Silva, Gustavo Randow dos Santos, Heloisa Loureiro de Sá Neves Motta, Pedro Afonso Nogueira Moisés Cardoso, Marcelo Costa Velho Mendes de Azevedo, Karina Lebeis Pires, et al. "Pyoderma Gangrenosum Simulating Necrotizing Fasciitis." Case Reports in Medicine 2015 (2015): 1–6. http://dx.doi.org/10.1155/2015/504970.
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Pyoderma gangrenosum received this name due to the notion that this disease was related to infections caused by bacteria in the genusStreptococcus. In contrast to this initial assumption, today the disease is thought to have an autoimmune origin. Necrotizing fasciitis was first mentioned around the fifth century AD, being referred to as a complication of erysipelas. It is a disease characterized by severe, rapidly progressing soft tissue infection, which causes necrosis of the subcutaneous tissue and the fascia. On the third day of hospitalization after antecubital venipuncture, a 59-year-old woman presented an erythematous and painful pustular lesion that quickly evolved into extensive ulceration circumvented by an erythematous halo and accompanied by toxemia. One of the proposed etiologies was necrotizing fasciitis. The microbiological results were all negative, while the histopathological analysis showed epidermal necrosis and inflammatory infiltrate composed predominantly of dermal neutrophils. Pyoderma gangrenosum was considered as a diagnosis. After 30 days, the patient was discharged with oral prednisone (60 mg/day), and the patient had complete healing of the initial injury in less than two months. This case was an unexpected event in the course of the hospitalization which was diagnosed as pyoderma gangrenosum associated with myelodysplastic syndrome.
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Matsumura, Natsuko, and Toshiyuki Yamamoto. "Linear lichen planus associated with primary aldosteronism." Our Dermatology Online 12, no. 4 (October 19, 2021): 468–69. http://dx.doi.org/10.7241/ourd.20214.31.
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Sir, Lichen planus (LP) is categorized as a chronic inflammatory skin disease of unknown etiology that involves immune reactions. It is characterized by flat-topped, polygonal, violaceous papules and plaques. It has various clinical presentations, such as classical LP, hypertrophic LP, LP pigmentosus, and linear LP (LLP). Primary aldosteronism (PA) is known to pose a higher risk of causing multiple autoimmune diseases [1]. Herein, we report a case with LLP and PA present at the same time. A 72-year-old Japanese female presented herself to our hospital with a three-month history of slightly itchy skin lesions on the lower right leg. A physical examination revealed flat-topped plaques on the lower right limb extending from the middle of the leg to the dorsum of the foot (Fig. 1a). There was no oral or nail involvement. The patient had a history of hypertension from the age of 62 years and was diagnosed with PA afterward. The patient had been treated with an antihypertensive drug since then without change in internal medication. The patient had no history of a preceding trauma, dental metal fillings, hepatitis, metastatic cancer, or any other infections. A histopathological examination of a skin biopsy from a lesion on the right leg revealed hyperkeratosis, a saw-tooth appearance of the epidermis, and severe liquefaction degeneration. A band-like lymphocytic infiltration was present in the upper dermis (Figs. 2a and 2b), as well as lichenoid infiltration into the dermis composed of CD4+ and CD8+ T lymphocytes. Predominantly, CD8+ T lymphocytes infiltrated into the epidermis (Figs. 2c and 2d). Clinical and histological findings confirmed the diagnosis of LPP.
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Haarberg, Kelley M. K., Meghan J. Wymore Brand, Amanda E. Ramer-Tait, Catherine C. Hauck, Patricia A. Murphy, Jesse M. Hostetter, and Michael J. Wannemuehler. "Oral administration of an ethanolic extract of Hypericum gentianoides attenuates spontaneous colitis in mdr1a-/- mice." Functional Foods in Health and Disease 6, no. 5 (May 30, 2016): 246. http://dx.doi.org/10.31989/ffhd.v6i5.253.
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Background: Nutraceuticals (i.e., complementary and alternative medicines) are gaining ground as therapeutic modalities for inflammatory and autoimmune disorders due to their low toxicity and high patient compliance. Several species of Hypericum have been shown to possess immunomodulatory capabilities in many disease models; however, the therapeutic potential of the chemically unique Hypericum gentianoides (HG) is largely untested. We investigated the efficacy of an orally administered ethanolic extract of HG (HGEE) to prophylactically inhibit/ameliorate the spontaneous colitis that develops in mdr1a deficient (mdr1a-/-) mice.Methods: Beginning at six weeks of age, vehicle (5% ethanol), HGEE (4.8 mg/day) or metronidazole (0.75 mg/mL) were orally administered daily to mdr1a-/- or FVBWT mice until they reached 20 weeks of age or had lost ≥ 15 % of their body weight. Macroscopic disease assessment included measurement of weight loss, colon shortening, and combined colonic/cecal macroscopic lesion scores. Colonic/cecal inflammation was also scored histologically. Inflammatory responses were assessed using myeloperoxidase (MPO) assay and analysis of serum cytokines/chemokines.Results: Daily administration of HGEE significantly (p < 0.05) delayed the onset of clinical signs of disease, reduced the associated morbidity and attenuated macroscopic and microscopic disease/inflammatory scores in mdr1a-/- mice. After 14 weeks of treatment, there were no adverse macroscopic or microscopic effects observed following the daily administration of HGEE to wild type FVB mice. Histological evaluation of colonic tissue revealed a decrease in neutrophil infiltration in HGEE treated mdr1a-/- mice, which was substantiated by a significant decrease (p ≤ 0.05) in colonic MPO activity. Compared to vehicle treated mdr1a-/- mice, levels of G-CSF, KC, and TNFα were significantly lower in the serum of mdr1a-/- mice treated with HGEE.Conclusions: Oral administration of HGEE was shown to be safe and effectively ameliorated mucosal inflammation and disease severity in mdr1a-/- mice. The attenuation of mucosal inflammation correlated with a reduction in the production of pro-inflammatory cytokines and the recruitment of inflammatory granulocytes to the intestinal mucosa and suggests that extracts of H. gentianoides has potential to be used as a CAM product for mucosal inflammation.Keywords: Hypericum gentianoides, colitis, IBD, mdr1a deficient mice, botanical
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Jang, Jiwon, Jong Sub Lee, Young-Jin Jang, Eui Su Choung, Wan Yi Li, Sang Woo Lee, Eunji Kim, Jong-Hoon Kim, and Jae Youl Cho. "Sorbaria kirilowii Ethanol Extract Exerts Anti-Inflammatory Effects In Vitro and In Vivo by Targeting Src/Nuclear Factor (NF)-κB." Biomolecules 10, no. 5 (May 10, 2020): 741. http://dx.doi.org/10.3390/biom10050741.
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Inflammation is a fundamental process for defending against foreign antigens that involves various transcriptional regulatory processes as well as molecular signaling pathways. Despite its protective roles in the human body, the activation of inflammation may also convey various diseases including autoimmune disease and cancer. Sorbaria kirilowii is a plant originating from Asia, with no anti-inflammatory activity reported. In this paper, we discovered an anti-inflammatory effect of S. kirilowii ethanol extract (Sk-EE) both in vivo and in vitro. In vitro effects of Sk-EE were determined with lipopolysaccharide (LPS)-stimulated RAW264.7 cells, while ex vivo analysis was performed using peritoneal macrophages of thioglycollate (TG)-induced mice. Sk-EE significantly reduced the nitric oxide (NO) production of induced macrophages and inhibited the expression of inflammation-related cytokines and the activation of transcription factors. Moreover, treatment with Sk-EE also decreased the activation of proteins involved in nuclear factor (NF)-κB signaling cascade; among them, Src was a prime target of Sk-EE. For in vivo assessment of the anti-inflammatory effect of Sk-EE, HCl/EtOH was given by the oral route to mice for gastritis induction. Sk-EE injection dose-dependently reduced the inflammatory lesion area of the stomach in gastritis-induced mice. Taking these results together, Sk-EE exerts its anti-inflammatory activity by regulating intracellular NF-κB signaling pathways and also shows an authentic effect on reducing gastric inflammation.
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Albrecht, Kim WorkowskiJoerg, Robin K. Avery, Robin K. Avery, Pranatharthi Chandrasekar, Roy F. Chemaly, Nicolas C. Issa, Camille Kotton, et al. "1060. Pritelivir in Immunocompromised Patients with Mucocutaneous Acyclovir-Resistant Herpes Simplex Virus-Infections – First Case Series." Open Forum Infectious Diseases 8, Supplement_1 (November 1, 2021): S622—S623. http://dx.doi.org/10.1093/ofid/ofab466.1254.
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Abstract Background HSV recurrences are usually managed effectively with existing antiviral drugs (nucleoside analogs such as acyclovir). However, in immunocompromised patients (e.g., malignancy, HIV, transplant), if lesions persist or recur while receiving antiviral treatment, acyclovir resistance should be suspected. In this population, there are limited treatment options. The helicase-primase inhibitor pritelivir is a novel oral antiviral, with a new mode of action and is active against both HSV-1 and HSV-2, including acyclovir and foscarnet-resistant strains. In this case series, we report the first clinical experiences with pritelivir in the treatment of immunocompromised patients with acyclovir resistant HSV infection. Methods All patient reported in this case series received pritelivir in a Phase 2 study. There were treated in an open-label design with a 400 mg pritelivir oral loading dose followed by a 100 mg oral maintenance dose daily for up to 28 days. Results Of the 23 patients, 11 had HIV infection and 12 had malignancy, transplant or an autoimmune disease. Of this cohort, 19 patients showed full resolution of their HSV-related lesions during the 28 day treatment period, while in 4 subjects lesions improved but did not completely heal during the observation period. Pritelivir was well tolerated without significant adverse effects.Reasons for incomplete lesion resolution during the 28 day treatment period, were extensive lesions in one patient, one patient with resistance development, and one patient with lesions in the oral cavity. Three patients subsequently experienced full resolution, while one patient required foscarnet due to CMV reactivation, necessitating early discontinuation. Conclusion Pritelivir is a promising novel treatment option for patients with severe mucocutaneous HSV-1/2 infections that are resistant to acyclovir and foscarnet. An international Phase 3 study is underway to evaluate pritelivir efficacy in immunocompromised patients. Disclosures Joerg Albrecht, MD/PhD, Biogen (Scientific Research Study Investigator)Investigator for AiCuris (Scientific Research Study Investigator) Robin K. Avery, MD, Aicuris (Grant/Research Support)Astellas (Grant/Research Support)Chimerix (Research Grant or Support)Merck (Grant/Research Support)Oxford Immunotec (Grant/Research Support)Qiagen (Grant/Research Support)Takeda/Shire (Grant/Research Support) Roy F. Chemaly, MD, MPH, FACP, FIDSA, AiCuris (Grant/Research Support)Ansun Biopharma (Consultant, Grant/Research Support)Chimerix (Consultant, Grant/Research Support)Clinigen (Consultant)Genentech (Consultant, Grant/Research Support)Janssen (Consultant, Grant/Research Support)Karius (Grant/Research Support)Merck (Consultant, Grant/Research Support)Molecular Partners (Consultant, Advisor or Review Panel member)Novartis (Grant/Research Support)Oxford Immunotec (Consultant, Grant/Research Support)Partner Therapeutics (Consultant)Pulmotec (Consultant, Grant/Research Support)Shire/Takeda (Consultant, Grant/Research Support)Viracor (Grant/Research Support)Xenex (Grant/Research Support) Nicolas C. Issa, MD, AiCuris (Scientific Research Study Investigator)Astellas (Scientific Research Study Investigator)GSK (Scientific Research Study Investigator)Merck (Scientific Research Study Investigator) Camille Kotton, MD, Shire/Takeda (Advisor or Review Panel member) Camille Kotton, MD, UpToDate (Individual(s) Involved: Self): I write chapters on zoonoses for UpToDate., Independent Contractor Princy N. Kumar, MD, AMGEN (Other Financial or Material Support, Honoraria)Eli Lilly (Grant/Research Support)Gilead (Grant/Research Support, Shareholder, Other Financial or Material Support, Honoraria)GSK (Grant/Research Support, Shareholder, Other Financial or Material Support, Honoraria)Merck & Co., Inc. (Grant/Research Support, Shareholder, Other Financial or Material Support, Honoraria) Moti Ramgopal, MD FACP FIDSA, Abbvie (Scientific Research Study Investigator, Speaker’s Bureau)Gilead (Consultant, Scientific Research Study Investigator, Speaker’s Bureau)Janssen (Consultant, Scientific Research Study Investigator, Research Grant or Support, Speaker’s Bureau)Merck (Consultant, Scientific Research Study Investigator)ViiV (Consultant, Scientific Research Study Investigator, Speaker’s Bureau) Anna Wald, MD, MPH, Aicuris (Consultant)Crozet (Consultant)GSK (Scientific Research Study Investigator)Merck (Other Financial or Material Support, DSMB)Sanofi (Scientific Research Study Investigator)X-Vax (Consultant) Michael G. Ison, MD, MS, Celltrion, Inc. (Consultant)
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Vargas, Diana L., and William R. Tyor. "Update on disease-modifying therapies for multiple sclerosis." Journal of Investigative Medicine 65, no. 5 (January 27, 2017): 883–91. http://dx.doi.org/10.1136/jim-2016-000339.
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Multiple sclerosis (MS) is an autoimmune, demyelinating disease of the central nervous system (CNS). It predominantly affects young women and is one of the most common causes of disability in young adults. MS is characterized by formation of white matter lesions in the CNS as a result of inflammation, demyelination, and axonal loss. Treatment has been a focus of neurological research for over 60 years. A number of disease-modifying therapies (DMTs) have become available making MS a treatable disease. These compounds target the inflammatory response in MS. They work by decreasing the chances of relapse, decreasing the chances of new lesion formation seen on MRI of the CNS and slowing the accumulation of disability. The first drugs for MS to be available were interferon-β and glatiramer acetate. These work by modulating the inflammatory response via different mechanisms that are briefly discussed. Newer agents have since become available and have significantly changed the dynamics of MS treatment. These include fingolimod, dimethyl fumarate and teriflunomide, which are oral agents. Other second-line and third-line Food and Drug Administration (FDA) approved medications include natalizumab and alemtuzumab. Natalizumab is considered one of the most potent treatments for relapse prevention. However, the high risk of progressive multifocal leukoencephalopathy (PML), which is caused by JC virus infection in the brain, tempers the more widespread use of this agent; nevertheless, JC virus antibody tests have helped to stratify the risk of PML. Alemtuzumab, which also has a considerable side effect profile, is likewise highly efficacious. Ocrelizumab, a monoclonal antibody to CD20 on B cells, is a highly effective agent for MS that is likely to be approved soon by the FDA. MS is a major contributor to healthcare costs and it is critical that healthcare providers be aware of the availability and benefits of DMTs. It is imperative that prompt and adequate treatment be established on diagnosis. Changes in therapy should be considered when there is evidence of disease activity as well as accumulation of disability or safety or tolerability concerns.