BackgroundStudies have shown a correlation between Tuberculosis (TB) and Takayasu arteritis (TA). Some even postulate that infection with TB is required for the initiation of aortoarteritis. Hence, this project was undertaken to find an association of TB and TA by studying the prevalence of Latent Tuberculosis Infection (LTBI) in Indian TA patients.ObjectivesTo study the prevalence of LTBI in Indian TA patients and see whether LTBI is more in these patients as compared to the historical cohort (40% in Indian population).MethodsThis was a cross sectional observational study. All consecutive patients with TA (satisfying the ACR 1990 criteria) were included prospectively from a period of May 2016 to December 2017. Their clinical, laboratory and radiological data were collected after obtaining informed consent. Patients were divided into groups based on the angiographic classification. LTBI was assessed by the Mantoux test and Quantiferon TB Gold test. Mantoux test (MT) was done with 5TU and results were read after 48–72 hours. An induration more than 10 mm was considered positive. Quantiferon TB Gold assay (QTB) was done by ELISA technique and (patient minus control) value >0.35 IU/ml was considered positive. A positive result of MT and /or QTB was considered positive for LTBI. Chest X-ray was included to access evidence of past or active TB lesions. Active infection was defined as clinical and microbiological and /or radiological evidence of TB. The study was approved by the Ethics committee of Medanta hospital.ResultsOut of 66 consecutive TA patients, 46 patients had tests available for LTBI and these were included in the analysis. The mean age of the cohort was 34.9 years with a median disease duration of 24 months. Males consisted of 11 patients whereas females formed the majority i.e. 35 patients (M: F= 1: 3.1). Angiographic Type V (54.3%) was the commonest in the cohort followed by Type IIB (17.3%), Type IV, I, IIA and III (15.2%, 8.6%, 2.1% and 2.1% respectively). LTBI positivity was present in 32.6% of the cohort; with 5 patients (10.8%) having both tests positive. 6 patients were MT positive without being QTB positive and 4 patients were only QTB positive. Eight patients had history of Tuberculosis out of which 1 was diagnosed with TB and TA simultaneously. Four patients were diagnosed as TA during the course of Anti tubercular treatment (ATT) between 4 to 6 months, whereas the rest were diagnosed after ATT completion. The mean duration of Anti tubercular treatment was 8 months. Koch’s contact was seen in 7 patients.Abstract FRI0507 – Table 1Patient characteristics and LTBICharacteristicValuePercentage (%) n=46MT positive only613QTB positive only48.6Both MT and QTB positive510.8LTBI positive1532.6n=8H/O TB8/4617.3TB LN450Pulmonary TB (progression)112.5Intestinal TB225TBM112.5Empirical ATT for PUO112.5MT225QTB00Both112.5n=7TB contact7/4615.2MT114.2QTB00Both00ConclusionsThe prevalence of LTBI in Indian Takayasu patients was 32.6%, which was not higher than the population prevalence (40% in the historical cohor...
Immunoglobulin G4-related disease (IgG4-RD) is an immune-mediated fibroinflammatory disease. Previously described diseases such as Mikulicz's disease, Riedel's thyroiditis, and Küttner's tumor are now considered to be part of IgG4-RD spectrum. In 1995, a unique form of pancreatitis having autoimmune etiology and showing good response to steroids was described. 1 Subsequently, these autoimmune pancreatitis (AIP) cases were found to be associated with elevated serum IgG4 concentration and unique histopathologic features. 2 In recent times, IgG4-RD has been described in virtually every organ system: the biliary tree, pancreas, aorta, meninges, lymph nodes, salivary glands, periorbital tissue, breast, prostate, thyroid, pericardium and skin. 1,3 Although tumefactive lesions are well described in the literature, very rarely, IgG4-RD may present as inflammatory pseudotumor or an abscess.IgG4-related breast disease, better known as IgG4-related mastitis (IgG4-RM), presents with palpable breast lump and remains an important differential diagnosis of breast malignancy. Very few cases of IgG4-RM have been described in the literature. In this article, we describe a case of IgG4-RD presenting as recurrent breast abscess and its management. CASE REPORTA 24-year-old female patient with no known comorbidities developed sudden onset pain and redness in right breast. She was diagnosed with right-sided mastitis by primary care physician and treated with oral antibiotics and analgesics for a week. She had symptomatic improvement with treatment. Two months later, she again developed
BackgroundThe ANCA-associated vasculitides (AAV) are systemic autoimmune diseases affecting small and medium-sized blood vessels. Upper airways, lungs, and kidneys are variably involved in the different types of AAV, and the consequences of a missed or delayed diagnosis of renal vasculitis are potentially life-threatening. AAV may be classified into clinical syndromes or based on their serology (Anti-PR3 or Anti-MPO). Patient survival and the risk of end-stage renal disease are closely associated with renal functional status.ObjectivesThis study was undertaken to study the disease characteristics and outcomes in patients of AAV based on the presence or absence of renal involvement.MethodsThis was a longitudinal, observational study conducted at a tertiary care hospital in Northern India. Between February 2020 and December 2021, all consecutive adult patients diagnosed with AAV based on their autoantibody profiles (using indirect immunofluorescence and Line ImmunoAssay) and clinical features were included in this study after taking their informed consent. Demographic details, clinical features, laboratory parameters, disease activity, and mortality or morbidity outcomes of patients were analysed prospectively. All outcomes were compared between patients with and without renal involvement.ResultsA total of 112 patients were included in our study, with a median age of 51.5 years. 74 (66%) patients had renal involvement either in the form of Nephritic syndrome, Nephrotic syndrome, RPRF (Rapidly progressive renal failure), Nephritic nephrotic syndrome, or Asymptomatic Urinary Sediments. c-ANCA and PR3 positivity were seen in more than two-thirds of our population, without any significant correlation with organ involvement. Patients with renal disease had a significantly higher proportion with diffuse alveolar haemorrhage (32.4% vs 10.5%, p=0.05) and palpable purpura (19.6% vs 7.9%, p-0.025), but significantly lower occurrences of nasal pathology (14% vs 42%, p=0.001) and subglottic stenosis (1.4% vs 18.4%, p=0.001). Mean BVAS at enrolment was significantly higher in the renal group (20.9 vs 12.89). Remission was achieved in 50% and 47.4% of the patients with and without renal involvement respectively. Rates of relapse (19/74 vs 14/38), refractory disease, and mortality were not significantly different among the two subgroups. The commonest organ involvement in disease flare was pulmonary involvement. 21.6% of the patients developed CKD over a median follow-up period of 18 months.ConclusionKidney involvement is one of the commonest manifestations of AAV. Patients with renal involvement may have higher mean BVAS scores and an increased risk of developing alveolar haemorrhage and purpuric skin rash; while nasal pathology and subglottic stenosis occurred more frequently in patients without renal disease. Rates of remission, refractory disease, and mortality were almost similar, regardless of renal involvement, while relapses were numerically more in the non-renal AAV patients.References[1]Stone JH, Merkel PA, Spiera R, Seo P, Langford CA, Hoffman GS, Kallenberg CG, St. Clair EW, Turkiewicz A, Tchao NK, Webber L. Rituximab versus cyclophosphamide for ANCA-associated vasculitis. New England Journal of Medicine. 2010 Jul 15;363(3):221-32.[2]Córdova-Sánchez BM, Mejía-Vilet JM, Morales-Buenrostro LE, Loyola-Rodríguez G, Uribe-Uribe NO, Correa-Rotter R. Clinical presentation and outcome prediction of clinical, serological, and histopathological classification schemes in ANCA-associated vasculitis with renal involvement. Clinical rheumatology. 2016 Jul;35(7):1805-16.[3]Kronbichler A, Shin JI, Lee KH, Nakagomi D, Quintana LF, Busch M, Craven A, Luqmani RA, Merkel PA, Mayer G, Jayne DR. Clinical associations of renal involvement in ANCA-associated vasculitis. Autoimmunity Reviews. 2020 Apr 1;19(4):102495.Acknowledgements:NIL.Disclosure of InterestsNone Declared.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.