Immunoglobulin-A–associated small-vessel vasculitis: A 10-year experience at the Massachusetts General Hospital

Linskey, Katy; Kroshinsky, Daniela; Mihm, Martín C.; Hoang, Mai P.

doi:10.1016/j.jaad.2011.06.012

Cited by 62 publications

(41 citation statements)

References 44 publications

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“…Of the 88 LCV cases with positive DIF, 70.5% were positive for immunoglobulin deposition and/or complement and/or fibrinogen, comparable with previous studies. 3 Different from our data, other authors reported that in patients presenting with cutaneous vasculitis, up to 100% of cases can be found to have vascular immunoglobulin, complement and/or fibrinogen immunofluorescence. 2 IgA was the most common type of immunoglobulin deposited in the vessel walls, being found in 34.5% of 88 cases.…”

Section: Discussioncontrasting

confidence: 99%

“…3 The association of IgAV and infection has been raised based on the observations in children, where 30%-65% of IgA vasculitis cases occur after an upper respiratory tract infection, mostly in autumn and winter, and follows a selflimited course. [18][19][20] In our study, infection was reported/suspected in 62.5% of the 32 IgAV cases, half of which had objective evidence for infection.…”

Section: Ig Deposition and Infectionmentioning

confidence: 99%

“…1 A retrospective study from Massachusetts General Hospital found that the presence of IgA deposition in LCV biopsies confers an 84% positive predictive value and an 81% negative predictive value for the diagnosis of HSP. 3 Prominent immunoglobulin M (IgM) deposition has been associated with cryoglobulinemia and lymphoproliferative diseases. [4][5][6] IgM has also been reported to adhere nonspecifically to damaged tissue, 7 thus its presence does not always represent immune complex deposition.…”

Section: Introductionmentioning

confidence: 99%

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Clinical Significance of Immunoglobulin Deposition in Leukocytoclastic Vasculitis

Alalwani

Billings

Gota

2014

The American Journal of Dermatopathology

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In patients with cutaneous LCV, IgA is the most common immunoglobulin found by DIF. IgA deposition, but not IgM or IgG, is predictive of associated renal and gastrointestinal organ involvement by vasculitis. No association between the type of immunoglobulin and preexisting infection or malignancy was found. DIF results add information that is clinically relevant to the diagnosis and management of LCV.

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Section: Discussioncontrasting

confidence: 99%

Section: Ig Deposition and Infectionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Clinical Significance of Immunoglobulin Deposition in Leukocytoclastic Vasculitis

Alalwani

Billings

Gota

2014

The American Journal of Dermatopathology

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“…Also the presence of the same may not correlate with disease activity. [20] Previous DIF studies showed positive findings mainly in the early stage of the disease. [1521–23]…”

Section: Discussionmentioning

confidence: 99%

Direct immunofluorescence in cutaneous vasculitis: Experience from a referral hospital in India

Nandeesh

Tirumalae²

2013

Indian J Dermatol

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Background:Cutaneous vasculitis is commonly recognized and biopsied, owing to ease of access. Most biopsies are also subjected to direct immunofluorescence (DIF), though the rates of positivity vary. This is an attempt to assess the utility of DIF and glean data that will help optimize the test.Objective:To assess the diagnostic utility of DIF in cutaneous vasculitis.Materials and Methods:All cases of suspected cutaneous vasculitis submitted for DIF between 2004 and 2010 were included. Clinical data, histopathologic diagnosis, DIF findings and additional tests such as anti nuclear antibody (ANA), anti neutrophil cytoplasmic antibody (ANCA) (where done) were noted.Results:There were 198 patients in the study group, with a female predominance. Purpura was the commonest clinical presentation. Extracutaneous involvement was noted in 29% of patients’ i.e., joint pain, abdominal pain and hematuria. Leukocytoclastic vasculitis was the commonest histologic diagnosis. DIF showed an overall positivity of 39% (n = 77) with C3 in 26% (n = 52) and IgA in 23% (n = 46) cases. Forty one cases of suspected Henoch Schonlein Purpura (HSP) showed IgA positivity. The timing of biopsy ranged from <3 days to six months, with 38% being done within seven days. DIF was positive in 86% of biopsies performed within seven days of onset of lesions. Sixty percent of patients with extracutaneous manifestations showed deposits. Vascular deposits were also noted in dermatitis herpetiformis, dematomyositis and prurigo.Conclusion:DIF positivity is strongly influenced by the timing of the biopsy and the presence of extracutaneous features. Its clinical value is greatest in patients with HSP, being contributory in 90% of cases. Vascular deposits may be seen in non-vasculitic conditions and need clinicopathologic correlation.

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“…Henoch-Schönlein purpura (HSP) is a small-vessel vasculitis that is known as an immunoglobulin (Ig) A (IgA)-related immune complex-mediated disease1. Although the pathogenesis of HSP is not yet fully understood, some researchers proposed that B-cell activation might play a critical role in the development of this disease.…”

Section: Introductionmentioning

confidence: 99%

Elevated Serum Levels of Visfatin in Patients with Henoch-Schönlein Purpura

et al. 2014

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BackgroundHenoch-Schönlein purpura (HSP) is an immune complex-mediated disease predominantly characterized by the deposition of circulating immune complexes containing immunoglobulin A (IgA) on the walls of small vessels. Although the pathogenesis of HSP is not yet fully understood, some researchers proposed that B-cell activation might play a critical role in the development of this disease.ObjectiveTo investigate the serum levels of visfatin (pre-B-cell colony-enhancing factor), B-cell-activating factor (BAFF), and CXCL13, and to analyze their association with disease severity.MethodsThe serum levels of visfatin, BAFF, and CXCL13 were measured by using a double-antibody sandwich enzyme-linked immunosorbent assay (ELISA) in 43 patients with HSP and 45 controls. The serum levels of IgA anticardiolipin antibodies (ACA) were detected by using a double-antigen sandwich ELISA.ResultsLevels of visfatin but not BAFF and CXCL13 were significantly elevated in the sera of patients with HSP in the acute stage, and restored to normal levels in the convalescent stage. Furthermore, serum levels of visfatin were significantly higher in patients with HSP having renal involvement than in those without renal involvement. Serum levels of visfatin were correlated with the severity of HSP and serum concentration of ACA-IgA.ConclusionWe show for the first time that the serum levels of visfatin are abnormally elevated in patients with HSP. Visfatin may be associated with the pathogenesis of HSP.

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Immunoglobulin-A–associated small-vessel vasculitis: A 10-year experience at the Massachusetts General Hospital

Cited by 62 publications

References 44 publications

Clinical Significance of Immunoglobulin Deposition in Leukocytoclastic Vasculitis

Clinical Significance of Immunoglobulin Deposition in Leukocytoclastic Vasculitis

Direct immunofluorescence in cutaneous vasculitis: Experience from a referral hospital in India

Elevated Serum Levels of Visfatin in Patients with Henoch-Schönlein Purpura

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