Non-infectious aortic and mitral valve vegetations in a patient with eosinophilic granulomatosis with polyangiitis

Karthikeyan, Kamalesh; Balla, Sudarshan; Alpert, Martin A.

doi:10.1136/bcr-2018-225947

Cited by 11 publications

(12 citation statements)

References 23 publications

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“…While EGPA itself is a rare disease, non-infectious vegetations have been documented in multiple cases. In a case report of a large non-infectious valvular vegetation associated with EGPA, they report cardiac complications in 50-62% of patients, most commonly in ANCA-negative cases [ 9 ]. According to Goodfield, cardiac involvement is not as rare as initially presumed, present in ≤ 44% of cases of EGPA [ 10 ].…”

Section: Discussionmentioning

confidence: 99%

A Rare Presentation of Polyangiitis Overlapping Syndrome

Subramanian¹,

Hanchosky²,

Vuyyuru³

et al. 2023

Cureus

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This case follows a 38-year-old Caucasian male with no known medical history who presented to the emergency department for syncope. He also endorsed a two-month history of fevers, weight loss, oral ulcers, rashes, joint swelling and arthralgias. After extensive workup, he was given a working diagnosis of granulomatosis with polyangiitis (GPA). Conflicting diagnostic evidence made it increasingly difficult to distinguish between GPA and eosinophilic granulomatosis with polyangiitis. In conclusion, we believe the patient may be better diagnosed with polyangiitis overlapping syndrome.

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Section: Discussionmentioning

confidence: 99%

A Rare Presentation of Polyangiitis Overlapping Syndrome

Subramanian¹,

Hanchosky²,

Vuyyuru³

et al. 2023

Cureus

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“…Pilania et al (7) also reported that pulmonary arterial hypertension is a rare occurrence in ANCA-associated vasculitis. Löffler endocarditis of HES or EGPA progresses through three stages, namely acute necrotic stage (infiltration of eosinophils in the myocardium), thrombotic stage (mural thrombi formation along the damaged endocardium), and fibrotic stage (the granulation tissue changing into hyaline fibrosis), which may overlap (2,8). Myocardial fibrosis may develop rapidly and immediate aggressive treatment may help to slow the progression of chronic heart failure (8)(9)(10).…”

Section: Discussionmentioning

confidence: 99%

“…Löffler endocarditis of HES or EGPA progresses through three stages, namely acute necrotic stage (infiltration of eosinophils in the myocardium), thrombotic stage (mural thrombi formation along the damaged endocardium), and fibrotic stage (the granulation tissue changing into hyaline fibrosis), which may overlap (2,8). Myocardial fibrosis may develop rapidly and immediate aggressive treatment may help to slow the progression of chronic heart failure (8)(9)(10). Right-sided heart failure can be a consequence of left ventricular dysfunction; however, Fitchett et al (11) believed that right ventricular failure might in certain circumstances develop either before or after left ventricular failure when there is a diffuse myocardial disease.…”

Section: Discussionmentioning

confidence: 99%

Case Report: An Unusual Presentation of Cardiovascular Involvement in Eosinophilic Granulomatosis With Polyangiitis

Zhou²,

Zhou³

et al. 2022

Front. Cardiovasc. Med.

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BackgroundBecause eosinophilic granulomatosis with polyangiitis (EGPA) is so rare and the symptoms so varied, it can be a challenge to get a correct diagnosis in clinical practice. Cardiovascular involvement is the main cause of death of EGPA. We are the first to report of cardiac magnetic resonance (CMR) findings about right-sided heart involvement in EGPA.Patient FindingsThe initial abnormalities detected by CMR were Löffler endocarditis with extensive thrombosis and left ventricular (LV) dysfunction. After active treatment, LV systolic function recovered and endocarditis with thrombosis significantly improved, but there was rapidly progressive pulmonary hypertension, enlargement of right atrium and right ventricle and persistent right-sided heart failure. The patient eventually died of sudden cardiac death 6 months after hospital discharge.ConclusionsLöffler endocarditis and right-sided heart involvement are both rare presentations in patients with EGPA. CMR is a reliable non-invasive tool to precisely and comprehensively assess cardiovascular involvement in EGPA.

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“…Генетическая предрасположенность к эндокардитам привлекает внимание ученых и клиницистов [6][7][8]; имеются данные об ассоциации однонуклеотидных полиморфизмов в генах гемостаза и фолатного цикла с синдромом вегетаций на клапанном аппарате сердца [9]. На выборке 123 пациентов с инфекционным эндокардитом (ИЭ) показана ассоциация более высокого риска ИЭ с генотипом ТТ полиморфизма rs1205 в гене CRP, а снижение риска ИЭ обусловлено генотипом GA полиморфизма rs1143634 гена IL1B, генотипом GT полиморфизма rs3212227 гена IL12B, генотипом АС полиморфизма rs1130864 гена CRP и G-аллелью полиморфизма rs1801197 гена CALCR [10].…”

Section: Introductionunclassified

Polymorphisms of candidate genes determining the clinical and hemostasiological characteristics of endocarditis of various etiology

et al. 2022

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Aim. To investigate polymorphisms of 18 genes as possible molecular genetic markers of predisposition or resistance to development of non-infective (NE) or infective endocarditis (IE).Materials and methods. The study encompassed 81 patients with NE and 94 patients with IE. The control group included 225 conditionally healthy people. Polymorphisms of 18 genes were tested using polymerase chain reaction (PCR).Results. For the first time, a statistically significant relationship was identified between gene polymorphisms and valvular vegetations: for genes in the hemostatic system – rs6025 (1691 G > A) of the F5 gene (AG genotype), rs1126643 (807 C > T) of the ITGA2 gene (TT genotype); for folate pathway genes – rs1805087 (2756 A > G) of the MTR gene (AG genotype) and rs11697325 (–8202 A/G) of the MMP9 gene (AA genotype) and rs2476601 (C1858T) of the PTPN22 gene (TT genotype). The protective effect of gene polymorphisms was revealed: for the NOS3 gene (4b / 4b genotype) and G (–572) C of the IL6 gene (CC genotype). For two polymorphisms, an association with thromboembolic complications in NE was revealed: rs1126643 (807 C > T) of the ITGA2 gene and rs1799889 (–675 5G > 4G) of the PAI (SERPINE1) gene. In IE, such an association was detected for the polymorphism rs11697325 (–8202 A/G) of the MMP-9 gene.Conclusion. The polymorphisms of candidate genes were revealed, that are associated with the clinical and hemostasiological characteristics of IE and NE. In NE, for the first time, the association with thromboembolic complications was identified for two polymorphisms: rs1126643 (807 C > T) of the ITGA2 gene and rs1799889 (– 675 5G > 4G) of the PAI-1 (SERPINE1) gene. In IE, such a relationship was detected for one polymorphism – rs11697325 (8202 A/G) of the MMP-9 gene.

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Non-infectious aortic and mitral valve vegetations in a patient with eosinophilic granulomatosis with polyangiitis

Cited by 11 publications

References 23 publications

A Rare Presentation of Polyangiitis Overlapping Syndrome

A Rare Presentation of Polyangiitis Overlapping Syndrome

Case Report: An Unusual Presentation of Cardiovascular Involvement in Eosinophilic Granulomatosis With Polyangiitis

Polymorphisms of candidate genes determining the clinical and hemostasiological characteristics of endocarditis of various etiology

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