Periaortitis Associated with Anti-neutrophil Cytoplasmic Antibodies Induced by Bevacizumab Combination Therapy

Murakami, Shuji; Saito, Haruhiro; Ohe, Miki; Kondo, Tetsuro; Oshita, Fumihiro; Yamada, Katsushi

doi:10.2169/internalmedicine.52.6632

Cited by 10 publications

(10 citation statements)

References 7 publications

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“…Este tipo de vasculitis puede originar periarteritis (periaortitis), aortitis estenosante (como este caso), dilatación, aneurismas, oclusión, disección y ruptura aórtica [1][2][3] . En los casos comunicados, además de la existencia de glomerulonefritis crescéntica ANCA(+) y aortitis (toráxica o abdominal), se ha descrito compromiso de válvula aórtica, tronco braquiocefálico, carótidas, subclavias, axilar, ilíacas comunes, pulmonares y ostium de las arterias coronarias 1,4,[10][11][12][13][14][15][16][17][18] . Si bien el mecanismo patogénico de este tipo de aortitis no es conocido, se ha propuesto que los ANCA originarían una vasculitis de vaso vasorum en la adventicia y que la inflamación se extendería a la media e íntima 2 .…”

Section: Discussionunclassified

“…Se ha utilizado la combinación de ciclofosfamida y esteroides y en casos refractarios, tocilizumab 2,3,17 . El pronóstico es similar a las Aortitis en paciente con vasculitis ANCA(+) -J. Vega et al vasculitis de vasos pequeños ANCA(+) pero han ocurrido muertes por rotura y disección aórtica 2 .…”

Section: Discussionunclassified

“…Las vasculitis de vasos grandes, en cambio, no los tienen 1,2 . El compromiso de vasos grandes en las vasculitis de vasos pequeños ANCA(+) es raro [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18] . Algunos autores consideran que es una coincidencia de dos patologías, otros creen que no lo es, sino que existe una patogénesis común 1,4,12 .…”

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Vasculitis de grandes vasos en paciente con vasculitis ANCA (+): Caso clínico

Vega

Guarda

2015

Rev. méd. Chile

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Section: Discussionunclassified

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Vasculitis de grandes vasos en paciente con vasculitis ANCA (+): Caso clínico

Vega

Guarda

2015

Rev. méd. Chile

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“…However, certain immunosuppressant drugs have been found as a possible risk factor [21][22]. Murakami et al described a case of a 57-year-old man who was taking bevacizumab for lung adenocarcinoma and later developed p-ANCA-positive periaortitis [21]. Ginsberg et al mentioned etanercept, an anti-tumor necrosis factor, as a possible cause of ANCA-associated large-vessel vasculitis [22].…”

Section: Risk Factors Leading To Aortitis In Aavmentioning

confidence: 99%

Aortic Involvement in Antineutrophil Cytoplasmic Antibodies Vasculitis, a Coincidence or a Real Association?

Tariq

Nishanth

Arshid

et al. 2020

Cureus

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Antineutrophil cytoplasmic antibodies (ANCA)-associated vasculitis (AAV) is a type of smallvessel vasculitis. It is unusual for ANCA to involve aorta. However, multiple cases have been found where ANCA involved large vessels, particularly the aorta. Among vasculitides, aortic vasculitis is a part of Takayasu arteritis (TAK). In this review article, we tried to find the mechanism behind the aortic involvement in AAV. PubMed was used as a primary search engine, and all the available cases of aortic, as well as large-vessel involvement in ANCAassociated vasculitis, were thoroughly reviewed. Very limited data was available that could provide the mechanism behind this involvement. It is observed that ANCA-associated aortitis is more common in immunocompromised people; however, cases in previously healthy individuals have also been found. Pathogenesis of ANCA-related aortitis is different from Takayasu arteritis and is more close to ANCA-associated small vasculitis. ANCA-related aortitis involves the aorta through the same mechanism as it uses to involve small vessels. This rare manifestation of ANCA-associated vasculitis could be life-threatening but has a good prognosis if timely diagnosed and treated. ANCA-associated vasculitis must be considered as a differential diagnosis while treating a case of aortitis. We believe that there is a need to revise the classification of different types of vasculitides, and physicians should be aware of the possible overlap between different forms of vasculitides.

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“…A few reports have further suggested a relationship with aortitis or periaortitis. However, only three cases of periaortitis induced by bevacizumab combination therapy [3] and granulocyte colony-stimulating factor [4,5] have been reported.…”

Section: Introductionmentioning

confidence: 99%

Periaortitis induced by epirubicin and cyclophosphamide for a patient with advanced breast cancer

et al. 2017

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Aortitis is an extremely rare condition, and it may mimic febrile neutropenia during cancer chemotherapy. A 55-year-old female diagnosed with T2N1M1 stage IV breast carcinoma received chemotherapy with EC (epirubicin 90 mg/m 2 and cyclophosphamide 600 mg/m 2 every 3 weeks). At the eleventh day after the first administration of EC, she developed a high-grade fever of 38°C and stomatitis. We started the intravenous administration of antibiotics at hospitalization, because the laboratory data showed normal white blood cell values 3800/ll but a severe inflammatory reaction (CRP 25.13 mg/dl). The fever and high CRP value continued, and the WBC rose to 14,500/ll at 20th day. However, her condition was stable. On the 25th day after the administration of EC, she complained of back pain, so we performed computed tomography (CT) again and observed thickening of the rind surrounding the descending aorta and bilateral pleural effusion, indicating acute periaortitis. We performed examinations concerning vasculitis and connective tissue disease, but the values were all within normal ranges showing no relationship with other diseases. We stopped the administration of antibiotics on the 20th day, and while we did not administer corticosteroids, however, the fever was resolved and her WBC decreased. She was discharged on day 33, and the other chemotherapy was restarted with pertuzumab, trastuzumab and docetaxel. The patient has remained well without inflammatory reactions. CT at 90 days after EC therapy showed the resolution of the thickened rind of the descending aorta and no aneurysmic changes.

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Periaortitis Associated with Anti-neutrophil Cytoplasmic Antibodies Induced by Bevacizumab Combination Therapy

Cited by 10 publications

References 7 publications

Vasculitis de grandes vasos en paciente con vasculitis ANCA (+): Caso clínico

Vasculitis de grandes vasos en paciente con vasculitis ANCA (+): Caso clínico

Aortic Involvement in Antineutrophil Cytoplasmic Antibodies Vasculitis, a Coincidence or a Real Association?

Periaortitis induced by epirubicin and cyclophosphamide for a patient with advanced breast cancer

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