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Vasculitides
Published in Ayşe Serap Karadağ, Lawrence Charles Parish, Jordan V. Wang, Roxburgh's Common Skin Diseases, 2022
Ivy M. Obonyo, Virginia A. Jones, Kayla A. Clark, Maria M. Tsoukas
Clinical presentation: EGPA is known to present sequentially, characterized by 3 phases: prodromal, eosinophilic, and vasculitic. The prodromal phase presents with long-standing asthma and can last anywhere from a few months to several years. Rhinitis, upper respiratory symptoms, fever, weight loss, and arthralgias may be seen. The eosinophilic phase presents with eosinophilia >10% and causes lung damage in the majority of cases. Extrapulmonary involvement may also be seen manifesting as cardiomyopathy and gastrointestinal symptoms. The eosinophilic phase is followed by the vasculitic phase, which causes inflammation of the small vasculature. EGPA varies in severity, and clinical presentations differ.
Paper 2
Published in Amanda Rabone, Benedict Thomson, Nicky Dineen, Vincent Helyar, Aidan Shaw, The Final FRCR, 2020
Amanda Rabone, Benedict Thomson, Nicky Dineen, Vincent Helyar, Aidan Shaw
A 22 year old female presents with fever, general malaise and right upper quadrant pain. She has recently returned from southeast Asia. Bloods tests reveal an eosinophilia. An ultrasound demonstrates an anechoic, 6-cm cyst within the right lobe of the liver. The cyst has thin, perceptible walls with several smaller adjacent cysts.
Adverse Reactions to Antibiotics in the Critical Care Unit
Published in Cheston B. Cunha, Burke A. Cunha, Infectious Diseases and Antimicrobial Stewardship in Critical Care Medicine, 2020
Diane M. Parente, Cheston B. Cunha, Michael Lorenzo
Factors that should lead the clinician to suspect a serious drug reaction include facial edema, mucosal involvement, palpable or extensive purpura, pruritic, and fever. The presence of eosinophilia is associated with more severe disease. Maculopapular eruptions associated with antibiotics are especially common, usually occurring within 1‒2 weeks after starting the offending agent and often becoming generalized and pruritic. The sensitivity of skin testing is low for β-lactam-induced maculopapular rashes. In patients with thrombocytopenia or other coagulopathies, hemorrhage into the skin may modify the appearance of the rash. In patients with penicillin-induced mild or moderately severe maculopapular rashes, it is generally safe to use cephalosporins [29].
Metabolomics of asthma, COPD, and asthma-COPD overlap: an overview
Published in Critical Reviews in Clinical Laboratory Sciences, 2023
Sanjukta Dasgupta, Nilanjana Ghosh, Parthasarathi Bhattacharyya, Sushmita Roy Chowdhury, Koel Chaudhury
In contrast to childhood asthma, which is largely allergic in nature, the symptoms in adult-onset asthma tend to be more persistent and less well controlled. Eosinophilic asthma is a severe type of asthma that arises due to a considerable increase in eosinophils in the airway lining and/or blood [140]. Most studies reported with this subtype suggest an alteration of lipid metabolism in these patients as compared to the non-eosinophilic group [70,75]. Eosinophilic asthma can occur in patients who have a tendency toward allergies (allergic or atopic) and also in those without an allergic predisposition. Allergic asthma is the most prevalent type of asthma and occurs in ∼7.3% of the population [141]. In only one study to date have the metabolites in allergic and non-allergic asthmatics been compared with healthy controls. Pathways associated with various amino acids and lipids were found to be significantly dysregulated in both the groups as compared to the controls [42]. Obesity is the most common co-morbidity of asthma and is associated with a higher risk of poor prognosis and exacerbations [142]. Several metabolomics studies have shown that energy metabolism was altered in obese asthmatics [52,53]. Interestingly, gender disparity in the prevalence of asthma has been demonstrated; in adult asthmatics, disease prevalence, and severity were reported to be higher in women than in men [143]. In only one study was an MS platform used to identify metabolites that differentiated male and female asthma patients; dysregulated lipid metabolism was found to be a major discriminant between the two groups [72].
Eosinophilic airway diseases: basic science, clinical manifestations and future challenges
Published in European Clinical Respiratory Journal, 2022
Christer Janson, Leif Bjermer, Lauri Lehtimäki, Hannu Kankaanranta, Jussi Karjalainen, Alan Altraja, Valentyna Yasinska, Bernt Aarli, Madeleine Rådinger, Johan Hellgren, Magnus Lofdahl, Peter H Howarth, Celeste Porsbjerg
Through the development of anti-eosinophilic treatments across the eosinophilic diseases described above, a number of challenges and directions for future research have been identified. These include: the need to identify events that may predict development of or progression to severe disease and any opportunities for early disease modification; the need to identify treatable traits, including clinical characteristics or biomarkers that will further improve the predicted response to treatment; and the need to understand comorbidities and their impact on prognosis. The ongoing requirement for real-world evidence of the long-term efficacy, safety and economic impact of biologic therapies is also clear. Moreover, it will be important to further our understanding of the most appropriate timing to introduce biologic treatments in any given patient, as well as how long to continue with treatments and whether switching or a combination of biologics may be appropriate treatment strategies in some patients. The Nordic countries have a long tradition of collaboration using patient registries, and Nordic asthma registries provide a unique opportunity to address some of these questions.
Multiple lung nodules, eosinophilia and severe asthma
Published in Canadian Journal of Respiratory, Critical Care, and Sleep Medicine, 2022
Anurag Bhalla, Jean-Claude Cutz, Ehsan A. Haider, Michael Trus, Parameswaran Nair
Asthma is a chronic lung disease characterized by variable airflow obstruction and airway hyperresponsiveness and is associated with airway inflammation.1 About 40% of asthmatics demonstrate an eosinophilic inflammatory endotype, where eosinophils play a key role in disease pathophysiology.2,3 In uncontrolled patients, it is vital to consider medication adherence and conduct a thorough work-up to investigate for co-morbidities that may be contributing to worsening asthma control.4 Persistent eosinophilia may be associated with other pulmonary diseases that can occur concurrently with asthma, including hypereosinophilic syndrome, eosinophilic granulomatosis with polyangiitis and allergic bronchopulmonary aspergillosis.5 Other non-pulmonary causes of eosinophilia that must also be considered include drug reactions, allergic and mast cell diseases, parasitic infections, malignancy (both solid tumors and hematological malignancies), rheumatologic diseases and eosinophilic gastrointestinal disorders (highlighted in Table 1).6 We present a rare case of a patient with severe asthma, eosinophilia and pulmonary nodules and document their treatment response with an anti-interleukin-5 receptor alpha (anti-IL-5Rα) monoclonal antibody (mAb).