Pleuraerguss bei Patienten mit Psoriasis-Arthritis: An Nebenwirkungen von TNF-α-Blockern denken

2021 ◽  
pp. 1-2
Author(s):  
Stefanie Keymel
Keyword(s):  
Pleural Effusion ◽  
Pulmonary Involvement ◽  
Chronic Inflammatory Disease ◽  
Tnf Inhibitors ◽  
Pleural Effusions ◽  
Drug Induced ◽  
Tnf Α ◽  
Drug Naïve ◽  
Extraarticular Manifestation ◽  
First Time

Psoriatic arthritis (PsA) is a chronic inflammatory disease associated with psoriasis. Pulmonary involvement is a rare extraarticular manifestation of the disease characterized by rigidity of the chest wall and apical pulmonary fibrosis. Pleural effusion is uncommon in PsA. We present four cases of patients with PsA who developed pleural effusions. We report for the first time a PsA patient who was drug-naïve and developed unilateral pleuritis. We also describe one PsA case with pleuritis while he was on methotrexate (MTX) and two PsA cases on tumor necrosis factor (TNF) inhibitors. The literature review revealed six cases with pleural effusion, which were drug-induced. These patients presented pleural effusions while they were treated with MTX (2 patients) and TNF inhibitors (4 patients). In PsA patients with pleuritis, a detailed investigation to rule out infections is necessary. In addition, increased pharmacovigilance will detect cases of drug-induced serositis.

scholarly journals Antitumor Necrosis Factor-Alpha (TNF-α) Infliximab-Induced Pleural Effusion and Pericarditis in Crohn’s Disease

2021 ◽  
Vol 2021 ◽  
pp. 1-3
Author(s):  
Ashley Fonseca ◽  
Julee Sunny ◽  
Lina M. Felipez
Keyword(s):  
Crohn’S Disease ◽  
Chest Pain ◽  
Pleural Effusion ◽  
Crohn's Disease ◽  
Pleural Effusions ◽  
Drug Induced ◽  
Necrosis Factor Alpha ◽  
Tnf Α ◽  
Factor Alpha ◽  
Necrosis Factor

Crohn’s disease (CD) is a chronic inflammatory disease that can be associated with intestinal and extraintestinal manifestations. Some patients are treated with infliximab, an antitumor necrosis factor-alpha (TNF-α) agent, to help them achieve and maintain clinical and biochemical remission. However, some patients with CD can present severe adverse effects such as drug-induced lupus and rarely present with pleural space and pericardium involvement. We report a case of an 18-year-old Hispanic male with CD who acquired anti-TNF-α-induced lupus after infliximab therapy presenting with pleural effusion and pericarditis. The patient presented with a 2-week history of pleuritic chest pain. Initial laboratory workup was remarkable for leukocytosis and increased inflammatory markers. Imaging and cardiovascular studies were consistent with pericarditis and pleural effusions. Serositis was initially thought to be reactive secondary to the current Mycoplasma pneumoniae infection. He was treated with colchicine 0.6 mg PO TID for six weeks and azithromycin 500 mg PO for seven days. Pain improved after discharge but resurfaced on the day of infliximab infusion. Imaging and cardiovascular studies demonstrated the persistence of pleural effusions and pericarditis. Ultrasound-guided thoracentesis was consistent with exudative pleural effusions. Rheumatological workup was remarkable for increased antihistone antibodies, consistent with drug-induced lupus. Infliximab-induced pericarditis and pleural effusions are rarely reported in the literature. It is thought that infliximab may have a proinflammatory activity or have a delayed type III hypersensitivity reaction. The first line of therapy of anti-TNF-α-induced lupus is the withdrawal of the offending drug. Our patient is unique as few cases of anti-TNF-α-induced pleural effusion and pericarditis in CD are reported. After discontinuing the offending drug, ustekinumab was started, and maintaining a steroid and colchicine regimen, the patient’s chest pain improved. Antihistone antibodies have returned to normal one month after starting ustekinumab.

scholarly journals The Role of Cytokine profile detection in Myelomatous pleural effusions

2021 ◽  
Author(s):  
Junhui Xu ◽  
Liang Gao ◽  
Miao Yan ◽  
Bingjie Wang ◽  
Zhengyang Song ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Pleural Effusion ◽  
Cytokine Profile ◽  
Pleural Effusions ◽  
Case Presentation ◽  
Cytokine Detection ◽  
Tnf Α ◽  
Tumor Load ◽  
Poor Outcomes

Abstract Background: Myelomatous pleural effusion (MPE), as a presentation of extramedullary infiltration of multiple myeloma (MM), is rare and associated with poor outcomes without comparatively effective treatment now. The value of the cytokine detection in pleural effusions to MPE has not been reported at present. Case presentation: We herein report a case of refractory and relapsed multiple myeloma which developed bilateral MPE due to disease progression caused by intolerance to various chemotherapy regimens. The cytomorphology and flow cytometry is adopted in the diagnosis confirmation. The chemotherapy containing immunomodulators combined with thoracic catheterization drainage is applied to the patient, showing a certain therapeutic effect. During the course of disease, the changes of cytokine profile in pleural effusion were monitored by Biolegend CBA technology, revealing that the cytokines such as IL-6 and IL-10 related to the tumor load in pleural effusion decreased with the improvement of the disease, while IL-2, IL-4, IL-17A, TNF - α, INF - γ, granzyme A, Granzyme B, perforin and granulysin increased with the improvement of the disease. Conclusions: There is a prospect that the cytokines level in pleural effusion becomes an indication to evaluate treatment response of MPE, and in the light of our finding, immunomodulators, IL-2 and INF - γ may be utilized in treating patients suffering MPE.

scholarly journals Black Pleural Effusion: A Unique Presentation of Metastatic Melanoma

2015 ◽  
Vol 8 (2) ◽  
pp. 222-225 ◽  
Author(s):  
Akansha Chhabra ◽  
Vikramjit Mukherjee ◽  
Mudit Chowdhary ◽  
Mauricio Danckers ◽  
David Fridman
Keyword(s):  
Pleural Effusion ◽  
Malignant Melanoma ◽  
Metastatic Melanoma ◽  
Pulmonary Involvement ◽  
The United States ◽  
Radiographic Evaluation ◽  
Pleural Effusions ◽  
Microscopic Appearance ◽  
History Of ◽  
Oxygen Requirements

Metastatic melanoma is a rare form of skin cancer, but one that comes with a high mortality rate. Pulmonary involvement is frequently seen in metastatic melanoma with only 2% of malignant melanoma patients with thorax metastasis presenting with pleural effusions. Herein, we report an extremely rare case of black pleural effusion from thoracic metastasis of cutaneous malignant melanoma. A 74-year-old man with known metastatic melanoma presented with a 1-month history of worsening lower back and hip pain and was found to have extensive osseous metastatic disease and multiple compression fractures. The patient underwent an uneventful kyphoplasty; however, the following day, he became acutely hypoxic and tachypneic with increased oxygen requirements. Radiographic evaluation revealed new bilateral pleural effusions. Bedside thoracentesis revealed a densely exudative, lymphocyte-predominant black effusion. Cytological examination showed numerous neoplastic cells with melanin deposition. A diagnosis of thoracic metastasis of malignant melanoma was established based on the gross and microscopic appearance of the pleural fluid. To the best of our knowledge, this is the first reported case of black pleural effusions secondary to metastatic melanoma in the United States. Despite the rarity of this presentation, it is important to determine the etiology of the black pleural effusion and to keep metastatic melanoma as a differential diagnosis.

CLINICAL SYMPTOMS, BIOCHEMISTRY AND CYTOLOGY OF PLEURAL, PERITONEAL EFFUSIONS

2016 ◽  
pp. 66-71
Author(s):  
Van Mao Nguyen ◽  
Huyen Quynh Trang Pham
Keyword(s):  
Pleural Effusion ◽  
Clinical Symptoms ◽  
Cross Sectional Study ◽  
Malignant Cells ◽  
Sectional Study ◽  
Pleural Effusions ◽  
Cross Sectional ◽  
Breath Sounds ◽  
Peritoneal Effusion ◽  
Neutrophil Leukocytes

Background: The cytology and the support of clinical symptoms, biochemistry for diagnosis of the cases of effusions are very important. Objectives: - To describe some of clinical symptoms and biochemistry of effusions. - To compare the results between cytology and biochemistry by the causes of pleural, peritoneal fluids. Material & Method: A cross-sectional study to describe all of 47 patients with pleural, peritoneal effusions examinated by cytology in the Hospital of Hue University of Medicine and Pharmacy from April 2013 to January 2014. Results: In 47 cases with effusions, pleural effusion accounting for 55.32%, following peritoneal effusions 29.79% and 14.89% with both of them. The most common symptoms in patients with pleural effusions were diminished or absent tactile fremitus, dull percussion, diminished or absent breath sounds (100%), in patients with peritoneal effusions was ascites (95.24%). 100% cases with pleural effusions, 50% cases with peritoneal effusions and 80% cases with pleural and peritoneal effusions were exudates. The percentage of malignant cells in patients with pleural effusions was 26.92%, in peritoneal effusions was 28.57%, in pleural and peritoneal effusions was 42.86%. The percentage of detecting the malignant cells in patients with suspected cancer in the first test was 57.14%, in the second was 9.53% and 33.33% undetectable. Most of cases which had malignant cells and inflammatory were exudates, all of the cases which had a few cells were transudates. Besides, 7.5% cases which had high neutrophil leukocytes were transudates. Conclusion: Cytology should be carry out adding to the clinical examinations and biochemistry tests to have an exact diagnosis, especially for the malignant ones. For the case with suspected cancer, we should repeat cytology test one more time to increase the ability to detect malignant cells. Key words: Effusion, pleural effusion, peritoneal effusion, cytology, biochemistry

Diagnostic efficacy and suitability of trans-thoracic ultrasonography for pleural fluid detection – The future non-invasive gold-standard?

2020 ◽  
Vol 13 (4) ◽  
pp. 184-190
Author(s):  
Muhammad Irfan ◽  
Abdul Rasheed Qureshi ◽  
Zeeshan Ashraf ◽  
Muhammad Amjad Ramzan ◽  
Tehmina Naeem ◽  
...  
Keyword(s):  
Pleural Effusion ◽  
Diagnostic Accuracy ◽  
Pleural Fluid ◽  
Gold Standard ◽  
Pleural Effusions ◽  
Diagnostic Efficacy ◽  
Chest Sonography ◽  
X Ray ◽  
Non Invasive ◽  
Fluid Detection

ABSTRACT Background: Conventionally Pleural effusions are suspected by history of pleuritis, evaluated by physical signs and multiple view radiography. Trans-thoracic pleural aspiration is done and aspirated pleural fluid is considered the gold-standard for pleural effusion. Chest sonography has the advantage of having high diagnostic efficacy over radiography for the detection of pleural effusion. Furthermore, ultrasonography is free from radiation hazards, inexpensive, readily available  and feasible for use in ICU, pregnant and pediatric patients. This study aims to explore the diagnostic accuracy of trans-thoracic ultrasonography for pleural fluid detection, which is free of such disadvantages. The objective is to determine the diagnostic efficacy of trans-thoracic ultrasound for detecting pleural effusion and also to assess its suitability for being a non-invasive gold-standard.   Subject and Methods: This retrospective study of 4597 cases was conducted at pulmonology  OPD-Gulab Devi Teaching Hospital, Lahore from November 2016 to July 2018. Adult patients with clinical features suggesting pleural effusions were included while those where no suspicion of pleural effusion, patients < 14 years and pregnant ladies were excluded. Patients were subjected to chest x-ray PA and Lateral views and chest ultrasonography was done by a senior qualified radiologist in OPD. Ultrasound-guided pleural aspiration was done in OPD & fluid was sent for analysis. At least 10ml aspirated fluid was considered as diagnostic for pleural effusion. Patient files containing history, physical examination, x-ray reports, ultrasound reports, pleural aspiration notes and informed consent were retrieved, reviewed and findings were recorded in the preformed proforma. Results were tabulated and conclusion was drawn by statistical analysis. Results: Out of 4597 cases, 4498 pleural effusion were manifested on CXR and only 2547(56.62%) pleural effusions were proved by ultrasound while 2050 (45.57%) cases were reported as no Pleural effusion. Chest sonography demonstrated sensitivity, specificity, PPV, NPV and diagnostic accuracy 100 % each. Conclusions: Trans-thoracic ultrasonography revealed an excellent efficacy that is why it can be considered as non-invasive gold standard for the detection of pleural effusion.

The Use of Somatex Shunt for Fetal Pleural Effusion: A Cohort of 8 Procedures

2021 ◽  
pp. 1-8
Author(s):  
Man Yan Chung ◽  
Wing Cheong Leung ◽  
Wing Ting Tse ◽  
Yuen Ha Ting ◽  
Kwok Ming Law ◽  
...  
Keyword(s):  
Pleural Effusion ◽  
Gestational Age ◽  
Single Case ◽  
Perinatal Outcomes ◽  
In Utero ◽  
Good Survival ◽  
Pleural Effusions ◽  
Premature Rupture Of Membranes ◽  
Premature Rupture ◽  
Live Births

<b><i>Introduction:</i></b> Fetal pleural effusion may require in utero shunting which is associated with procedure-related complications. <b><i>Objective:</i></b> To evaluate the efficacy and complications of the newly designed Somatex shunt in treating fetal pleural effusion. <b><i>Methods:</i></b> Consecutive cases with primary fetal pleural effusion who were treated with the Somatex shunt between 2018 and 2019 were evaluated. Perinatal outcomes and complications were retrospectively analyzed. <b><i>Results:</i></b> There were 6 cases of unilateral and 1 case of bilateral pleural effusion, and hence a total of 8 pleuroamniotic shunting procedures were performed. The median gestational age at diagnosis and shunting was 20.7 and 22.6 weeks, respectively. All 8 procedures were successful, achieving complete in utero drainage. All but one were live births (85.7%) with a median gestational age of 38 weeks. The single case of in utero death occurred 4.7 weeks after successful shunting, and no cause could be identified after autopsy. The rates of preterm birth and premature rupture of membranes were 33.3% (2/6) and 16.7% (1/6), respectively. Four of the 8 procedures (50%) had minor shunt-related complications such as dislodgement and entrapment, occurring at a median of 7.7 weeks after shunting. None of the shunts became blocked. <b><i>Conclusions:</i></b> The Somatex shunt is effective in relieving fetal pleural effusions with good survival rate. Overall, it was a safe instrument, though minor shunt complications occurred.

scholarly journals Acute myeloid leukemia with leukemic pleural effusion and high levels of pleural adenosine deaminase: A case report and review of literature

Open Medicine ◽  
2021 ◽  
Vol 16 (1) ◽  
pp. 387-396
Author(s):  
Sing-Ting Wang ◽  
Chieh-Lung Chen ◽  
Shih-Hsin Liang ◽  
Shih-Peng Yeh ◽  
Wen-Chien Cheng
Keyword(s):  
Acute Myeloid Leukemia ◽  
Pleural Effusion ◽  
Adenosine Deaminase ◽  
Myeloid Leukemia ◽  
Diagnostic Yield ◽  
Leukemic Cells ◽  
Pleural Effusions ◽  
Diagnostic Dilemma ◽  
True Incidence ◽  
Acute Myeloid

Abstract Pleural effusions are rarely observed in association with acute myeloid leukemia (AML), and their true incidence remains unknown. Given the low diagnostic yield from cytopathologic analysis of malignant pleural effusions and the fact that patients with leukemia are often thrombocytopenic and unable to tolerate invasive procedures, the incidence of leukemic effusions may be underestimated. Here, we report a rare case of pleural effusion in a patient with newly diagnosed AML. Initial analysis revealed an exudative, lymphocyte-predominant effusion. High levels of adenosine deaminase (ADA) were detected in pleural fluid, consistent with a diagnosis of tuberculosis. However, the analysis of pleural cytology revealed leukemic cells, permitting the diagnosis of leukemic effusion to be made. The patient underwent induction chemotherapy and pleural effusion resolved without recurrence. This case emphasizes the diagnostic dilemma presented by high levels of ADA in a leukemic pleural effusion, as this association has not been previously considered in the literature.

scholarly journals Anti-Rheumatic Effect of Antisense Oligonucleotide Cytos-11 Targeting TNF-α Expression

2021 ◽  
Vol 22 (3) ◽  
pp. 1022
Author(s):  
Tatyana P. Makalish ◽  
Ilya O. Golovkin ◽  
Volodymyr V. Oberemok ◽  
Kateryna V. Laikova ◽  
Zenure Z. Temirova ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Gene Expression ◽  
Rat Model ◽  
Peripheral Blood ◽  
Antisense Oligonucleotide ◽  
Joint Inflammation ◽  
Blood Concentrations ◽  
Tnf Α ◽  
Effective Drugs ◽  
First Time

The urgency of the search for inexpensive and effective drugs with localized action for the treatment of rheumatoid arthritis continues unabated. In this study, for the first time we investigated the Cytos-11 antisense oligonucleotide suppression of TNF-α gene expression in a rat model of rheumatoid arthritis induced by complete Freund’s adjuvant. Cytos-11 has been shown to effectively reduce peripheral blood concentrations of TNF-α, reduce joint inflammation, and reduce pannus development. The results achieved following treatment with the antisense oligonucleotide Cytos-11 were similar to those of adalimumab (Humira®); they also compared favorably with those results, which provides evidence of the promise of drugs based on antisense technologies in the treatment of this disease.

scholarly journals AB0327 DRUG-INDUCED LUPUS ERYTHEMATOSUS SECONDARY TO ANTI-TNF-Α AGENTS IN PATIENTS WITH SPONDYLOARTHRITIS AND PSORIATIC ARTHRITIS

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 1188.2-1189
Author(s):  
A. Martins ◽  
D. Santos Oliveira ◽  
F. R. Martins ◽  
M. Rato ◽  
F. Oliveira Pinheiro ◽  
...  
Keyword(s):  
Psoriatic Arthritis ◽  
Clinical Features ◽  
Lupus Erythematosus ◽  
Disease Duration ◽  
Age At Diagnosis ◽  
Categorical Variables ◽  
Drug Induced ◽  
Laboratory Findings ◽  
Conversion Rates ◽  
Tnf Α

Background:Induction of autoantibodies is frequently observed in patients treated with TNF-α antagonist and the possible development of drug-induced lupus erythematosus (DILE) remains a matter of concern. The prevalence of DILE secondary to anti-TNF-α therapy is estimated around 0.5-1% and clinical features include arthritis/arthralgia, rash, serositis, fever, myalgias, cytopenias, among others. According to the literature, DILE secondary to anti-TNF-α agents differs in several ways from the clinical and laboratory findings typically associated with classic DILE.Objectives:To estimate the incidence of induction of antinuclear antibodies (ANA) and DILE in a monocentric cohort of patients with spondyloarthritis and psoriatic arthritis treated with anti-TNF-α agents. To describe the clinical and laboratorial features and outcomes of patients with DILE.Methods:We performed a retrospective analysis of patients with spondyloarthritis and psoriatic arthritis treated with anti-TNF-α agents, from our University Hospital, who have been registered on the Portuguese Rheumatic Diseases Register (Reuma.pt) between July 2001 and December 2020. Patients with positive ANA (titer > 1/100) before the anti-TNF-α therapy were excluded. Because specific criteria for the diagnosis of DILE have not been established, we considered the diagnosis in case of a temporal relationship between clinical manifestations and anti-TNF-α treatment and fulfillment of ACR/EULAR 2019 classification criteria for SLE. In patients with DILE, clinical features, laboratory findings, systemic therapies and outcome after discontinuation of medication were collected from reuma.pt and medical records. For the clinical and demographic predictors, continuous variables were analyzed using a two-sided t-test and categorical variables using a Fisher’s exact test. P-value <0.05 was considered statistically significant.Results:In the spondyloarthritis group, 290 patients were included (44.8% females, mean age at diagnosis of 33.3 ± 11.5 years and mean disease duration of 15.1 ± 10.4 years) and in the psoriatic arthritis group, 116 patients were included (50.0% females, mean age at diagnosis of 40.1 ± 11.0 years and mean disease duration of 13.1 ± 6.8 years). In our study, we observed high serology conversion rates (positive ANA in 67.9% and 58.6% of patients with Spondyloarthritis and Psoriatic Arthritis, respectively), with similar conversion rates between different anti-TNF drugs. Three patients with spondyloarthritis (1.0%) and 1 patient with psoriatic arthritis (0.9%) developed DILE. Etanercept was the causative agent in 2 cases, infliximab and adalimumab in 1 case, each. Peripheral arthritis (new onset or abrupt worsening) occurred in 2 patients, serositis in 1 patient, constitutional symptoms in 2 patients, subnephrotic proteinuria in 1 patient, lymphopenia in 2 patients and hypocomplementemia in 1 patient. Specific treatment was prescribed to the 4 patients (oral corticosteroids) and they achieved complete recovery. After anti–TNF-α treatment interruption, no patient had recurrent disease. We observed that patients with DILE had a significantly longer disease duration (> 8.4 years; p=0.04) and a significantly longer duration of therapy with anti-TNF (> 4.0 years; p=0.04) when compared to patients without DILE.Conclusion:Despite the frequent induction of autoantibodies, the development of DILE secondary to anti–TNF-α agents is rare. Our study demonstrates an incidence rate similar to other studies reported before. The clinical and laboratorial characteristics of our patients with DILE attributable to anti–TNF-α agents differ significantly from DILE due to more traditional agents, as is described in literature. Overall, patients in this study had mild disease that improved after therapy discontinuation, without recurrence of the disease. It seems that a longer disease duration and a longer period under anti-TNF-α therapy may increase the risk of DILE development.Disclosure of Interests:None declared

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