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Marvin I. Schwarz - One of the best experts on this subject based on the ideXlab platform.
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Pulmonary Capillaritis in lung transplant recipients: treatment and effect on allograft function.
The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation, 2005Co-Authors: Todd L. Astor, Marvin I. Schwarz, David Weill, Carlyne D. Cool, Isaac Teitelbaum, Martin R. ZamoraAbstract:The clinical outcomes of lung transplant recipients presenting with post-transplant pulmonary Capillaritis have not been well described. We retrospectively reviewed 40 cases of biopsy-proven pulmonary Capillaritis in lung transplant recipients. Patients presented with a clinical syndrome characterized by dyspnea, hypoxemia, abnormal chest X-ray, and a decrease in forced expiratory volume in 1 second (FEV 1 ); 25% presented with hemoptysis, and 18% with fulminant respiratory failure. Therapy with intravenous corticosteroids resulted in clinical improvement in 17 cases (43%). A response to plasmapheresis was seen in 12 (67%) of 18 cases refractory to corticosteroids. There were 5 deaths within 3 months of diagnosis. Nine (82%) of 11 lung transplant recipients who presented with Capillaritis within 4 weeks post-transplant were alive at 1 year; all but 1 patient achieved expected percent predicted FEV 1 values. Only 3 (14%) of 21 who presented with Capillaritis > 1 month after transplant had a >20% decrease in the FEV 1 after 12 months. These results suggest that post-transplant pulmonary Capillaritis is (1) likely a form of acute allograft rejection clinically and histologically distinct from typical acute rejection, (2) less responsive to corticosteroid therapy than typical acute rejection, and (3) not associated with long-term adverse effects on allograft function.
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Small vessel vasculitis of the lung
Thorax, 2000Co-Authors: Marvin I. Schwarz, Kevin K. BrownAbstract:The small vessel vasculitides of the lungs1-3 (table1) are inflammatory destructive processes that affect the arterioles, venules, and alveolar capillaries located within the interstitial compartment. An intense infiltration of activated neutrophils results in fibrinoid necrosis and dissolution of arteriolar and venular walls, thus compromising the vascular lumen. Accompanying the arteriolitis and venulitis is a distinct interstitial (alveolar wall) component referred to as necrotising pulmonary Capillaritis.4-9 Necrotising pulmonary Capillaritis can occur in isolation, in the absence of histological evidence of arteriolitis or venulitis. It is recognised by a marked interstitial neutrophilic infiltration and many of these cells are undergoing leucocytoclasis or fragmentation (fig 1). Because these neutrophils are constantly undergoing cell death (apoptosis), pyknotic cells and nuclear fragments (dust) accumulate within the lung parenchyma. The interstitial space becomes broadened by oedema, fibrin, and the neutrophilic infiltrate and eventually undergoes fibrinoid necrosis (fig 2). During this process the integrity of interstitial capillaries is damaged, permitting red blood cells to traverse the now incompetent alveolar capillary basement membranes and freely enter the interstitial compartment and flood alveolar spaces. Clinically this is referred to as diffuse alveolar haemorrhage, and this accompanies most episodes of small vessel vasculitis in the lungs regardless of aetiology. Fibrin and neutrophils also traverse the damaged alveolar capillary basement membranes and enter the alveolar spaces with the red blood cells. Other histological features in the small vessel vasculitides of the lung include arteriolar and capillary thrombosis, organising haemorrhage, epithelial type 2 cell hyperplasia, and eventually the accumulation of free parenchymal haemosiderin and haemosiderin containing macrophages in alveolar spaces (fig 3). With time, and after repeated episodes of diffuse alveolar haemorrhage due to pulmonary Capillaritis, both interstitial pulmonary fibrosis and a progressive obstructive lung disease with the physiological and computed tomographic appearance of emphysema have been described.9 …
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diffuse alveolar hemorrhage and pulmonary Capillaritis due to propylthiouracil
Chest, 1999Co-Authors: Samjot Singh Dhillon, Digvijay Singh, Nathaniel Doe, Alam M Qadri, Santuccio Ricciardi, Marvin I. SchwarzAbstract:Propylthiouracil (PTU) has recently been observed to be associated with antineutrophil cytoplasmic antibody (ANCA)–positive small vessel vasculitis, resulting in crescentic glomerulonephritis and, infrequently, diffuse alveolar hemorrhage (DAH). We describe a case of a 23-year-old pregnant woman who developed a perinuclear ANCA and antimyeloperoxidase-positive small vessel vasculitis manifesting as DAH and crescentic glomerulonephritis after she began taking PTU. An open lung biopsy was consistent with pulmonary Capillaritis. She responded to corticosteroid therapy and discontinuation of PTU. DAH can be caused by pulmonary Capillaritis, bland hemorrhage, or diffuse alveolar damage. To our knowledge, this represents the first documentation of an underlying pulmonary Capillaritis in a case of PTU-induced DAH.
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Isolated Pulmonary Capillaritis and Diffuse Alveolar Hemorrhage in Rheumatoid Arthritis and Mixed Connective Tissue Disease
Chest, 1998Co-Authors: Marvin I. Schwarz, Martin R. Zamora, Tony N. Hodges, Edward D. Chan, Russell P. Bowler, Rubin M TuderAbstract:Study objectives To demonstrate that pulmonary Capillaritis and diffuse alveolar hemorrhage (DAH) occur and are isolated to the lung and therefore not part of systemic vasculitis at the time of the DAH episode in rheumatoid arthritis (RA) and mixed connective tissue disease (MCTD). Design Lung biopsy specimens from patients with DAH were reviewed and those with the histologic features of pulmonary Capillaritis were identified. Setting The patients were selected from seven Denver-area general hospitals. Patients Fifty-eight patients with biopsy specimen proved pulmonary Capillaritis (1991 to 1997) were identified and classified according to disease. Three patients met the American Rheumatism Association criteria for RA and one patient fulfilled clinical and serologic criteria for MCTD. Interventions All clinical, laboratory, and radiographic data on initial presentation and at follow-up periods were extracted from the charts of the four study patients. Histologic slides were reviewed and immunofluorescent studies of lung tissue were performed. Measurements and results All four patients had a connective tissue disease diagnosis prior to the DAH episode. Symptoms referable to pulmonary Capillaritis were of short duration (2 to 14 days) and there was no clinical or serologic evidence for an accompanying systemic vasculitis, in particular glomeronephritis. Three patients, two with RA and one with MCTD, demonstrated pulmonary immune complex deposition. Three resolved their illness following IV methylprednisilone and cyclophosphamide therapy. One RA patient died following a myocardial infarction. In the three survivors, no further episodes of DAH have occurred after a mean of 24 months (range, 10 to 48 months). Conclusions To our knowledge, these are the first cases of DAH due to pulmonary Capillaritis documented to complicate RA and MCTD. The Capillaritis was not part of a systemic vasculitis at the time of the DAH episode, but rather represented an isolated small-vessel vasculitis of the lungs in this group of patients. Immune complex deposition may be involved in the pathogenesis.
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diffuse alveolar hemorrhage with underlying isolated pauciimmune pulmonary Capillaritis
American Journal of Respiratory and Critical Care Medicine, 1997Co-Authors: C A Jennings, T E King, Rubin M Tuder, Reuben M Cherniack, Marvin I. SchwarzAbstract:Diffuse alveolar hemorrhage (DAH) resulting from pulmonary Capillaritis typically accompanies the systemic vasculitides and collagen vascular diseases. Isolated pulmonary Capillaritis and DAH without systemic disease occurs in patients with antineutrophil cytoplasmic antibodies. However, isolated pulmonary Capillaritis and DAH is not described for patients without clinical or serologic evidence for an underlying systemic disease. To describe such patients, we undertook a retrospective chart review of 29 patients with DAH and biopsy-proven pulmonary Capillaritis from seven Denver hospitals. Eight (28%) were diagnosed with isolated pulmonary Capillaritis without clinical, serologic, or histologic evidence of an associated illness. Their median age was 30 yr. No association with occupational or drug exposures was identified. All had lower respiratory tract symptoms; seven had upper respiratory tract symptoms. None demonstrated systemic disease or evidence of glomerulonephritis. All were antineutrophil cytoplasmic antibody negative. Other serologies were not significant where measured. Direct immunofluorescence studies of lung tissue were negative in five. Six presented with acute respiratory failure, four requiring mechanical ventilation. One died during initial hospitalization; seven survived. Median follow-up is 43 mo (7 to 73 mo). Five remain in remission. Two experienced multiple recurrences of DAH but without development of systemic disease while on therapy. Herein we characterize DAH and isolated pulmonary Capillaritis in the absence of clinical, serologic, or histologic evidence indicating an accompanying systemic illness. The prognosis for this group appears favorable.
Boudewijn Van Damme - One of the best experts on this subject based on the ideXlab platform.
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subclinical peritubular Capillaritis at 3 months is associated with chronic rejection at 1 year
Transplantation, 2007Co-Authors: Evelyne Lerut, Maarten Naesens, Dirk Kuypers, Yves Vanrenterghem, Boudewijn Van DammeAbstract:Background. Peritubular Capillaritis has been associated with chronic rejection, but the characteristics of subclinical lesions in peritubular capillaries are unknown. Methods. Fifty-three renal allograft recipients underwent a protocol biopsy at both 3 and 12 months after transplantation. Subclinical chronic antibody-mediated rejection (CAMR) at 1 year was diagnosed when three or more of five criteria were present: basement membrane multilayering of peritubular capillaries (MLPTC), transplant glomerulopathy, increase in intimal fibrosis between 3 and 12 months, C4d deposition in peritubular capillaries, and the presence of anti-human leukocyte antigen antibodies. Results. Six (11.3%) patients met the criteria of CAMR. MLPTC was the most sensitive (83.3%) and specific (89.1%) histological criterion (P=0.0008). Five patients had peritubular Capillaritis at their 3-month biopsy. They all developed MLPTC at 1 year (P<0.0001). Three of the patients with early peritubular Capillaritis met the criteria of CAMR at 1 year (P=0.0002). Conclusions. Through early detection of subclinical peritubular Capillaritis, renal allograft recipients who are at risk for development of MLPTC might be identified. Larger series are needed to confirm these preliminary findings, but this report suggests peritubular Capillaritis as an early detection marker for patients at risk for CAMR.
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Subclinical peritubular Capillaritis at 3 months is associated with chronic rejection at 1 year.
Transplantation, 2007Co-Authors: Evelyne Lerut, Maarten Naesens, Dirk Kuypers, Yves Vanrenterghem, Boudewijn Van DammeAbstract:Background. Peritubular Capillaritis has been associated with chronic rejection, but the characteristics of subclinical lesions in peritubular capillaries are unknown. Methods. Fifty-three renal allograft recipients underwent a protocol biopsy at both 3 and 12 months after transplantation. Subclinical chronic antibody-mediated rejection (CAMR) at 1 year was diagnosed when three or more of five criteria were present: basement membrane multilayering of peritubular capillaries (MLPTC), transplant glomerulopathy, increase in intimal fibrosis between 3 and 12 months, C4d deposition in peritubular capillaries, and the presence of anti-human leukocyte antigen antibodies. Results. Six (11.3%) patients met the criteria of CAMR. MLPTC was the most sensitive (83.3%) and specific (89.1%) histological criterion (P=0.0008). Five patients had peritubular Capillaritis at their 3-month biopsy. They all developed MLPTC at 1 year (P
Željko Kikić - One of the best experts on this subject based on the ideXlab platform.
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Diffuse Extent of Peritubular Capillaritis in Late Antibody-Mediated Rejection: Associations With Levels of Donor-Specific Antibodies and Chronic Allograft Injury.
Transplantation, 2017Co-Authors: Nicolas Kozakowski, Harald Herkner, Georg A. Böhmig, Heinz Regele, Gregor Bond, Farsad Eskandary, Rainer Oberbauer, Željko KikićAbstract:Background Recently, diffuse peritubular Capillaritis (ptc) has been suggested to independently predict chronic transplant injury and loss, and although the ptc score is a diagnostic criterion for antibody-mediated rejection, the utility of diffuse ptc is under debate. Methods We evaluated the diagnostic value of ptc characteristics in this cross-sectional study including 85 biopsies of patients with donor-specific antibodies (DSA). Biopsies were reevaluated for the extent (diffuse vs focal), score and leukocytic composition in relation to DSA binding strength (mean fluorescence intensity [MFI]_max). Chronic allograft injury (transplant chronic glomerulopathy [cg] or chronic lesion score CLS]) were associated with ptc features. Results Peritubular Capillaritis was detected in 50% (76% mononuclear ptc). Peritubular Capillaritis scores 1, 2, and 3 were present in 36%, 55%, and 9%, and focal or diffuse ptc in 36% or 64%. Diffuse ptc was associated with DSA MFI_max (median: 4407 vs 2419 [focal ptc; P = 0.04] or 1946 [no ptc; P = 0.004]), cg (58% vs no ptc 24% [P = 0.02]), and higher CLS (mean: 6.81 vs 4.67 [focal ptc, P = 0.01] or 5.18 [no ptc, P = 0.001]), respectively. The association of ptc score of 2 or greater with cg was slightly better than with diffuse ptc. Diffuse ptc and ptc score of 2 or greater remained independently related to cg after adjusting for DSA_MFI_max, C4d, or previous rejection episodes, however lost their independent relation after adjusting for total microcirculation scores. Diffuse ptc was the only ptc characteristic independently related to CLS. Conclusions Our results emphasize the clinical relevance of reporting diffuse ptc, which may relate to DSA binding strength and potentially to chronic graft injury.
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The diffuse extent of peritubular Capillaritis in renal allograft rejection is an independent risk factor for graft loss
Kidney international, 2015Co-Authors: Nicolas Kozakowski, Harald Herkner, Georg A. Böhmig, Heinz Regele, Christoph Kornauth, Gregor Bond, Željko KikićAbstract:By the Banff classification, the score of peritubular Capillaritis, its extent, and its cellular composition should normally be reported in renal allograft pathology. While the score represents an important diagnostic and prognostic variable, the clinical value of Capillaritis extent or composition has yet to be resolved. In a retrospective study of 749 renal transplant recipients subjected to 1322 indication biopsies, we found that prevalence scores of 1, 2, or 3 in the biopsy specimens were 10.7, 11.6, and 2.6%, respectively. Focal and diffuse peritubular Capillaritis (inflammation over 50% of cortical peritubular capillaries) was diagnosed in 10.5 or 14.4% of cases, respectively. Mononuclear, granulocytic, and mixed peritubular Capillaritis was present in 13.1, 3.3, and 8.5%, respectively. While peritubular Capillaritis without further subclassification was not related to higher allograft loss rates, a score of 3 (hazard ratio 2.57 (CI: 1.25–5.28)) and diffuse peritubular Capillaritis (1.67 (1.1–2.54)) were significant impartial risk factors for allograft loss. Diffuse peritubular Capillaritis was independently associated with features of chronic antibody-mediated rejection and greater eGFR decline after 3 years. In contrast, detailed report of leukocytic composition in peritubular Capillaritis did not confer additional prognostic information. Thus, in contrast to typing the infiltrating inflammatory cells, the score and extent of peritubular Capillaritis in kidney allograft pathology is essential to assess transplant prognosis.
Evelyne Lerut - One of the best experts on this subject based on the ideXlab platform.
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subclinical peritubular Capillaritis at 3 months is associated with chronic rejection at 1 year
Transplantation, 2007Co-Authors: Evelyne Lerut, Maarten Naesens, Dirk Kuypers, Yves Vanrenterghem, Boudewijn Van DammeAbstract:Background. Peritubular Capillaritis has been associated with chronic rejection, but the characteristics of subclinical lesions in peritubular capillaries are unknown. Methods. Fifty-three renal allograft recipients underwent a protocol biopsy at both 3 and 12 months after transplantation. Subclinical chronic antibody-mediated rejection (CAMR) at 1 year was diagnosed when three or more of five criteria were present: basement membrane multilayering of peritubular capillaries (MLPTC), transplant glomerulopathy, increase in intimal fibrosis between 3 and 12 months, C4d deposition in peritubular capillaries, and the presence of anti-human leukocyte antigen antibodies. Results. Six (11.3%) patients met the criteria of CAMR. MLPTC was the most sensitive (83.3%) and specific (89.1%) histological criterion (P=0.0008). Five patients had peritubular Capillaritis at their 3-month biopsy. They all developed MLPTC at 1 year (P<0.0001). Three of the patients with early peritubular Capillaritis met the criteria of CAMR at 1 year (P=0.0002). Conclusions. Through early detection of subclinical peritubular Capillaritis, renal allograft recipients who are at risk for development of MLPTC might be identified. Larger series are needed to confirm these preliminary findings, but this report suggests peritubular Capillaritis as an early detection marker for patients at risk for CAMR.
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Subclinical peritubular Capillaritis at 3 months is associated with chronic rejection at 1 year.
Transplantation, 2007Co-Authors: Evelyne Lerut, Maarten Naesens, Dirk Kuypers, Yves Vanrenterghem, Boudewijn Van DammeAbstract:Background. Peritubular Capillaritis has been associated with chronic rejection, but the characteristics of subclinical lesions in peritubular capillaries are unknown. Methods. Fifty-three renal allograft recipients underwent a protocol biopsy at both 3 and 12 months after transplantation. Subclinical chronic antibody-mediated rejection (CAMR) at 1 year was diagnosed when three or more of five criteria were present: basement membrane multilayering of peritubular capillaries (MLPTC), transplant glomerulopathy, increase in intimal fibrosis between 3 and 12 months, C4d deposition in peritubular capillaries, and the presence of anti-human leukocyte antigen antibodies. Results. Six (11.3%) patients met the criteria of CAMR. MLPTC was the most sensitive (83.3%) and specific (89.1%) histological criterion (P=0.0008). Five patients had peritubular Capillaritis at their 3-month biopsy. They all developed MLPTC at 1 year (P
Yu-ping Dang - One of the best experts on this subject based on the ideXlab platform.
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Unilateral linear Capillaritis: two unusual Chinese cases.
European journal of dermatology : EJD, 2007Co-Authors: Guang Zhao, Wen Liu, Yu-ping DangAbstract:Unilateral linear Capillaritis (ULC) is a rare special variation of pigmented purpuric dermatosis (PPD), which is characterized clinically by linear or segmental distribution of pigmented purpuric macules located predominantly on the lower extremities and showing a favorable prognosis. In this case report, we describe two unusual cases of ULC, in one male and one female patient, with unilateral lesions involving the upper extremities that loosely follow the dermatome lines. Biopsy results revealed a common histopathology feature to PPD without heavy band-like infiltration in the upper dermis. On review 20 months after the onset, the eruptions of Patient 1 had spontaneously faded from parts of the affected area. Meanwhile, after a period of 18 months post onset, the eruptions of Patient 2 had became less visible after treatment with PUVA for 2 months, leaving a faded pigmentation.
