1/12. Systemic toxicity following administration of sirolimus (formerly rapamycin) for psoriasis: association of capillary leak syndrome with apoptosis of lesional lymphocytes.BACKGROUND: sirolimus (formerly rapamycin) is an immunosuppressive agent that interferes with T-cell activation. After 2 individuals with psoriasis developed a capillary leak syndrome following treatment with oral sirolimus lesional skin cells and activated peripheral blood cells were analyzed for induction of apoptosis. OBSERVATIONS: A keratome skin specimen from 1 patient with sirolimus-induced capillary leak syndrome had a 2.3-fold increase in percentage of apoptotic cells (to 48%) compared with an unaffected sirolimus-treated patient with psoriasis (21%). Activated peripheral blood T cells from patients with psoriasis tended to exhibit greater spontaneous or dexamethasone-induced apoptosis than did normal T cells, particularly in the presence of sirolimus. CONCLUSIONS: Severe adverse effects of sirolimus include fever, anemia, and capillary leak syndrome. These symptoms may be the result of drug-induced apoptosis of lesional leukocytes, especially activated T lymphocytes, and possibly release of inflammatory mediators. Because patients with severe psoriasis may develop capillary leak from various systemic therapies, clinical monitoring is advisable for patients with inflammatory diseases who are treated with immune modulators.- - - - - - - - - - ranking = 1keywords = capillary leak syndrome, capillary leak, leak syndrome, capillary, leak (Clic here for more details about this article) |
2/12. capillary leak syndrome induced by acitretin.The mucocutaneous side-effects of systemic retinoids are well known. We report a patient with diffuse oedema, which is a very rare side-effect of retinoids. The pathophysiology of this condition is poorly known because of the rarity of relevant observations, but apparently corresponds to capillary leak syndrome. The outcome is invariably favourable following withdrawal of the drug, which should be definitively contraindicated in the patient.- - - - - - - - - - ranking = 0.2283641210851keywords = capillary leak syndrome, capillary leak, leak syndrome, capillary, leak (Clic here for more details about this article) |
3/12. Generalized pustular psoriasis complicated by acute respiratory distress syndrome.psoriasis has a chronic and relatively benign course. However, severe complications are possible. One rare complication is acute interstitial pneumonitis. This entity should be suspected when a patient presents with dyspnoea and high fever. knowledge of this pathology is crucial, for although it is essential to rule out aetiologies requiring specific management such as microbial infection or drug-related syndromes, diagnosis should not be delayed as its severe clinical course is improved by corticosteroids. We report two patients with an acute respiratory distress syndrome arising during the course of pustular psoriasis. Repeated bacteriological testing in lungs and blood remained negative. In both cases lung involvement was severe, requiring artificial ventilation. Dramatic clinical resolution was obtained by using corticosteroids. Besides infectious causes and drug hypersensitivity to methotrexate or acitretin, acute respiratory distress syndrome, sometimes due to a pulmonary capillary leak syndrome, is a rare cause of pneumonitis in the course of psoriasis, and may be fatal. Its pathogenesis is unknown. However, animal models suggest a role for T-helper (Th) 1 lymphocytes, known to be activated in psoriasis, and a role for tumour necrosis factor-alpha, a major Th1 cytokine, in alveolar damage.- - - - - - - - - - ranking = 0.13901211034113keywords = capillary leak syndrome, capillary leak, leak syndrome, capillary, leak (Clic here for more details about this article) |
4/12. acitretin induces capillary leak syndrome in a patient with pustular psoriasis.capillary leak syndrome is a rare and potentially life-threatening condition caused by a shift of intravascular fluid and proteins to the interstitial space. We describe a patient with pustular psoriasis in whom capillary leak syndrome developed after the start of acitretin. Immediate withdrawal of retinoic acid is necessary and corticosteroid therapy should be considered.- - - - - - - - - - ranking = 0.71739855439163keywords = capillary leak syndrome, capillary leak, leak syndrome, capillary, leak (Clic here for more details about this article) |
5/12. Pulmonary capillary leak syndrome complicating generalized pustular psoriasis: possible role of cytokines.Two cases are reported of generalized pustular psoriasis complicated by profound alterations in pulmonary capillary permeability. Several features suggest the involvement of cytokines in the pathogenesis of this condition.- - - - - - - - - - ranking = 0.55612830476848keywords = capillary leak syndrome, capillary leak, leak syndrome, capillary, leak (Clic here for more details about this article) |
6/12. psoriasis vulgaris associated with mesangiocapillary glomerulonephritis.A patient experienced the concomitant onset of psoriasis vulgaris and mesangiocapillary glomerulonephritis (MCGN) with massive proteinuria. Laboratory examination revealed reduced glomerular filtration rate (GFR), elevated serum IgG, IgA and circulating immune complex (CIC) levels. Both diseases responded promptly to combined therapy with prednisolone, urokinase and plasma exchange. CIC and GFR were normalized with histological improvement. To our knowledge, this is the first case of glomerulonephritis, which can be related to psoriasis vulgaris through an immune mechanism.- - - - - - - - - - ranking = 0.00039931701983541keywords = capillary (Clic here for more details about this article) |
7/12. psoriasis and intraocular inflammation.Presented in this series were seven men and three women. Ages when seen, ranged from 32 to 68 years (average 54). psoriasis had begun in childhood in the women and in the late 20's and 30's in the men. arthritis (ankylosing spondylitis) was present in only one. Their ocular inflammations began from ages 26 to 62 (average 41). The onset of the inflammation was acute iritis in four and in indolent iridocylcitis in six. All but one were bilateral and chronic. The vitreous had heavy debris in nine of the ten patients. The retina was normal in only three. Boggy congestion was present in two with cystoid edema. Patches of edema. fluorescein leaking, depigmentation of both maculae, pars plana exudate, and retinal vessel obliteration to grey-white, shaggy cords was present in at least one of the remaining five patients. Systemic corticosteroid therapy has been used in eight of the ten patients described in this report. Doses no higher than 30 mg of prednisone per day were used to initiate reversal of the inflammatory response. In case 10, knowledge of the sensitivity of the process to steroids led to the successful rapid reversal of a recalcitrant iritis with only 20 mg of prednisone as a first dose and 20 mg per day for less than three weeks. maintenance corticosteroid therapy ranged from 40 mg of prednisone every other day in case 9, prednisone 12.5 mg one day and 5 mg the next in case 8, to 8 mg of Aristocort or methylprednisolone acetate (M-edrol) daily in cases 1 and 2. In summary, these patients are older, have an indolent onset bilateral uveitis with dense vitreous debris, retinal abnormalites, and are extremely sensitive to systemic corticosteroids. Many of these patients had undergone the series of clinical evaluations known as a "uveitis survey." Many different systemic abnormalities were found and merited treatment which rarely made a difference in their ocular disease, though two improved after infected teeth were treated. Assuming that these ocular diseases were related to psoriasis, one can then challenge the value of anything found by a "uveitis survey." The author uses information gained from such studies to insure that the patient is in the best possible heatlh and then makes clinical correlations such as presented in this paper. The rarity of this combination of ocular inflammations in patients with psoriasis makes it risky to propose that this is a significant association. Arguments that this is a disease entity began with the clinical similarities: older age, indolent onset, vitreous and retinal involvement, and the extreme sensitivity to systemic corticosteroids. None of these patients had psoriatic arthritis and only one had ankylosing spondylitis. The best explanation for the fact that this disorder has not been emphasized in the past would be an attitude of ophthalmologists and physicians that the eye and skin disease were coincident.- - - - - - - - - - ranking = 1.0318158428795E-5keywords = leak (Clic here for more details about this article) |
8/12. pressure inhibition of the Koebner reaction by capillary occlusion.A 38-year-old male with extensive psoriasis received a linear experimental abrasion. Immediate pressure was applied for 24 hours to the central portion of the traumatized site. During a psoriatic relapse 5 weeks later, Koebnerization occurred in the abraded areas but spared the site where pressure had been previously applied. The mechanism is not known but may be due to a local suppressive effect of pressure on inflammation.- - - - - - - - - - ranking = 0.00031945361586833keywords = capillary (Clic here for more details about this article) |
9/12. Pigmented villonodular synovitis associated with psoriatic polyarthropathy: and electron microscopic and immunocytochemical study.A case of pigmented villonodular synovitis in a patient with psoriatic polyarthropathy was studied by means of light microscopy, electron microscopy and immunocytochemical techniques. The lesion consisted of mononuclear phagocytes with features intermediate between type A and type B cells, two types of multinucleate giant cells, an abnormal vasculature, extravasated fibrin and erythrocytes. An unexpected feature was the presence of a mononuclear cell whose cytoplasm contained intermediate filaments and reacted strongly to antisera to cytokeratins. Such a cell type has not previously been described in this condition and its significance is unclear. The findings support the theory that the pathogenesis of PVNS involves leakage of blood through abnormal vessels resulting in the local accumulation and proliferation of mononuclear phagocytes, connective tissue cells and unidentified cytokeratin positive mononuclear cells. The aetiology of the vascular damage, however, remains unknown.- - - - - - - - - - ranking = 1.0318158428795E-5keywords = leak (Clic here for more details about this article) |
10/12. Progressive interstitial lung disease from prolonged methotrexate therapy.Progressive interstitial fibrosis with roentgenographic honeycombing developed in the case of a psoriatic patient who had been on a regimen of methotrexate for 18 years. Examination revealed a combined restrictive and obstructive defect in pulmonary mechanics and severe compromise of gas transfer across the pulmonary alveolar-capillary membrane. Improvement in the level of arterial blood gases and pulmonary diffusing capacity occurred after discontinuation of methotrexate therapy. Interstitial fibrosis of the lung is a potential complication of methotrexate therapy for psoriasis.- - - - - - - - - - ranking = 7.9863403967083E-5keywords = capillary (Clic here for more details about this article) |
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