1. New insights on IgA vasculitis with underlying solid tumor: a nationwide French study of 30 patients
- Author
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Le Sébastien Burel, Zahir Amoura, Achille Aouba, Anne-Sophie Darrigade, François Maillot, Christian Combe, Alexandra Audemard-Verger, Guillaume Moulis, Hubert de Boysson, Arsène Mekinian, Antoine Hankard, Jean-Marie Michot, Carole Vandamme-Giard, Alexandre Karras, Florent Guerville, G. Maigné, Geoffrey Urbanski, Alban Deroux, Etienne Rivière, Benoit Brihaye, Benjamin Terrier, and Johan Chanal
- Subjects
Adult ,Male ,Vasculitis ,medicine.medical_specialty ,Henoch-Schonlein purpura ,IgA Vasculitis ,Malignancy ,Gastroenterology ,Rheumatology ,Neoplasms ,Internal medicine ,medicine ,Humans ,Aged ,Retrospective Studies ,Aged, 80 and over ,business.industry ,Cancer ,Retrospective cohort study ,General Medicine ,Middle Aged ,medicine.disease ,Immunoglobulin A ,IgA vasculitis ,Adenocarcinoma ,Female ,France ,business - Abstract
IgA vasculitis (IgAV) frequently occurs during or after a mucosal infection; it also rarely occurs in patients with cancer. We hypothesized that cancer could impact the baseline characteristics and/or outcome of vasculitis. We aimed to describe the presentation of IgAV in patients with cancer (IgAV ca+) compared to patients without cancer.We conducted a nationwide retrospective study of adult patients in France who presented with both IgAV and cancer. Baseline characteristics were described and compared with those of the 260 patients included in a nationwide French IgAV study.Thirty patients were included. The mean age was 69 ± 12 years; 80% were men. Compared to patients without underlying cancer, IgAV ca+ patients were older (69 ± 12 vs. 50 ± 18 years; p 0.0001) and they presented more frequently with necrotic purpura (53 vs. 26%; p 0.002) and intra-alveolar hemorrhage (10 vs. 0.5%; p 0.0001). IgAV ca+ patients frequently had elevated serum IgA levels (79 vs. 53%; p 0.034); most (n = 22, 73%) had adenocarcinoma or urothelial carcinoma involving the large intestines (n = 6), bladder (n = 5), and lung (n = 5). Most IgAV ca+ patients had progressive cancer (n = 21); a minority had metastatic disease (n = 2) at IgAV diagnosis. After a median follow-up of 3 months, 8 deaths were observed but none was related to IgAV.Compared to their noncancer counterpart, patients with IgAV related to cancer were older and more frequently presented with necrotizing purpura, intra-alveolar hemorrhage, and elevated serum IgA levels. Adult patients with IgAV and these latter characteristics should be carefully screened for cancer. Key Points • Clinical and biological characteristics of patients presenting with IgAV are distinct depending on the underlying cause of vasculitis related to cancer. • Patients with IgAV related to cancer are older, and compared to their counterparts without IgAV, they present more frequently with necrotic purpura, alveolar hemorrhage, and elevated serum IgA levels. • All adult patients with IgAV should be screened for cancer, and there should be a focus on elderly male patients presenting with necrotic purpura and/or alveolar hemorrhage.
- Published
- 2020