Research ArticleArticle
IgA Vasculitis with Underlying Liver Cirrhosis: A French Nationwide Case Series of 20 Patients
Ines Elhani, Evangéline Pillebout, Benjamin Terrier, Antoine Hankard, François Vrtovsnik, Noémie Jourde-Chiche, Sophie Greillier, Matthieu Groh, Nabil Belfeki, Adrien Bigot, Hubert de Boysson, Georges-Philippe Pageaux, Loïc Raffray, Geoffrey Urbanski, Isabelle Ollivier, Francois Maillot, Achille Aouba and Alexandra Audemard-Verger on behalf of the French Vasculitis Study Group (FVSG) and the HSPrognosis Group
The Journal of Rheumatology August 2020, jrheum.200293; DOI: https://doi.org/10.3899/jrheum.200293
Ines Elhani
I. Elhani, MD, A. Hankard, MD, H. de Boysson, MD, A. Aouba, MD, Department of Internal Medicine, Caen, Normandie Université, UNICAEN, CHU de Caen Normandie; E. Pillebout, MD, Department of Nephrology, Hôpital Saint Louis, AP-HP, Paris; B. Terrier, MD, Université Paris Descartes, and Department of Internal Medicine, Hôpital Cochin, and National Referral Center for Systemic and Autoimmune Diseases, Hôpital Cochin, Paris; F. Vrtovsnik, MD, Department of Nephrology, Bichat- Claude Bernard Hospital, AP-HP, and Inserm U1149 - CRI, University of Paris, Paris; N. Jourde-Chiche, MD, S. Greillier, MD, Aix-Marseille Univ, C2VN, INSERM, INRA, Centre de Néphrologie et Transplantation Rénale, CHU de la Conception, AP-HM, Marseille; M. Groh, MD, Department of Internal Medicine, National Referral Center for Hypereosinophilic Syndrome (CEREO), Suresnes; N. Belfeki, MD, Department of Internal Medicine, Groupe Hospitalier Sud Ile de France, Melun; A. Bigot, MD, F. Maillot, MD, A. Audemard-Verger, MD, PhD, Department of Internal Medicine and Clinical Immunology, CHRU Tours, and University of Tours, Tours; G.P. Pageaux, MD, Liver Transplantation Unit, Digestive Department, Saint Eloi University Hospital, University of Montpellier, Montpellier; L. Raffray, MD, Department of Internal Medicine, Centre Hospitalier Universitaire de la Réunion, Réunion; G. Urbanski, MD, Department of Internal Medicine, Centre Hospitalier Universitaire d’Angers, Angers; I. Ollivier, MD, Department of Hepato-Gastroenterology and Nutrition, Caen University Hospital, Caen, France. Address correspondence to Dr. A. Audemard-Verger, Department of Internal Medicine and Clinical Immunology, CHRU Tours, Tours, France, University of Tours, Tours, France. Email: a.audemard-verger@chu-tours.fr. Accepted for publication August 6, 2020.
Evangéline Pillebout
I. Elhani, MD, A. Hankard, MD, H. de Boysson, MD, A. Aouba, MD, Department of Internal Medicine, Caen, Normandie Université, UNICAEN, CHU de Caen Normandie; E. Pillebout, MD, Department of Nephrology, Hôpital Saint Louis, AP-HP, Paris; B. Terrier, MD, Université Paris Descartes, and Department of Internal Medicine, Hôpital Cochin, and National Referral Center for Systemic and Autoimmune Diseases, Hôpital Cochin, Paris; F. Vrtovsnik, MD, Department of Nephrology, Bichat- Claude Bernard Hospital, AP-HP, and Inserm U1149 - CRI, University of Paris, Paris; N. Jourde-Chiche, MD, S. Greillier, MD, Aix-Marseille Univ, C2VN, INSERM, INRA, Centre de Néphrologie et Transplantation Rénale, CHU de la Conception, AP-HM, Marseille; M. Groh, MD, Department of Internal Medicine, National Referral Center for Hypereosinophilic Syndrome (CEREO), Suresnes; N. Belfeki, MD, Department of Internal Medicine, Groupe Hospitalier Sud Ile de France, Melun; A. Bigot, MD, F. Maillot, MD, A. Audemard-Verger, MD, PhD, Department of Internal Medicine and Clinical Immunology, CHRU Tours, and University of Tours, Tours; G.P. Pageaux, MD, Liver Transplantation Unit, Digestive Department, Saint Eloi University Hospital, University of Montpellier, Montpellier; L. Raffray, MD, Department of Internal Medicine, Centre Hospitalier Universitaire de la Réunion, Réunion; G. Urbanski, MD, Department of Internal Medicine, Centre Hospitalier Universitaire d’Angers, Angers; I. Ollivier, MD, Department of Hepato-Gastroenterology and Nutrition, Caen University Hospital, Caen, France. Address correspondence to Dr. A. Audemard-Verger, Department of Internal Medicine and Clinical Immunology, CHRU Tours, Tours, France, University of Tours, Tours, France. Email: a.audemard-verger@chu-tours.fr. Accepted for publication August 6, 2020.
Benjamin Terrier
I. Elhani, MD, A. Hankard, MD, H. de Boysson, MD, A. Aouba, MD, Department of Internal Medicine, Caen, Normandie Université, UNICAEN, CHU de Caen Normandie; E. Pillebout, MD, Department of Nephrology, Hôpital Saint Louis, AP-HP, Paris; B. Terrier, MD, Université Paris Descartes, and Department of Internal Medicine, Hôpital Cochin, and National Referral Center for Systemic and Autoimmune Diseases, Hôpital Cochin, Paris; F. Vrtovsnik, MD, Department of Nephrology, Bichat- Claude Bernard Hospital, AP-HP, and Inserm U1149 - CRI, University of Paris, Paris; N. Jourde-Chiche, MD, S. Greillier, MD, Aix-Marseille Univ, C2VN, INSERM, INRA, Centre de Néphrologie et Transplantation Rénale, CHU de la Conception, AP-HM, Marseille; M. Groh, MD, Department of Internal Medicine, National Referral Center for Hypereosinophilic Syndrome (CEREO), Suresnes; N. Belfeki, MD, Department of Internal Medicine, Groupe Hospitalier Sud Ile de France, Melun; A. Bigot, MD, F. Maillot, MD, A. Audemard-Verger, MD, PhD, Department of Internal Medicine and Clinical Immunology, CHRU Tours, and University of Tours, Tours; G.P. Pageaux, MD, Liver Transplantation Unit, Digestive Department, Saint Eloi University Hospital, University of Montpellier, Montpellier; L. Raffray, MD, Department of Internal Medicine, Centre Hospitalier Universitaire de la Réunion, Réunion; G. Urbanski, MD, Department of Internal Medicine, Centre Hospitalier Universitaire d’Angers, Angers; I. Ollivier, MD, Department of Hepato-Gastroenterology and Nutrition, Caen University Hospital, Caen, France. Address correspondence to Dr. A. Audemard-Verger, Department of Internal Medicine and Clinical Immunology, CHRU Tours, Tours, France, University of Tours, Tours, France. Email: a.audemard-verger@chu-tours.fr. Accepted for publication August 6, 2020.
Antoine Hankard
I. Elhani, MD, A. Hankard, MD, H. de Boysson, MD, A. Aouba, MD, Department of Internal Medicine, Caen, Normandie Université, UNICAEN, CHU de Caen Normandie; E. Pillebout, MD, Department of Nephrology, Hôpital Saint Louis, AP-HP, Paris; B. Terrier, MD, Université Paris Descartes, and Department of Internal Medicine, Hôpital Cochin, and National Referral Center for Systemic and Autoimmune Diseases, Hôpital Cochin, Paris; F. Vrtovsnik, MD, Department of Nephrology, Bichat- Claude Bernard Hospital, AP-HP, and Inserm U1149 - CRI, University of Paris, Paris; N. Jourde-Chiche, MD, S. Greillier, MD, Aix-Marseille Univ, C2VN, INSERM, INRA, Centre de Néphrologie et Transplantation Rénale, CHU de la Conception, AP-HM, Marseille; M. Groh, MD, Department of Internal Medicine, National Referral Center for Hypereosinophilic Syndrome (CEREO), Suresnes; N. Belfeki, MD, Department of Internal Medicine, Groupe Hospitalier Sud Ile de France, Melun; A. Bigot, MD, F. Maillot, MD, A. Audemard-Verger, MD, PhD, Department of Internal Medicine and Clinical Immunology, CHRU Tours, and University of Tours, Tours; G.P. Pageaux, MD, Liver Transplantation Unit, Digestive Department, Saint Eloi University Hospital, University of Montpellier, Montpellier; L. Raffray, MD, Department of Internal Medicine, Centre Hospitalier Universitaire de la Réunion, Réunion; G. Urbanski, MD, Department of Internal Medicine, Centre Hospitalier Universitaire d’Angers, Angers; I. Ollivier, MD, Department of Hepato-Gastroenterology and Nutrition, Caen University Hospital, Caen, France. Address correspondence to Dr. A. Audemard-Verger, Department of Internal Medicine and Clinical Immunology, CHRU Tours, Tours, France, University of Tours, Tours, France. Email: a.audemard-verger@chu-tours.fr. Accepted for publication August 6, 2020.
François Vrtovsnik
I. Elhani, MD, A. Hankard, MD, H. de Boysson, MD, A. Aouba, MD, Department of Internal Medicine, Caen, Normandie Université, UNICAEN, CHU de Caen Normandie; E. Pillebout, MD, Department of Nephrology, Hôpital Saint Louis, AP-HP, Paris; B. Terrier, MD, Université Paris Descartes, and Department of Internal Medicine, Hôpital Cochin, and National Referral Center for Systemic and Autoimmune Diseases, Hôpital Cochin, Paris; F. Vrtovsnik, MD, Department of Nephrology, Bichat- Claude Bernard Hospital, AP-HP, and Inserm U1149 - CRI, University of Paris, Paris; N. Jourde-Chiche, MD, S. Greillier, MD, Aix-Marseille Univ, C2VN, INSERM, INRA, Centre de Néphrologie et Transplantation Rénale, CHU de la Conception, AP-HM, Marseille; M. Groh, MD, Department of Internal Medicine, National Referral Center for Hypereosinophilic Syndrome (CEREO), Suresnes; N. Belfeki, MD, Department of Internal Medicine, Groupe Hospitalier Sud Ile de France, Melun; A. Bigot, MD, F. Maillot, MD, A. Audemard-Verger, MD, PhD, Department of Internal Medicine and Clinical Immunology, CHRU Tours, and University of Tours, Tours; G.P. Pageaux, MD, Liver Transplantation Unit, Digestive Department, Saint Eloi University Hospital, University of Montpellier, Montpellier; L. Raffray, MD, Department of Internal Medicine, Centre Hospitalier Universitaire de la Réunion, Réunion; G. Urbanski, MD, Department of Internal Medicine, Centre Hospitalier Universitaire d’Angers, Angers; I. Ollivier, MD, Department of Hepato-Gastroenterology and Nutrition, Caen University Hospital, Caen, France. Address correspondence to Dr. A. Audemard-Verger, Department of Internal Medicine and Clinical Immunology, CHRU Tours, Tours, France, University of Tours, Tours, France. Email: a.audemard-verger@chu-tours.fr. Accepted for publication August 6, 2020.
Noémie Jourde-Chiche
I. Elhani, MD, A. Hankard, MD, H. de Boysson, MD, A. Aouba, MD, Department of Internal Medicine, Caen, Normandie Université, UNICAEN, CHU de Caen Normandie; E. Pillebout, MD, Department of Nephrology, Hôpital Saint Louis, AP-HP, Paris; B. Terrier, MD, Université Paris Descartes, and Department of Internal Medicine, Hôpital Cochin, and National Referral Center for Systemic and Autoimmune Diseases, Hôpital Cochin, Paris; F. Vrtovsnik, MD, Department of Nephrology, Bichat- Claude Bernard Hospital, AP-HP, and Inserm U1149 - CRI, University of Paris, Paris; N. Jourde-Chiche, MD, S. Greillier, MD, Aix-Marseille Univ, C2VN, INSERM, INRA, Centre de Néphrologie et Transplantation Rénale, CHU de la Conception, AP-HM, Marseille; M. Groh, MD, Department of Internal Medicine, National Referral Center for Hypereosinophilic Syndrome (CEREO), Suresnes; N. Belfeki, MD, Department of Internal Medicine, Groupe Hospitalier Sud Ile de France, Melun; A. Bigot, MD, F. Maillot, MD, A. Audemard-Verger, MD, PhD, Department of Internal Medicine and Clinical Immunology, CHRU Tours, and University of Tours, Tours; G.P. Pageaux, MD, Liver Transplantation Unit, Digestive Department, Saint Eloi University Hospital, University of Montpellier, Montpellier; L. Raffray, MD, Department of Internal Medicine, Centre Hospitalier Universitaire de la Réunion, Réunion; G. Urbanski, MD, Department of Internal Medicine, Centre Hospitalier Universitaire d’Angers, Angers; I. Ollivier, MD, Department of Hepato-Gastroenterology and Nutrition, Caen University Hospital, Caen, France. Address correspondence to Dr. A. Audemard-Verger, Department of Internal Medicine and Clinical Immunology, CHRU Tours, Tours, France, University of Tours, Tours, France. Email: a.audemard-verger@chu-tours.fr. Accepted for publication August 6, 2020.
Sophie Greillier
I. Elhani, MD, A. Hankard, MD, H. de Boysson, MD, A. Aouba, MD, Department of Internal Medicine, Caen, Normandie Université, UNICAEN, CHU de Caen Normandie; E. Pillebout, MD, Department of Nephrology, Hôpital Saint Louis, AP-HP, Paris; B. Terrier, MD, Université Paris Descartes, and Department of Internal Medicine, Hôpital Cochin, and National Referral Center for Systemic and Autoimmune Diseases, Hôpital Cochin, Paris; F. Vrtovsnik, MD, Department of Nephrology, Bichat- Claude Bernard Hospital, AP-HP, and Inserm U1149 - CRI, University of Paris, Paris; N. Jourde-Chiche, MD, S. Greillier, MD, Aix-Marseille Univ, C2VN, INSERM, INRA, Centre de Néphrologie et Transplantation Rénale, CHU de la Conception, AP-HM, Marseille; M. Groh, MD, Department of Internal Medicine, National Referral Center for Hypereosinophilic Syndrome (CEREO), Suresnes; N. Belfeki, MD, Department of Internal Medicine, Groupe Hospitalier Sud Ile de France, Melun; A. Bigot, MD, F. Maillot, MD, A. Audemard-Verger, MD, PhD, Department of Internal Medicine and Clinical Immunology, CHRU Tours, and University of Tours, Tours; G.P. Pageaux, MD, Liver Transplantation Unit, Digestive Department, Saint Eloi University Hospital, University of Montpellier, Montpellier; L. Raffray, MD, Department of Internal Medicine, Centre Hospitalier Universitaire de la Réunion, Réunion; G. Urbanski, MD, Department of Internal Medicine, Centre Hospitalier Universitaire d’Angers, Angers; I. Ollivier, MD, Department of Hepato-Gastroenterology and Nutrition, Caen University Hospital, Caen, France. Address correspondence to Dr. A. Audemard-Verger, Department of Internal Medicine and Clinical Immunology, CHRU Tours, Tours, France, University of Tours, Tours, France. Email: a.audemard-verger@chu-tours.fr. Accepted for publication August 6, 2020.
Matthieu Groh
I. Elhani, MD, A. Hankard, MD, H. de Boysson, MD, A. Aouba, MD, Department of Internal Medicine, Caen, Normandie Université, UNICAEN, CHU de Caen Normandie; E. Pillebout, MD, Department of Nephrology, Hôpital Saint Louis, AP-HP, Paris; B. Terrier, MD, Université Paris Descartes, and Department of Internal Medicine, Hôpital Cochin, and National Referral Center for Systemic and Autoimmune Diseases, Hôpital Cochin, Paris; F. Vrtovsnik, MD, Department of Nephrology, Bichat- Claude Bernard Hospital, AP-HP, and Inserm U1149 - CRI, University of Paris, Paris; N. Jourde-Chiche, MD, S. Greillier, MD, Aix-Marseille Univ, C2VN, INSERM, INRA, Centre de Néphrologie et Transplantation Rénale, CHU de la Conception, AP-HM, Marseille; M. Groh, MD, Department of Internal Medicine, National Referral Center for Hypereosinophilic Syndrome (CEREO), Suresnes; N. Belfeki, MD, Department of Internal Medicine, Groupe Hospitalier Sud Ile de France, Melun; A. Bigot, MD, F. Maillot, MD, A. Audemard-Verger, MD, PhD, Department of Internal Medicine and Clinical Immunology, CHRU Tours, and University of Tours, Tours; G.P. Pageaux, MD, Liver Transplantation Unit, Digestive Department, Saint Eloi University Hospital, University of Montpellier, Montpellier; L. Raffray, MD, Department of Internal Medicine, Centre Hospitalier Universitaire de la Réunion, Réunion; G. Urbanski, MD, Department of Internal Medicine, Centre Hospitalier Universitaire d’Angers, Angers; I. Ollivier, MD, Department of Hepato-Gastroenterology and Nutrition, Caen University Hospital, Caen, France. Address correspondence to Dr. A. Audemard-Verger, Department of Internal Medicine and Clinical Immunology, CHRU Tours, Tours, France, University of Tours, Tours, France. Email: a.audemard-verger@chu-tours.fr. Accepted for publication August 6, 2020.
Nabil Belfeki
I. Elhani, MD, A. Hankard, MD, H. de Boysson, MD, A. Aouba, MD, Department of Internal Medicine, Caen, Normandie Université, UNICAEN, CHU de Caen Normandie; E. Pillebout, MD, Department of Nephrology, Hôpital Saint Louis, AP-HP, Paris; B. Terrier, MD, Université Paris Descartes, and Department of Internal Medicine, Hôpital Cochin, and National Referral Center for Systemic and Autoimmune Diseases, Hôpital Cochin, Paris; F. Vrtovsnik, MD, Department of Nephrology, Bichat- Claude Bernard Hospital, AP-HP, and Inserm U1149 - CRI, University of Paris, Paris; N. Jourde-Chiche, MD, S. Greillier, MD, Aix-Marseille Univ, C2VN, INSERM, INRA, Centre de Néphrologie et Transplantation Rénale, CHU de la Conception, AP-HM, Marseille; M. Groh, MD, Department of Internal Medicine, National Referral Center for Hypereosinophilic Syndrome (CEREO), Suresnes; N. Belfeki, MD, Department of Internal Medicine, Groupe Hospitalier Sud Ile de France, Melun; A. Bigot, MD, F. Maillot, MD, A. Audemard-Verger, MD, PhD, Department of Internal Medicine and Clinical Immunology, CHRU Tours, and University of Tours, Tours; G.P. Pageaux, MD, Liver Transplantation Unit, Digestive Department, Saint Eloi University Hospital, University of Montpellier, Montpellier; L. Raffray, MD, Department of Internal Medicine, Centre Hospitalier Universitaire de la Réunion, Réunion; G. Urbanski, MD, Department of Internal Medicine, Centre Hospitalier Universitaire d’Angers, Angers; I. Ollivier, MD, Department of Hepato-Gastroenterology and Nutrition, Caen University Hospital, Caen, France. Address correspondence to Dr. A. Audemard-Verger, Department of Internal Medicine and Clinical Immunology, CHRU Tours, Tours, France, University of Tours, Tours, France. Email: a.audemard-verger@chu-tours.fr. Accepted for publication August 6, 2020.
Adrien Bigot
I. Elhani, MD, A. Hankard, MD, H. de Boysson, MD, A. Aouba, MD, Department of Internal Medicine, Caen, Normandie Université, UNICAEN, CHU de Caen Normandie; E. Pillebout, MD, Department of Nephrology, Hôpital Saint Louis, AP-HP, Paris; B. Terrier, MD, Université Paris Descartes, and Department of Internal Medicine, Hôpital Cochin, and National Referral Center for Systemic and Autoimmune Diseases, Hôpital Cochin, Paris; F. Vrtovsnik, MD, Department of Nephrology, Bichat- Claude Bernard Hospital, AP-HP, and Inserm U1149 - CRI, University of Paris, Paris; N. Jourde-Chiche, MD, S. Greillier, MD, Aix-Marseille Univ, C2VN, INSERM, INRA, Centre de Néphrologie et Transplantation Rénale, CHU de la Conception, AP-HM, Marseille; M. Groh, MD, Department of Internal Medicine, National Referral Center for Hypereosinophilic Syndrome (CEREO), Suresnes; N. Belfeki, MD, Department of Internal Medicine, Groupe Hospitalier Sud Ile de France, Melun; A. Bigot, MD, F. Maillot, MD, A. Audemard-Verger, MD, PhD, Department of Internal Medicine and Clinical Immunology, CHRU Tours, and University of Tours, Tours; G.P. Pageaux, MD, Liver Transplantation Unit, Digestive Department, Saint Eloi University Hospital, University of Montpellier, Montpellier; L. Raffray, MD, Department of Internal Medicine, Centre Hospitalier Universitaire de la Réunion, Réunion; G. Urbanski, MD, Department of Internal Medicine, Centre Hospitalier Universitaire d’Angers, Angers; I. Ollivier, MD, Department of Hepato-Gastroenterology and Nutrition, Caen University Hospital, Caen, France. Address correspondence to Dr. A. Audemard-Verger, Department of Internal Medicine and Clinical Immunology, CHRU Tours, Tours, France, University of Tours, Tours, France. Email: a.audemard-verger@chu-tours.fr. Accepted for publication August 6, 2020.
Hubert de Boysson
I. Elhani, MD, A. Hankard, MD, H. de Boysson, MD, A. Aouba, MD, Department of Internal Medicine, Caen, Normandie Université, UNICAEN, CHU de Caen Normandie; E. Pillebout, MD, Department of Nephrology, Hôpital Saint Louis, AP-HP, Paris; B. Terrier, MD, Université Paris Descartes, and Department of Internal Medicine, Hôpital Cochin, and National Referral Center for Systemic and Autoimmune Diseases, Hôpital Cochin, Paris; F. Vrtovsnik, MD, Department of Nephrology, Bichat- Claude Bernard Hospital, AP-HP, and Inserm U1149 - CRI, University of Paris, Paris; N. Jourde-Chiche, MD, S. Greillier, MD, Aix-Marseille Univ, C2VN, INSERM, INRA, Centre de Néphrologie et Transplantation Rénale, CHU de la Conception, AP-HM, Marseille; M. Groh, MD, Department of Internal Medicine, National Referral Center for Hypereosinophilic Syndrome (CEREO), Suresnes; N. Belfeki, MD, Department of Internal Medicine, Groupe Hospitalier Sud Ile de France, Melun; A. Bigot, MD, F. Maillot, MD, A. Audemard-Verger, MD, PhD, Department of Internal Medicine and Clinical Immunology, CHRU Tours, and University of Tours, Tours; G.P. Pageaux, MD, Liver Transplantation Unit, Digestive Department, Saint Eloi University Hospital, University of Montpellier, Montpellier; L. Raffray, MD, Department of Internal Medicine, Centre Hospitalier Universitaire de la Réunion, Réunion; G. Urbanski, MD, Department of Internal Medicine, Centre Hospitalier Universitaire d’Angers, Angers; I. Ollivier, MD, Department of Hepato-Gastroenterology and Nutrition, Caen University Hospital, Caen, France. Address correspondence to Dr. A. Audemard-Verger, Department of Internal Medicine and Clinical Immunology, CHRU Tours, Tours, France, University of Tours, Tours, France. Email: a.audemard-verger@chu-tours.fr. Accepted for publication August 6, 2020.
Georges-Philippe Pageaux
I. Elhani, MD, A. Hankard, MD, H. de Boysson, MD, A. Aouba, MD, Department of Internal Medicine, Caen, Normandie Université, UNICAEN, CHU de Caen Normandie; E. Pillebout, MD, Department of Nephrology, Hôpital Saint Louis, AP-HP, Paris; B. Terrier, MD, Université Paris Descartes, and Department of Internal Medicine, Hôpital Cochin, and National Referral Center for Systemic and Autoimmune Diseases, Hôpital Cochin, Paris; F. Vrtovsnik, MD, Department of Nephrology, Bichat- Claude Bernard Hospital, AP-HP, and Inserm U1149 - CRI, University of Paris, Paris; N. Jourde-Chiche, MD, S. Greillier, MD, Aix-Marseille Univ, C2VN, INSERM, INRA, Centre de Néphrologie et Transplantation Rénale, CHU de la Conception, AP-HM, Marseille; M. Groh, MD, Department of Internal Medicine, National Referral Center for Hypereosinophilic Syndrome (CEREO), Suresnes; N. Belfeki, MD, Department of Internal Medicine, Groupe Hospitalier Sud Ile de France, Melun; A. Bigot, MD, F. Maillot, MD, A. Audemard-Verger, MD, PhD, Department of Internal Medicine and Clinical Immunology, CHRU Tours, and University of Tours, Tours; G.P. Pageaux, MD, Liver Transplantation Unit, Digestive Department, Saint Eloi University Hospital, University of Montpellier, Montpellier; L. Raffray, MD, Department of Internal Medicine, Centre Hospitalier Universitaire de la Réunion, Réunion; G. Urbanski, MD, Department of Internal Medicine, Centre Hospitalier Universitaire d’Angers, Angers; I. Ollivier, MD, Department of Hepato-Gastroenterology and Nutrition, Caen University Hospital, Caen, France. Address correspondence to Dr. A. Audemard-Verger, Department of Internal Medicine and Clinical Immunology, CHRU Tours, Tours, France, University of Tours, Tours, France. Email: a.audemard-verger@chu-tours.fr. Accepted for publication August 6, 2020.
Loïc Raffray
I. Elhani, MD, A. Hankard, MD, H. de Boysson, MD, A. Aouba, MD, Department of Internal Medicine, Caen, Normandie Université, UNICAEN, CHU de Caen Normandie; E. Pillebout, MD, Department of Nephrology, Hôpital Saint Louis, AP-HP, Paris; B. Terrier, MD, Université Paris Descartes, and Department of Internal Medicine, Hôpital Cochin, and National Referral Center for Systemic and Autoimmune Diseases, Hôpital Cochin, Paris; F. Vrtovsnik, MD, Department of Nephrology, Bichat- Claude Bernard Hospital, AP-HP, and Inserm U1149 - CRI, University of Paris, Paris; N. Jourde-Chiche, MD, S. Greillier, MD, Aix-Marseille Univ, C2VN, INSERM, INRA, Centre de Néphrologie et Transplantation Rénale, CHU de la Conception, AP-HM, Marseille; M. Groh, MD, Department of Internal Medicine, National Referral Center for Hypereosinophilic Syndrome (CEREO), Suresnes; N. Belfeki, MD, Department of Internal Medicine, Groupe Hospitalier Sud Ile de France, Melun; A. Bigot, MD, F. Maillot, MD, A. Audemard-Verger, MD, PhD, Department of Internal Medicine and Clinical Immunology, CHRU Tours, and University of Tours, Tours; G.P. Pageaux, MD, Liver Transplantation Unit, Digestive Department, Saint Eloi University Hospital, University of Montpellier, Montpellier; L. Raffray, MD, Department of Internal Medicine, Centre Hospitalier Universitaire de la Réunion, Réunion; G. Urbanski, MD, Department of Internal Medicine, Centre Hospitalier Universitaire d’Angers, Angers; I. Ollivier, MD, Department of Hepato-Gastroenterology and Nutrition, Caen University Hospital, Caen, France. Address correspondence to Dr. A. Audemard-Verger, Department of Internal Medicine and Clinical Immunology, CHRU Tours, Tours, France, University of Tours, Tours, France. Email: a.audemard-verger@chu-tours.fr. Accepted for publication August 6, 2020.
Geoffrey Urbanski
I. Elhani, MD, A. Hankard, MD, H. de Boysson, MD, A. Aouba, MD, Department of Internal Medicine, Caen, Normandie Université, UNICAEN, CHU de Caen Normandie; E. Pillebout, MD, Department of Nephrology, Hôpital Saint Louis, AP-HP, Paris; B. Terrier, MD, Université Paris Descartes, and Department of Internal Medicine, Hôpital Cochin, and National Referral Center for Systemic and Autoimmune Diseases, Hôpital Cochin, Paris; F. Vrtovsnik, MD, Department of Nephrology, Bichat- Claude Bernard Hospital, AP-HP, and Inserm U1149 - CRI, University of Paris, Paris; N. Jourde-Chiche, MD, S. Greillier, MD, Aix-Marseille Univ, C2VN, INSERM, INRA, Centre de Néphrologie et Transplantation Rénale, CHU de la Conception, AP-HM, Marseille; M. Groh, MD, Department of Internal Medicine, National Referral Center for Hypereosinophilic Syndrome (CEREO), Suresnes; N. Belfeki, MD, Department of Internal Medicine, Groupe Hospitalier Sud Ile de France, Melun; A. Bigot, MD, F. Maillot, MD, A. Audemard-Verger, MD, PhD, Department of Internal Medicine and Clinical Immunology, CHRU Tours, and University of Tours, Tours; G.P. Pageaux, MD, Liver Transplantation Unit, Digestive Department, Saint Eloi University Hospital, University of Montpellier, Montpellier; L. Raffray, MD, Department of Internal Medicine, Centre Hospitalier Universitaire de la Réunion, Réunion; G. Urbanski, MD, Department of Internal Medicine, Centre Hospitalier Universitaire d’Angers, Angers; I. Ollivier, MD, Department of Hepato-Gastroenterology and Nutrition, Caen University Hospital, Caen, France. Address correspondence to Dr. A. Audemard-Verger, Department of Internal Medicine and Clinical Immunology, CHRU Tours, Tours, France, University of Tours, Tours, France. Email: a.audemard-verger@chu-tours.fr. Accepted for publication August 6, 2020.
Isabelle Ollivier
I. Elhani, MD, A. Hankard, MD, H. de Boysson, MD, A. Aouba, MD, Department of Internal Medicine, Caen, Normandie Université, UNICAEN, CHU de Caen Normandie; E. Pillebout, MD, Department of Nephrology, Hôpital Saint Louis, AP-HP, Paris; B. Terrier, MD, Université Paris Descartes, and Department of Internal Medicine, Hôpital Cochin, and National Referral Center for Systemic and Autoimmune Diseases, Hôpital Cochin, Paris; F. Vrtovsnik, MD, Department of Nephrology, Bichat- Claude Bernard Hospital, AP-HP, and Inserm U1149 - CRI, University of Paris, Paris; N. Jourde-Chiche, MD, S. Greillier, MD, Aix-Marseille Univ, C2VN, INSERM, INRA, Centre de Néphrologie et Transplantation Rénale, CHU de la Conception, AP-HM, Marseille; M. Groh, MD, Department of Internal Medicine, National Referral Center for Hypereosinophilic Syndrome (CEREO), Suresnes; N. Belfeki, MD, Department of Internal Medicine, Groupe Hospitalier Sud Ile de France, Melun; A. Bigot, MD, F. Maillot, MD, A. Audemard-Verger, MD, PhD, Department of Internal Medicine and Clinical Immunology, CHRU Tours, and University of Tours, Tours; G.P. Pageaux, MD, Liver Transplantation Unit, Digestive Department, Saint Eloi University Hospital, University of Montpellier, Montpellier; L. Raffray, MD, Department of Internal Medicine, Centre Hospitalier Universitaire de la Réunion, Réunion; G. Urbanski, MD, Department of Internal Medicine, Centre Hospitalier Universitaire d’Angers, Angers; I. Ollivier, MD, Department of Hepato-Gastroenterology and Nutrition, Caen University Hospital, Caen, France. Address correspondence to Dr. A. Audemard-Verger, Department of Internal Medicine and Clinical Immunology, CHRU Tours, Tours, France, University of Tours, Tours, France. Email: a.audemard-verger@chu-tours.fr. Accepted for publication August 6, 2020.
Francois Maillot
I. Elhani, MD, A. Hankard, MD, H. de Boysson, MD, A. Aouba, MD, Department of Internal Medicine, Caen, Normandie Université, UNICAEN, CHU de Caen Normandie; E. Pillebout, MD, Department of Nephrology, Hôpital Saint Louis, AP-HP, Paris; B. Terrier, MD, Université Paris Descartes, and Department of Internal Medicine, Hôpital Cochin, and National Referral Center for Systemic and Autoimmune Diseases, Hôpital Cochin, Paris; F. Vrtovsnik, MD, Department of Nephrology, Bichat- Claude Bernard Hospital, AP-HP, and Inserm U1149 - CRI, University of Paris, Paris; N. Jourde-Chiche, MD, S. Greillier, MD, Aix-Marseille Univ, C2VN, INSERM, INRA, Centre de Néphrologie et Transplantation Rénale, CHU de la Conception, AP-HM, Marseille; M. Groh, MD, Department of Internal Medicine, National Referral Center for Hypereosinophilic Syndrome (CEREO), Suresnes; N. Belfeki, MD, Department of Internal Medicine, Groupe Hospitalier Sud Ile de France, Melun; A. Bigot, MD, F. Maillot, MD, A. Audemard-Verger, MD, PhD, Department of Internal Medicine and Clinical Immunology, CHRU Tours, and University of Tours, Tours; G.P. Pageaux, MD, Liver Transplantation Unit, Digestive Department, Saint Eloi University Hospital, University of Montpellier, Montpellier; L. Raffray, MD, Department of Internal Medicine, Centre Hospitalier Universitaire de la Réunion, Réunion; G. Urbanski, MD, Department of Internal Medicine, Centre Hospitalier Universitaire d’Angers, Angers; I. Ollivier, MD, Department of Hepato-Gastroenterology and Nutrition, Caen University Hospital, Caen, France. Address correspondence to Dr. A. Audemard-Verger, Department of Internal Medicine and Clinical Immunology, CHRU Tours, Tours, France, University of Tours, Tours, France. Email: a.audemard-verger@chu-tours.fr. Accepted for publication August 6, 2020.
Achille Aouba
I. Elhani, MD, A. Hankard, MD, H. de Boysson, MD, A. Aouba, MD, Department of Internal Medicine, Caen, Normandie Université, UNICAEN, CHU de Caen Normandie; E. Pillebout, MD, Department of Nephrology, Hôpital Saint Louis, AP-HP, Paris; B. Terrier, MD, Université Paris Descartes, and Department of Internal Medicine, Hôpital Cochin, and National Referral Center for Systemic and Autoimmune Diseases, Hôpital Cochin, Paris; F. Vrtovsnik, MD, Department of Nephrology, Bichat- Claude Bernard Hospital, AP-HP, and Inserm U1149 - CRI, University of Paris, Paris; N. Jourde-Chiche, MD, S. Greillier, MD, Aix-Marseille Univ, C2VN, INSERM, INRA, Centre de Néphrologie et Transplantation Rénale, CHU de la Conception, AP-HM, Marseille; M. Groh, MD, Department of Internal Medicine, National Referral Center for Hypereosinophilic Syndrome (CEREO), Suresnes; N. Belfeki, MD, Department of Internal Medicine, Groupe Hospitalier Sud Ile de France, Melun; A. Bigot, MD, F. Maillot, MD, A. Audemard-Verger, MD, PhD, Department of Internal Medicine and Clinical Immunology, CHRU Tours, and University of Tours, Tours; G.P. Pageaux, MD, Liver Transplantation Unit, Digestive Department, Saint Eloi University Hospital, University of Montpellier, Montpellier; L. Raffray, MD, Department of Internal Medicine, Centre Hospitalier Universitaire de la Réunion, Réunion; G. Urbanski, MD, Department of Internal Medicine, Centre Hospitalier Universitaire d’Angers, Angers; I. Ollivier, MD, Department of Hepato-Gastroenterology and Nutrition, Caen University Hospital, Caen, France. Address correspondence to Dr. A. Audemard-Verger, Department of Internal Medicine and Clinical Immunology, CHRU Tours, Tours, France, University of Tours, Tours, France. Email: a.audemard-verger@chu-tours.fr. Accepted for publication August 6, 2020.
Alexandra Audemard-Verger
I. Elhani, MD, A. Hankard, MD, H. de Boysson, MD, A. Aouba, MD, Department of Internal Medicine, Caen, Normandie Université, UNICAEN, CHU de Caen Normandie; E. Pillebout, MD, Department of Nephrology, Hôpital Saint Louis, AP-HP, Paris; B. Terrier, MD, Université Paris Descartes, and Department of Internal Medicine, Hôpital Cochin, and National Referral Center for Systemic and Autoimmune Diseases, Hôpital Cochin, Paris; F. Vrtovsnik, MD, Department of Nephrology, Bichat- Claude Bernard Hospital, AP-HP, and Inserm U1149 - CRI, University of Paris, Paris; N. Jourde-Chiche, MD, S. Greillier, MD, Aix-Marseille Univ, C2VN, INSERM, INRA, Centre de Néphrologie et Transplantation Rénale, CHU de la Conception, AP-HM, Marseille; M. Groh, MD, Department of Internal Medicine, National Referral Center for Hypereosinophilic Syndrome (CEREO), Suresnes; N. Belfeki, MD, Department of Internal Medicine, Groupe Hospitalier Sud Ile de France, Melun; A. Bigot, MD, F. Maillot, MD, A. Audemard-Verger, MD, PhD, Department of Internal Medicine and Clinical Immunology, CHRU Tours, and University of Tours, Tours; G.P. Pageaux, MD, Liver Transplantation Unit, Digestive Department, Saint Eloi University Hospital, University of Montpellier, Montpellier; L. Raffray, MD, Department of Internal Medicine, Centre Hospitalier Universitaire de la Réunion, Réunion; G. Urbanski, MD, Department of Internal Medicine, Centre Hospitalier Universitaire d’Angers, Angers; I. Ollivier, MD, Department of Hepato-Gastroenterology and Nutrition, Caen University Hospital, Caen, France. Address correspondence to Dr. A. Audemard-Verger, Department of Internal Medicine and Clinical Immunology, CHRU Tours, Tours, France, University of Tours, Tours, France. Email: a.audemard-verger@chu-tours.fr. Accepted for publication August 6, 2020.
Abstract
Objective Immunoglobulin A vasculitis (IgAV) and nephropathy (IgAN) share common immunological mechanisms. Liver cirrhosis is well known to be associated with IgAN. Here, we aimed to describe the presentation and outcome of IgAV patients with underlying cirrhosis.
Methods We conducted a French nationwide retrospective study of adult patients presenting with both IgAV and cirrhosis. Baseline characteristics were compared to those of the 260 patients included in the French nationwide IgAV registry (IGAVAS).
Results Twenty patients were included, and 7 (35%) were female. The mean ± SD age was 62.7 ± 11 years. At baseline, compared with IGAVAS patients, patients with underlying cirrhosis were older (62.7 ± 11 vs 50.1 ± 18, P < 0.01) and displayed more constitutional symptoms (weight loss 25% vs 8%, P = 0.03). Patients with underlying cirrhosis were also more likely to exhibit elevated serum IgA levels (5.6 g/L vs 3.6 g/L, P = 0.02). Cirrhosis and IgAV were diagnosed simultaneously in 12 patients (60%). Cirrhosis was mainly related to alcohol intake (n = 15, 75%), followed by nonalcoholic steato-hepatitis (n = 2), chronic viral hepatitis (n = 1), hemochromatosis (n = 1), and autoimmune hepatitis (n = 1). During follow-up with a median of 17 months (IQR 12–84), 10/13 (77%) exhibited IgAV remission at Month 3. One patient presented a minor relapse. Six patients died, but no deaths were related to IgAV.
Conclusion We report the first case series of IgAV patients with underlining cirrhosis, to our knowledge, which was mainly alcohol related. The liver disease did not seem to affect baseline vasculitis characteristics. Physicians should investigate the existence of liver cirrhosis at IgAV diagnosis, especially in the context of alcohol abuse.
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In this issue
The Journal of Rheumatology
Vol. 48, Issue 3
1 Mar 2021
IgA Vasculitis with Underlying Liver Cirrhosis: A French Nationwide Case Series of 20 Patients
Ines Elhani, Evangéline Pillebout, Benjamin Terrier, Antoine Hankard, François Vrtovsnik, Noémie Jourde-Chiche, Sophie Greillier, Matthieu Groh, Nabil Belfeki, Adrien Bigot, Hubert de Boysson, Georges-Philippe Pageaux, Loïc Raffray, Geoffrey Urbanski, Isabelle Ollivier, Francois Maillot, Achille Aouba, Alexandra Audemard-Verger
The Journal of Rheumatology Aug 2020, jrheum.200293; DOI: 10.3899/jrheum.200293
IgA Vasculitis with Underlying Liver Cirrhosis: A French Nationwide Case Series of 20 Patients
Ines Elhani, Evangéline Pillebout, Benjamin Terrier, Antoine Hankard, François Vrtovsnik, Noémie Jourde-Chiche, Sophie Greillier, Matthieu Groh, Nabil Belfeki, Adrien Bigot, Hubert de Boysson, Georges-Philippe Pageaux, Loïc Raffray, Geoffrey Urbanski, Isabelle Ollivier, Francois Maillot, Achille Aouba, Alexandra Audemard-Verger
The Journal of Rheumatology Aug 2020, jrheum.200293; DOI: 10.3899/jrheum.200293
