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Autoimmunity and autoinflammation as the yin and yang of idiopathic recurrent acute pericarditis.
[familial mediterranean fever]
Autoimmunity
and
autoinflammation
are
generally
considered
as
mutually
exclusive
mechanisms
of
diseases
but
may
concur
to
specific
syndromes
.
Idiopathic
recurrent
acute
pericarditis
(
IRAP
)
is
defined
as
the
recurrence
of
pericardial
symptoms
at
any
point
following
the
prior
cessation
of
acute
pericarditis
,
and
the
latency
is
generally
6
weeks
.
Manifestations
of
pericarditis
such
as
pericardial
friction
rub
,
electrocardiographic
changes
,
and
pericardial
effusion
are
less
frequent
in
the
subsequent
episodes
compared
to
the
index
attack
,
and
in
some
cases
the
only
clinical
sign
is
represented
by
a
suggestive
chest
pain
.
Several
autoimmune
diseases
may
manifest
with
pericarditis
which
is
often
related
to
viral
infections
,
while
postviral
pericarditis
may
in
turn
display
a
nonspecific
autoimmune
background
.
Similarly
,
autoinflammatory
syndromes
such
as
familial
Mediterranean
fever
and
tumor
necrosis
factor
receptor-associated
periodic
syndrome
are
characterized
by
self-limiting
pericardial
symptoms
.
Corticosteroids
are
generally
effective
,
thus
supporting
the
autoimmune
nature
of
IRAP
,
but
dramatic
results
are
obtained
with
interleukin-
1
blocking
agents
in
corticosteroid-dependent
cases
,
pointing
to
a
pathogenic
role
for
the
inflammasome
.
Based
on
these
observations
,
we
submit
that
IRAP
represents
a
paradigmatic
example
of
the
putative
coexistence
of
autoimmunity
and
autoinflammation
:
the
main
aim
of
this
review
is
to
critically
discuss
the
hypothesis
as
well
as
the
current
understanding
of
this
enigmatic
clinical
condition
.
Diseases
Validation
Diseases presenting
"fever"
symptom
22q11.2 deletion syndrome
acute rheumatic fever
alexander disease
allergic bronchopulmonary aspergillosis
canavan disease
carcinoma of the gallbladder
child syndrome
congenital toxoplasmosis
cushing syndrome
cystinuria
dracunculiasis
erdheim-chester disease
esophageal adenocarcinoma
esophageal carcinoma
familial mediterranean fever
focal myositis
hodgkin lymphoma, classical
lamellar ichthyosis
legionellosis
locked-in syndrome
malignant atrophic papulosis
neonatal adrenoleukodystrophy
neuralgic amyotrophy
oculocutaneous albinism
papillon-lefèvre syndrome
pyomyositis
pyruvate dehydrogenase deficiency
scrub typhus
severe combined immunodeficiency
sneddon syndrome
systemic capillary leak syndrome
triple a syndrome
typhoid
waldenström macroglobulinemia
wolf-hirschhorn syndrome
This symptom has already been validated