Browsing by Author "Sourabh Pathania"

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Correlation of the Disease Activity and Pro-inflammatory Cytokine Expression Between Young and Elderly Onset Rheumatoid Arthritis
(SAGE Publications Ltd, 2025) Shivam Sharma; Sourabh Pathania; Diparani Takhelmayum; Kailash Kumar; Anup P. Singh
Background and Aims: Rheumatoid arthritis (RA) is a complex autoimmune inflammatory disease-causing disability. The immunopathogenic difference between elderly onset RA (EORA) and younger-onset RA (YORA) and the factors responsible for their clinical characteristics are yet to be explored completely. The study was done to correlate inflammatory biomarkers in EORA patients and compare with YORA patients. Methods: A cross-sectional study comprising 30 patients each for YORA and EORA was done. Serum levels of interleukin IL-1β, IL-6, IL-8, tumour necrosis factor-alpha (TNF-α), interferon-gamma (IFN-γ) and anticyclic citrullinated peptide were determined by Enzyme-Linked Immunosorbent Assay (ELISA). These were correlated with disease activity using the DAS28, and the modified Larson score was used to assess bone erosion. Results: Significantly higher levels of serum IL-6 (25.1 vs. 12.8 pg/mL) and IL-8 (83.5 vs. 65.15 pg/mL) were found in EORA patients, while significantly higher levels of serum TNF-α (360.8 vs. 86.3 pg/mL) were found in patients with YORA. IL-1β, IL-8 and TNF-α have a significantly positive correlation with DAS28 in YORA, while IL-1β, TNF-α and IFN-γ are significantly associated with disease activity in EORA. Increased bone erosion was linked to EORA. Conclusion: Apart from clinical symptoms, serological profile, EORA, and YORA have a distinct cytokines profile. This provides a valuable insight for selecting targeted therapies, especially in managing naive and refractory RA cases of EORA. Given the higher risk of joint damage in EORA, early and aggressive management may result in early remission and improve patient’s quality of life. © 2025 The Author(s). This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access page (https://us.sagepub.com/en-us/nam/open-access-at-sage).
DRESS Syndrome with Cold Agglutinins: An Unusual Immune Response to Anticonvulsants
(Bentham Science Publishers, 2025) Sumit Jaiswal; Sourabh Pathania; Gaurav Sharma; Ankur Singh; Upinder Kaur; Anup P. Singh; Sankha Shubhra Chakrabarti
Introduction: DRESS (Drug Reaction with Eosinophilia and Systemic Symptoms) is a rare adverse drug reaction characterized by cutaneous and systemic manifestations, with a mortality rate of up to 10%. In this study, we describe the case of a 77-year-old man who developed DRESS syndrome with cold agglutination. Case Presentation: A 77-year-old man prescribed phenytoin and carbamazepine for suspected cranial neuralgia after a tooth extraction developed high-grade fever and hemorrhagic crusting on the upper and lower lips and oral mucosa, morbilliform rashes over the chest, abdomen, and back along with facial edema, all occurring over 2 weeks. Clinically significant right-sided submandibular, cervical, and axillary lymphadenopathy was observed. Additional findings, including peripheral blood eosinophilia, hepatitis, and coagulopathy, helped us make a provisional diagnosis of DRESS syndrome. The peripheral blood smear showed an incidental finding of cold agglutination phenomenon at room temperature (16 °C; winter months in North India), which disappeared under warmer conditions. However, gross hemolysis was not confirmed. The patient showed significant response in both clinical and hematological parameters within 24 hours of initiating intravenous dexamethasone, which was continued and gradually tapered over 14 days. Follow-up at one month showed the disappearance of the cold agglutination phenomenon. Conclusion: Cold agglutination in DRESS syndrome has not been documented in detail in the past. One hypothesis is the agglutination of red blood cells (RBCs) due to the effect of the pathogenetic antibodies in DRESS syndrome directed against RBC antigens. Further molecular research may elucidate the pathways of this rare clinical finding. © 2025 Bentham Science Publishers.