Mouth and genital ulcers with inflamed cartilage syndrome

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Mouth and genital ulcers with inflamed cartilage syndrome
Other namesMAGIC syndrome
Specialty Dermatology

Mouth and genital ulcers with inflamed cartilage syndrome or MAGIC syndrome refers to a condition in which an individual exhibits symptoms of both relapsing polychondritis (RP) and Behcet's disease (BD). [1] Inflammatory ulcers in the mouth, genitalia, and skin are the hallmark of Behcet's disease (BD), a multisystem illness that is chronic and relapsing. [2] Autoimmune recurrent chondritis of the larynx, tracheobronchial tree, nose, ears, and mouth is known as relapsing polychondritis (RP). [3]

Contents

Signs and symptoms

The median time interval between the onset of symptoms and the diagnosis was 6 years, with a range of 26 days to 14 years. This suggests that the symptoms of MAGIC syndrome may manifest relatively long after the initial onset of symptoms. During the course of MAGIC syndrome, the signs and symptoms of BD may typically occur before those of RP. [4]

Causes

An autoimmune response to Type II collagen, which is found in cartilage and the sclera of the eye, may play a role in the pathophysiology of RP. [5] A genetic connection to HLA-DR4 (DRB1*04 subtype alleles) may also exist. [5] About 30% of cases of RP are linked to additional illnesses, such as autoimmune disorders. [5] Seventy percent of patients with BD have HLA-B51, which is linked to the multisystem disorder that is associated with histopathological leukocytoclastic vasculitis. [5] Only two of the five cases that could be evaluated, though, had HLA-B51 positivity. Two of the four cases that could be evaluated had HLA-DR4 positivity. [4] MAGIC syndrome may not be a distinct medical condition, according to some writers. [5] [6] It could be RP developing as a result of BD, another autoimmune disease association, or RP and vasculitis. [5]

Diagnosis

When the symptoms of BD and RP are combined into a single clinical entity, the diagnosis of MAGIC syndrome is made. [7]

Treatment

The available pharmacological treatments for MAGIC syndrome include biologics (tocilizumab and infliximab), immunosuppressants (cyclosporin A, methotrexate, cyclophosphamide, and azathioprine), steroids (corticosteroids, methylprednisolone, prednisolone, and prednisone), colchicines, dapsone, and nonsteroidal anti-inflammatory drugs. [4]

Epidemiology

In the English-language published work as of 2016, there have been 16 reports of MAGIC syndrome (21 patients). The patients, who were 8 men and 13 women, ranged in age from 10 to 59 years old (mean, 35.8; median, 37.0), with early middle age being the most common age range. [4]

History

Firestein initially identified the syndrome in 1985. It was characterized by recurrent oral and genital ulcers as well as inflammation of the cartilage in the ears, nose, throat, and rib cage. [7]

See also

Related Research Articles

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<span class="mw-page-title-main">Uveitis</span> Inflammation of the uvea of the eye

Uveitis is inflammation of the uvea, the pigmented layer of the eye between the inner retina and the outer fibrous layer composed of the sclera and cornea. The uvea consists of the middle layer of pigmented vascular structures of the eye and includes the iris, ciliary body, and choroid. Uveitis is described anatomically, by the part of the eye affected, as anterior, intermediate or posterior, or panuveitic if all parts are involved. Anterior uveitis (iridocyclitis) is the most common, with the incidence of uveitis overall affecting approximately 1:4500, most commonly those between the ages of 20-60. Symptoms include eye pain, eye redness, floaters and blurred vision, and ophthalmic examination may show dilated ciliary blood vessels and the presence of cells in the anterior chamber. Uveitis may arise spontaneously, have a genetic component, or be associated with an autoimmune disease or infection. While the eye is a relatively protected environment, its immune mechanisms may be overcome resulting in inflammation and tissue destruction associated with T-cell activation.

<span class="mw-page-title-main">Gastrointestinal disease</span> Medical condition

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<span class="mw-page-title-main">Aphthous stomatitis</span> Common condition of mouth ulcers

Aphthous stomatitis, or recurrent aphthous stomatitis (RAS), is a common condition characterized by the repeated formation of benign and non-contagious mouth ulcers (aphthae) in otherwise healthy individuals. The informal term canker sore is also used, mainly in North America, although it may also refer to other types of mouth ulcers. The cause is not completely understood but involves a T cell-mediated immune response triggered by a variety of factors which may include nutritional deficiencies, local trauma, stress, hormonal influences, allergies, genetic predisposition, certain foods, dehydration, some food additives, or some hygienic chemical additives like SDS.

<span class="mw-page-title-main">Relapsing polychondritis</span> Medical condition

Relapsing polychondritis is a systemic disease characterized by repeated episodes of inflammation and in some cases deterioration of cartilage. The disease can be life-threatening if the respiratory tract, heart valves, or blood vessels are affected. The exact mechanism is poorly understood.

<span class="mw-page-title-main">Reactive arthritis</span> Medical condition

Reactive arthritis, also known as Reiter's syndrome, is a form of inflammatory arthritis that develops in response to an infection in another part of the body (cross-reactivity). Coming into contact with bacteria and developing an infection can trigger the disease. By the time the patient presents with symptoms, often the "trigger" infection has been cured or is in remission in chronic cases, thus making determination of the initial cause difficult.

A genital ulcer is an open sore located on the genital area, which includes the vulva, penis, perianal region, or anus. Genital ulcers are most commonly caused by infectious agents. However, this is not always the case, as a genital ulcer may have noninfectious causes as well.

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<span class="mw-page-title-main">Autoimmune inner ear disease</span> Medical condition

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<span class="mw-page-title-main">HLA-B51</span> Serotype

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<span class="mw-page-title-main">Autoimmune polyendocrine syndrome type 2</span> Medical condition

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<span class="mw-page-title-main">Hughes–Stovin syndrome</span> Autoimmune disorder

Hughes–Stovin Syndrome (HSS) is a rare autoimmune disorder often described as inflammation in relation to blood vessels, a form of vasculitis. It is not associated with any known cause and is typically characterized by multiple aneurysms in pulmonary arteries and deep vein thromboses. It is named after the two British physicians, John Patterson Hughes and Peter George Ingle Stovin, who first described it in 1959. HSS is presumed to be a rare variant of Behçet's disease, which entails more general problems with the circulatory system. Due to its clinical similarity with Behçet's disease, it has also been referred to as 'Incomplete Behçet's disease.' Most patients are young adult males between the age of 20–40. Common clinical presentations include fever, cough, dyspnea and hemoptysis. Radiological features are similar to those of Behçet's disease.

<span class="mw-page-title-main">Red ear syndrome</span> Medical condition

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<span class="mw-page-title-main">Behçet's disease</span> Inflammatory disorder

Behçet's disease (BD) is a type of inflammatory disorder which affects multiple parts of the body. The most common symptoms include painful sores on the mucous membranes of the mouth and other parts of the body, inflammation of parts of the eye, and arthritis. The sores can last from a few days, up to a week or more. Less commonly there may be inflammation of the brain or spinal cord, blood clots, aneurysms, or blindness. Often, the symptoms come and go.

<span class="mw-page-title-main">Tracheobronchomalacia</span> Medical condition

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References

  1. Pak, Stella; Logemann, Shaina; Dee, Christine; Fershko, Adam (October 4, 2017). "Breaking the Magic: Mouth and Genital Ulcers with Inflamed Cartilage Syndrome". Cureus. Cureus, Inc. 9 (10): e1743. doi: 10.7759/cureus.1743 . ISSN   2168-8184. PMC   5714402 . PMID   29218258.
  2. Alpsoy, Erkan (April 14, 2016). "Behçet's disease: A comprehensive review with a focus on epidemiology, etiology and clinical features, and management of mucocutaneous lesions". The Journal of Dermatology. Wiley. 43 (6): 620–632. doi:10.1111/1346-8138.13381. ISSN   0385-2407. PMID   27075942.
  3. Cantarini, Luca; Vitale, Antonio; Brizi, Maria Giuseppina; Caso, Francesco; Frediani, Bruno; Punzi, Leonardo; Galeazzi, Mauro; Rigante, Donato (2014). "Diagnosis and classification of relapsing polychondritis". Journal of Autoimmunity. Elsevier BV. 48–49: 53–59. doi:10.1016/j.jaut.2014.01.026. ISSN   0896-8411. PMID   24461536.
  4. 1 2 3 4 Nakai, Noriaki; Kaneko, Yuka; Kida, Takashi; Kawahito, Yutaka; Katoh, Norito (2016). "Mouth and genital ulcers with inflamed cartilage syndrome: Case report and review of the published work". Indian Journal of Dermatology. Medknow. 61 (3): 347. doi: 10.4103/0019-5154.182463 . ISSN   0019-5154. PMID   27293269.
  5. 1 2 3 4 5 6 Kötter, I; Deuter, C; Günaydin, I; Zierhut, M (2006). "MAGIC or not MAGIC--does the MAGIC (mouth and genital ulcers with inflamed cartilage) syndrome really exist? A case report and review of the literature". Clinical and Experimental Rheumatology. 24 (5 Suppl 42): S108–S112. PMID   17067439 . Retrieved 13 January 2024.
  6. Nascimento, Ana Claudia Mendes do; Gaspardo, Daniela Barros Cortez; Cortez, Tatiana Mimura; Miot, Helio Amante (2014). "Syndrome In Question". Anais Brasileiros de Dermatologia. FapUNIFESP (SciELO). 89 (1): 177–179. doi:10.1590/abd1806-4841.20142615. ISSN   0365-0596. PMC   3938379 . PMID   24626673.
  7. 1 2 Firestein, Gary S.; Gruber, Harry E.; Weisman, Michael H.; Zvaifler, Nathan J.; Barber, Joan; O'Duffy, J.Desmond (1985). "Mouth and genital ulcers with inflamed cartilage: MAGIC syndrome. Five patients with features of relapsing polychondritis and behçet's disease". The American Journal of Medicine. Elsevier BV. 79 (1): 65–72. doi:10.1016/0002-9343(85)90547-9. ISSN   0002-9343. PMID   4014306.

Further reading