Lior Sagi

Tel Aviv University, Tel Aviv, Tel Aviv, Israel

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Publications (11)25.57 Total impact

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    ABSTRACT: Autoimmune bullous skin disorders are characterized by a severe and potentially lethal course and may require aggressive long-term treatment with systemic corticosteroids and other immunosuppressive drugs, which can lead to serious adverse events. Recently, anti-CD20 antibody, Rituximab, was reported to be beneficial as an adjuvant therapy in these diseases. Herein, we present 2 case reports of patients suffering from resistant rare diseases from the aforementioned spectrum: linear IgA dermatosis and Pemphigoid gestationis. The patients were successfully treated with Rituximab (Mabthera). This is one of the first reports of this kind of treatment for these rare life-threatening diseases. These case reports emphasize the role of Rituximab as a crisis therapy in autoimmune blistering diseases.
    Harefuah 10/2012; 151(10):562-5, 606.
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    ABSTRACT: Pemphigus and bullous pemphigoid are two autoimmune diseases that have a similar pathogenesis. Both have a genetic predisposition which promotes the production of auto-antibodies targeted against different components of the epidermal desmosome and hemidesmosome. Environmental factors play an important role in the pathogenesis of this autoimmune disease. Among these, the role of infectious agents was debated as a causative factor. We sought to determine a possible connection between various infectious agents and autoimmune bullous disease (ABD). A cohort of 148 serum samples of patients with pemphigus, bullous pemphigoid and controls was screened for evidence of a prior infection with HBV, HCV, EBV, CMV, Helicobacter pylori, Toxoplasma gondii and Treponema pallidum, utilizing the Bio-Rad BioPlex 2200 system as well as ELISA assays to complete the panel. HBV, HCV, H. pylori, T. gondii and CMV were demonstrated to have significantly higher prevalence of antibodies in patients with pemphigus and bullous pemphigoid in comparison to controls. Among them, we found a novel association between H. pylori and ABD. Our study suggests a contributing role for HBV, HCV, H. pylori, T. gondii and CMV in inducing ABD in the genetically susceptible host.
    Autoimmunity reviews 07/2011; 10(9):527-35. · 6.37 Impact Factor
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    ABSTRACT: Chronic urticaria is a relatively common disorder that can be severe and may impair quality of life. The management of recalcitrant chronic urticaria that is not responding to histamine antagonists includes short-term systemic corticosteroids, anti-inflammatory drugs (colchicine, dapsone and sulfasalazine) and immunomodulatory agents, such as cyclosporine, methotrexate, plasmapheresis and intravenous immunoglobulin. We report here our retrospective experience with the use of methotrexate in 8 patients (2 males and 6 females) with recalcitrant chronic urticaria who were not responding to high-dose first- and second-generation antihistamines. The mean duration of the disease prior to methotrexate treatment was 12 ± 8 months. Patients were treated for a mean duration of 4.5 months with a mean dose of 15 mg methotrexate/week. A complete response was achieved in 7 out of 8 patients (87%). Five out of the 7 patients were disease-free during a period of 1-10 months follow-up after discontinuing methotrexate and prednisone therapy. No serious adverse effects were reported. Methotrexate is an effective and safe treatment for chronic urticaria in patients who are not responsive to conventional therapy.
    Acta Dermato-Venereologica 05/2011; 91(3):303-6.
  • Lior Sagi, Henri Trau
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    ABSTRACT: The Koebner phenomenon is one of the most well-known entities in dermatology. It was first described by Heinrich Koebner in 1876 as the formation of psoriatic lesions in uninvolved skin of psoriatic patients after cutaneous trauma. This isomorphic phenomenon is now known to involve numerous diseases, among them vitiligo, lichen planus, and Darier disease. The pathogenesis of the Koebner phenomenon is still obscure but may involve cytokines, stress proteins, adhesion molecules, and autoantigens. This contribution reviews the clinical manifestations of Koebner phenomenon, its provocative factors, suggested pathogenesis mechanisms, and the various skin conditions that exhibit this unique response.
    Clinics in dermatology 01/2011; 29(2):231-6. · 3.11 Impact Factor
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    ABSTRACT: The treatment of pemphigus, an autoimmune bullous disease, is based on the combination of corticosteroids and adjuvant therapies, such as immunosuppressive drugs, anti-inflammatory drugs and immunomodulatory procedures, such as intravenous immunoglobulin and therapeutic plasma exchange (TPE). This study aims to assess our experience with TPE as a steroid-sparing modality in moderate and severe intractable pemphigus patients. A retrospective evaluation for all intractable pemphigus patients treated by TPE in a university-affiliated tertiary referral medical centre between the years 1998 and 2008. Treatment protocol included three TPE treatments weekly for 1-3 months, combined with monthly pulse therapy of dexamethasone and/or cyclophosphamide. Maintenance therapy was based on once/bi weekly TPE treatments or monthly intravenous immunoglobulin. Seven patients were included in the study, four with severe pemphigus vulgaris and three with moderate disease. Six of the seven patients responded to TPE: Four patients (57%) achieved complete remission and two patients (28%) achieved partial remission on minimal therapy. Mild adverse effects related to TPE were observed in two patients and included dizziness and mild headache. TPE is a well-tolerated effective steroid-sparing agent in recalcitrant pemphigus patients.
    Journal of the European Academy of Dermatology and Venereology 01/2011; 25(1):82-6. · 2.69 Impact Factor
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    The Israel Medical Association journal: IMAJ 01/2010; 12(1):57-8. · 0.98 Impact Factor
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    Canadian family physician Medecin de famille canadien 10/2009; 55(10):997-9. · 1.19 Impact Factor
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    ABSTRACT: Gross migration of silicone gel from ruptured breast implants is a rare event. It is associated with extravasation of gel into the breast parenchyma, and to distant locations such as the abdominal wall and inguinal areas. This silicone deposits present as subcutaneous nodules and cause a local reaction known as siliconoma. We evaluated a 56-year-old woman who presented with a 2-year history of painful, firm and ill-defined subcutaneous nodules on the medial aspect of the shins and ankles. Her medical history was notable for bilateral breast augmentation with silicone implants 30 years before presentation. Although there were no signs or symptoms on breast examination, ultrasonography and magnetic resonance imaging confirmed that both implants had ruptured. Histological examination of a punch biopsy from a nodule on the shin found lobular granulomatous panniculitis. An excisional biopsy of the lesion was analysed by scanning electron microscopy and was found to contain silicone. This is a rare case of gross migration of silicone to the shins, originating from ruptured breast implants. To our knowledge, there is no previous report of silicone migration to such a distant location. We discuss the common presentation of silicone migration and highlight the importance of awareness among dermatologists and plastic surgeons about this unusual occurrence.
    Clinical and Experimental Dermatology 06/2009; 34(5):e99-101. · 1.33 Impact Factor
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    ABSTRACT: Pancreatic panniculitis is a rare complication of carcinoma of the pancreas, most often accompanying the rare acinar cystadenocarcinoma. It presents with painful erythematous subcutaneous nodules typically located on the leg. We present a case of a 79-year-old man with neuroendocrine carcinoma of the pancreas and liver metastasis, who developed painful subcutaneous nodules on his shins. Laboratory values included a raised lipase level with normal amylase level and peripheral eosinophilia. The patient was treated with nonsteroidal anti-inflammatory drugs, dexamethasone and antibiotics, with resolution of the dermatological symptoms.
    Clinical and Experimental Dermatology 01/2009; 34(5):e205-7. · 1.33 Impact Factor
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    ABSTRACT: The objective of this study is to report a case of primary antiphospholipid syndrome (APS) presenting as complete renal artery occlusion, and to review the literature on the subject. We describe the clinical presentation, course and outcome of one patient who presented with resistant hypertension later found to be due to thrombosis and complete occlusion of the left renal artery. We review the medical literature registered in the Medline PubMed database from 1966 to 2004 using keywords: antiphospholipid, Hughes syndrome, kidney, renal, renal artery thrombosis. We describe one patient and analyzed ten well-documented cases of renal artery thrombosis due to APS. Most of the patients were women, at a mean age of 32 years. All but one case had primary APS. The presenting symptom was hypertension in ten cases. Most patients had both lupus anticoagulant and anticardiolipin antibodies. Arterial occlusion was left sided in 55%, right sided in 27% and bilateral in 18%. Renal artery thrombosis is an uncommon presentation of APS. This entity should be considered in the differential diagnosis of severe hypertension.
    Rheumatology International 12/2008; 29(7):831-5. · 2.21 Impact Factor
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    ABSTRACT: Pemphigus is a group of autoimmune bullous diseases characterized by a loss of cell adhesion and blister formation within the epidermis in the skin and/or the mucosal surfaces. Pemphigus develops due to the interaction between predisposing genetic factors and environmental factors. Among the latter, infectious agents such as viruses and bacteria were reported as preceding or exacerbating pemphigus disease. In this article we review the literature concerning the relationship between pemphigus, viral and bacterial pathogens.
    Autoimmunity reviews 09/2008; 8(1):33-5. · 6.37 Impact Factor

Publication Stats

61 Citations
25.57 Total Impact Points

Institutions

  • 2010–2011
    • Tel Aviv University
      • Department of Dermatology
      Tel Aviv, Tel Aviv, Israel
  • 2008–2011
    • Sheba Medical Center
      • Department of Dermatology
      Gan, Tel Aviv, Israel