• Raphael Borie, Marie Pierre Debray, Alexis F Guedon, Arsene Mekinian, Louis Terriou, Valentin Lacombe, Estibaliz Lazaro, Aurore Meyer, Alexis Mathian, Samuel Ardois, Guillaume Vial, Thomas Moulinet, Benjamin Terrier, Yvan Jamilloux, Mael Heiblig, Jean-David Bouaziz, Eve Zakine, Roderau Outh, Sylvie Groslerons, Adrien Bigot, Edouard Flamarion, Marie Kostine, Pierrick Henneton, Sebastien Humbert, Arnaud Constantin, Maxime Samson, Nadine Magy Bertrand, Pascal Biscay, Celine Dieval, Herve Lobbes, Juliette Jeannel, Amelie Servettaz, Leo Adelaide, Julie Graveleau, Benjamin de Sainte-Marie, Joris Galland, Vivien Guillotin, Eugénie Duroyon, Marie Templé, Rim Bourguiba, Sophie Georgin Lavialle, Olivier Kosmider, Alexandra Audemard-Verger, and French VEXAS Group.
• Service de Pneumologie A, Hôpital Bichat, APHP, Paris, France; INSERM, Unité 1152, Université de Paris, Paris, France. Electronic address: raphael.borie@aphp.fr.
• Chest. 2023 Mar 1; 163 (3): 575585575-585.

BackgroundThe vacuoles, E1 enzyme, X-linked, autoinflammatory, somatic (VEXAS) syndrome is a newly identified autoinflammatory disorder related to somatic UBA1 mutations. Up to 72% of patients may show lung involvement.Research QuestionWhat are the pleuropulmonary manifestations in VEXAS syndrome?Study Design And MethodsOne hundred fourteen patients were included in the French cohort of VEXAS syndrome between November 2020 and May 2021. Each patient included in the study who had an available chest CT scan was discussed in an adjudication multidisciplinary team and classified as showing potentially pleuropulmonary-specific involvement of VEXAS syndrome or others.ResultsFifty-one patients had a CT scan available for review and 45 patients (39%) showed pleuropulmonary abnormalities on chest CT scan that were considered related to VEXAS syndrome after adjudication. Most patients were men (95%) with a median age 67.0 years at the onset of symptoms. Among these 45 patients, 44% reported dyspnea and 40% reported cough. All 45 patients showed lung opacities on chest CT scan (including ground-glass opacities [87%], consolidations [49%], reticulation [38%], and septal lines [51%]) and 53% of patients showed pleural effusion. Most patients showed improvement with prednisone, but usually required > 20 mg/d. The main clinical and biological features as well the median survival did not differ between the 45 patients with pleuropulmonary involvement and the rest of the cohort, suggesting that the prevalence of pleuropulmonary involvement might have been underdiagnosed in the rest of the cohort.InterpretationPulmonary manifestations are frequent in VEXAS syndrome, but rarely are at the forefront. The initial outcome is favorable with prednisone and does not seem to lead to pulmonary fibrosis.Copyright © 2022 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

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