An 87-year-old woman was referred to our ophthalmology ward due to decreased visual acuity and intense right orbital pain, which had been present for four weeks. The anamnesis was not contributory, except that she had been vaccinated against severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) four weeks prior to symptom onset. Her best-corrected visual acuity was hand movements in the right eye and 20/20 in the left eye. Intra-ocular pressure was 34 mmHg and 16 mmHg, respectively. Right eye slit lamp examination revealed palpebral oedema, chemosis, and temporal scleral thickening with conjunctival injection. The cornea was edematous with endothelial precipitates. The anterior chamber was shallow with a closed angle, associated with grade 1+ cells and 1+ flare, according to the SUN grading system. Mild vitreous inflammation was present (grade 0.5+ vitreous cells), and a total choroidal detachment was visible. In the absence of any other plausible cause, unilateral choroidal effusion with secondary angle-closure due to severe panuveitis was considered a possible adverse event following vaccination against SARS-CoV2.

Introduction:Primary angiitis of the CNS (PACNS) is a rare inflammatory disorder affecting blood vessels of the brain and spinal cord causing acute stroke. This study aimed to describe clinical, biochemical, imaging and histopathological findings of a retrospective single-center PACNS cohort in comparison to a cohort of secondary angiitis of CNS (SACNS). Methods:All consecutive patients diagnosed with PACNS or SACNS between 2000 and 2023 were identified using our institutional database. Univariate comparison between both groups and multivariate analysis for independent predictors was performed, as well as Receiving Operating Characteristic analysis for white blood cell count predictive of PACNS. Kaplan-Meier curves were used for evaluating survival outcomes. Results:We identified 20 patients in each group. PACNS patients presented more frequently with seizures (40% vs. 5%, p = 0.02) and pseudotumoral lesions (45% vs. 10%, p = 0.014). In PACNS patients, median serum WBC count at diagnosis was lower (8.4×103/mm3 [6.4-9.9] vs. 11.2×103/mm3 [9-13.6] p = 0.027) and [18F]FDG-PET/CT (p = 0.001) was negative in all cases. No significant differences were observed for lumbar puncture profiles and diffusion weighted imaging patterns. Small-vessel vasculitis with a lymphocytic pattern was the most represented histologic phenotype in both groups. Serum WBC count ≤9.93 ×103/mm3 was the only independent predictor of PACNS using multivariate analysis [OR 95%CI 5.107, (1.177-22.159)]. Both groups did not differ in terms of mortality, relapse and clinical outcome. Conclusion:In our study, PACNS patients presented more often with pseudotumoral lesions, seizures and small-vessel involvement and lymphocytic histologic pattern. WBC count ≤9.93×103/mm3 was an independent predictor of PACNS diagnosis.

To define a timeframe of recurrences according to the clinical presentation of inflammation and the course of the disease. This could influence final visual acuity and avoid ocular complication such as cataract, glaucoma, choroidal neovascularization, subretinal fibrosis or fundus depigmentation. Retrospective study of nineteen patients affected by Vogt-Koyanagi-Harada disease followed between 2003 and 2018. Within our case series, 53

PurposeTo review the clinical presentation and diagnostic workup of patients presenting with ocular sarcoidosis as initial manifestation of the disease and identify risk factors for disease recurrence.MethodsAll cases of sarcoidosis followed in our departments of Ophthalmology and Internal Medicine were retrospectively reviewed. Among 177 patients, 50 had ocular sarcoidosis as initial presentation of the disease. Clinical, biological, radiological, and treatment data were collected. Logistic regression analysis was conducted to identify risk factors for recurrence.ResultsMean age of patients was 51 years, with an equal M/F ratio. Bilateral ocular involvement was present in 86% of cases, with granulomatous panuveitis being the most common manifestation (48%). Two-thirds of patients had extraocular symptoms related to the disease, mostly fatigue. The most frequently involved extraocular site was the supradiaphragmatic lymph nodes, identified in 84% of cases. CRP was normal in 68% of patients, while ACE and lysozyme were elevated in 19% and 64% of cases, respectively. Histopathological confirmation was obtained in 68% of patients. Female sex (odds ratio [OR] 6.66, 95% confidence interval [CI] 1.50-40.40, p = 0.021) and granulomatous panuveitis (OR 7.23, 95% CI 1.70-40.99, p = 0.013) were identified as significant risk factors for disease recurrence.ConclusionOcular sarcoidosis is a common initial presentation of systemic sarcoidosis. Diagnosis should be suspected in the presence of bilateral granulomatous panuveitis. Chest CT scan or 18F-FDG PET/CT is mandatory for systemic workup and biopsy is necessary for definite diagnosis. Female sex and a panuveitis presentation are significantly associated with disease recurrence.

We report a case of disseminated Bacillus Calmette-Guerin (BCG)-itis with zosteriform skin eruption, purpura, and livedo racemosa in a 70-year-old critically ill patient who has a history of in situ bladder carcinoma treated with intravesical BCG instillations for the last three years. He presented with fever, fatigue, and a painful lesion on his back, initially diagnosed as herpes zoster. Despite antiviral treatment, he exhibited persistent fever, an inflammatory syndrome, and mild liver enzyme elevation. Initial imaging revealed findings consistent with pneumonia, for which antibiotics were prescribed with no improvement. A subsequent fluorodeoxyglucose (FDG) PET scan identified hypermetabolic lesions in the liver, prompting a biopsy that showed non-caseating granulomas. Skin biopsies from the zosteriform papular eruption on the back and purpura with livedo racemosa on the right foot revealed non-caseating granulomas. Specific Wade Fite staining performed on skin biopsies indicated evidence of mycobacterial infection. Additionally, cultures and Ziehl-Nielsen staining of blood and bone marrow confirmed Mycobacterium bovis infection, establishing the diagnosis of disseminated BCG-itis. Treatment with rifampicin, ethambutol, and moxifloxacin, and a later switch to isoniazid, along with corticosteroids, resolved the skin lesions and improved the patient's condition. This case underscores the diagnostic challenges and the importance of considering disseminated BCG-itis in patients treated with prior intravesical BCG instillations for in situ bladder carcinoma presenting with persistent fever, multi-organ involvement, and diverse skin manifestations including zosteriform papules, purpura, and livedo racemosa.

Intravascular large B cell lymphoma (IVLBCL) is a very rare subtype of aggressive non-Hodgkin B cell lymphoma characterized by intravascular proliferation of clonal B lymphocytes, classically associated with pulmonary and cutaneous disease and, less frequently, with central nervous system (CNS) involvement. Brain imaging findings are usually non-specific, with evidence of multiple vascular occlusions and stroke as non-specific multifocal abnormalities. We present an exceptionally rare case of IVLBCL in a patient with unexplained inflammatory syndrome with B symptoms and rapidly progressive neurological impairment, with multifocal hemorrhagic and tumefactive brain lesions seen on MRI. We suggest that in this clinical setting, the presence of tumefactive and hemorrhagic lesions should raise suspicion for IVLBCL and lead to the decision to perform a biopsy, which, nonetheless, remains the diagnostic gold standard.

A caucasian male in his 60s presented with a several-month history of weight loss and recurrent fever, accompanied by bilateral sensorineural hearing loss and progressive uveitis. Initial investigations were inconclusive, including Pet CT and duodenal biopsy with Tropheryma whipplei polymerase chain reaction (PCR). Based on a suspicion of autoimmune disease, immunosuppressive treatment was initiated without clinical improvement. Whipple disease (WD) was finally disclosed through positive PCR identification of Trophyrema whipplei in vitreous biopsy and repeated stool sampling. The patient was treated with intravenous ceftriaxone and doxycycline. After a few days of antibiotics, the patient's visual acuity decreased dramatically with left eye pain and hypopyon, suggesting an immune reconstitution inflammatory syndrome (IRIS) and requiring high-dose steroids. This case report highlights the diagnostic and treatment challenges of Whipple's disease, a rare systemic infection often misdiagnosed due to its nonspecific symptoms.

Background: Tuberculosis (TB) and sarcoidosis are two common granulomatous diseases involving lymph nodes. Differential diagnosis is not always easy because pathogen demonstration in tuberculosis is not always possible and both diseases share clinical, radiological and histological patterns. The aim of our study was to identify factors associated with each diagnosis and set up a predictive score for TB. Methods: All cases of lymph node tuberculosis and sarcoidosis were retrospectively reviewed. Demographics, clinical characteristics, laboratory and imaging data, and microbiological and histological results were collected and compared. Results: Among 441 patients screened, 192 patients were included in the final analysis. The multivariate analysis showed that weight loss, necrotic granuloma, normal serum lysozyme level and hypergammaglobulinemia were significantly associated with TB. A risk score of TB was built based on these variables and was able to discriminate TB versus sarcoidosis with an AUC of 0.85 (95% CI: 0.79–0.91). Using the Youden’s J statistic, its most discriminant value (−0.36) was associated with a sensitivity of 80% and a specificity of 75%. Conclusions: We developed a score based on weight loss, necrotic granuloma, normal serum lysozyme level and hypergammaglobulinemia with an excellent capacity to discriminate TB versus sarcoidosis. This score needs still to be validated in a multicentric prospective study.

Background and Objectives The diagnosis of multiple sclerosis (MS) can be challenging in clinical practice because MS presentation can be atypical and mimicked by other diseases. We evaluated the diagnostic performance, alone or in combination, of the central vein sign (CVS), paramagnetic rim lesion (PRL), and cortical lesion (CL), as well as their association with clinical outcomes. Methods In this multicenter observational study, we first conducted a cross-sectional analysis of the CVS (proportion of CVS-positive lesions or simplified determination of CVS in 3/6 lesions-Select3*/Select6*), PRL, and CL in MS and non-MS cases on 3T-MRI brain images, including 3D T2-FLAIR, T2*-echo-planar imaging magnitude and phase, double inversion recovery, and magnetization prepared rapid gradient echo image sequences. Then, we longitudinally analyzed the progression independent of relapse and MRI activity (PIRA) in MS cases over the 2 years after study entry. Receiver operating characteristic curves were used to test diagnostic performance and regression models to predict diagnosis and clinical outcomes. Results The presence of >= 41% CVS-positive lesions/>= 1 CL/>= 1 PRL (optimal cutoffs) had 96%/90%/93% specificity, 97%/84%/60% sensitivity, and 0.99/0.90/0.77 area under the curve (AUC), respectively, to distinguish MS (n = 185) from non-MS (n = 100) cases. The Select3*/Select6* algorithms showed 93%/95% specificity, 97%/89% sensitivity, and 0.95/0.92 AUC. The combination of CVS, CL, and PRL improved the diagnostic performance, especially when Select3*/Select6* were used (93%/94% specificity, 98%/96% sensitivity, 0.99/0.98 AUC; p = 0.002/p < 0.001). In MS cases (n = 185), both CL and PRL were associated with higher MS disability and severity. Longitudinal analysis (n = 61) showed that MS cases with >4 PRL at baseline were more likely to experience PIRA at 2-year follow-up (odds ratio 17.0, 95% confidence interval: 2.1-138.5; p = 0.008), whereas no association was observed between other baseline MRI measures and PIRA, including the number of CL. Discussion The combination of CVS, CL, and PRL can improve MS differential diagnosis. CL and PRL also correlated with clinical measures of poor prognosis, with PRL being a predictor of disability accrual independent of clinical/MRI activity.

Immune-mediated necrotizing myopathy (IMNM) is a rare type of auto-immune myositis, characterized by symmetric muscle pain, proximal weakness, elevated serum CK levels and pathologic findings of necrotized muscle fibers. IMNM may be seronegative, associated with anti-signal recognition particle (SRP) antibodies or anti-hydroxy-3-methylglutaryl-CoA reductase (HMGCR) antibodies, the last widely related with statin use. This last entity affects only 2 to 3 of 100,000 patients under statins. Recently, patients carrying the class II human leukocyte antigen (HLA) DRB1*11:01 were identified to be more at risk to present IMNM with anti-HMGCR antibodies. We describe the case of a daughter and father diagnosed with HMGCR-IMNM and both carrying HLA DRB1*11:01. To our knowledge, it is the first familial case reported in the literature.

An 84-year-old Caucasian woman presented to our clinic with a diffuse erythematous skin eruption associated with fever and fatigue. The patient has a two-month-old diagnosis of cortico-resistant bullous pemphigoid for which a treatment with dapsone was started one month earlier. Clinical examination confirmed an extended erythematous skin eruption over the trunk and limbs (Fig. 1). Oxygen saturation was measured at 84% with normal lung auscultation. Further clinical examination was normal. Biological findings showed hemolytic anemia; low hemoglobin (7.9 g/dL), elevated unconjugated bilirubin (1.5 mg/dL) and LDH levels (751 UI/L), and low haptoglobin (< 0.10 g/L) associated with an eosinophilia (up to 6840/µL), elevated C-reactive protein (up to 156 mg/L) and 10.5% of methemoglobinemia. Enhanced thoracic CT-scan showed no evidence of pulmonary embolism but disclosed mediastinal and axillary adenomegalies. Dapsone was discontinued and the patient was treated with methylprednisolone 0.5 mg/kg with an improvement of the rash. Second look to blood analysis performed in another center revealed decrease in G6PD enzyme's function 7.4 UI/g HgB (expected value 8.6–17.4 UI/g HgB). Multiple toxicity of dapsone: DRESS syndrome, methemoglobinemia and hemolytic anemia. Dapsone is a sulfone antibiotic used to treat leprosy and various chronic inflammatory dermatologic conditions such as bullous pemphigoid. Its use is however limited by rare but severe adverse events including DRESS syndrome, methemoglobinemia and hemolytic anemia. Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) is a rare but severe toxidermia. Reaction often occurs between two and eight weeks after introduction of the causative drug. Classical presentation includes a maculo-papular rash, fever, malaise, adenopathies, eosinophilia and multivisceral involvement. Many drugs have been described as DRESS-providers among which dapsone [[1]Chen Y.C. Chiu H.C. Chu C.Y. Drug reaction with eosinophilia and systemic symptoms: a retrospective study of 60 cases.Arch Dermatol. 2010; 146 (Dec1373-9Epub 2010 Aug 16. PMID: 20713773)https://doi.org/10.1001/archdermatol.2010.198Crossref Scopus (248) Google Scholar]. Early diagnosis and treatment are essential to prevent further complications and eventual death. Immediate cessation of the causative drug and corticosteroids are the corner stones of the treatment. Dapsone is also responsible of hematological complications; the most frequent are methemoglobinemia, - for which it is considered as the most common causing drug - and hemolysis. Its toxic metabolite, hydroxylamine, is responsible for methemoglobine formation through direct hemoglobin oxidation [[2]Jonkers B.R.P. Cobanoglu G. Blok E.J. Köbben J.J. van der Helm M.W. van Hoof I.J.A.M. Tintu A.N. Bethlehem C. Versmissen J. Symptomatic rebound methaemoglobinaemia after treatment with dapsone.Neth J Med. 2020; 78 (SepPMID: 33093248): 277-281PubMed Google Scholar]. Secondary generated reactive oxygen species accumulate within red blood cells in case of G6PD deficiency and directly damage cell membranes, leading to hemolysis. In patients without G6PD deficiency, hydroxylamine metabolite can directly affect phosphorylation of red blood cells membrane proteins, leading to hemolytic anemia [[3]Pamba A. Richardson N.D. Carter N. Duparc S. Premji Z. Tiono A.B. Luzzatto L. Clinical spectrum and severity of hemolytic anemia in glucose 6-phosphate dehydrogenase-deficient children receiving dapsone.Blood. 2012; 120 (Nov 154123-33Epub 2012 Sep 19. PMID: 22993389)https://doi.org/10.1182/blood-2012-03-416032Crossref PubMed Scopus (95) Google Scholar]. G6PD deficiency testing prior initiation of the treatment is therefore highly recommended, as complete blood cell count monitoring during treatment.

[18F]FDG-PET/CT is a useful tool for diagnosis and cancer detection in idiopathic inflammatory myopathies (IIMs), especially polymyositis (PM) and dermatomyositis (DM). Data deriving from Europe are lacking. We describe [18F]FDG-PET/CT results in a Belgian cohort with IIMs, focusing on patients with PM and DM. All of the cases of IIMs admitted between December 2010 and January 2023 to the Cliniques Universitaires Saint-Luc (Belgium) were retrospectively reviewed. In total, 44 patients were identified with suspected IIMs; among them, 29 were retained for final analysis. The mean age of the retained patients was 48.7 years; 19 patients were female (65.5%). Twenty-two patients had DM and seven had PM. The mean serum creatinine kinase (CK) and the mean CRP levels were 3125 UI/L and 30.3 mg/L, respectively. [18F]FDG-PET/CT imaging was performed for 27 patients, detecting interstitial lung diseases (ILDs) in 7 patients (25.9%), cancer in 3 patients (11.1%), and abnormal muscle FDG uptake compatible with myositis in 13 patients (48.1%). All of the patients who were detected to have ILDs via PET/CT imaging were confirmed using a low-dose lung CT scan. Among the patients who were detected to have abnormal muscle FDG uptake via PET/CT scans (13/28), the EMG was positive in 12 patients (p = 0.004), while the MRI was positive in 8 patients (p = 0.02). We further observed that there was a significantly higher level of CK in the group with abnormal muscle FDG uptake (p = 0.008). Our study showed that PET/CT is useful for detecting cancer and ILDs. We showed that the detection of abnormal muscle uptake via PET/CT was in accordance with EMG and MRI results, as well as with the mean CK value, and that the presence of dyspnea was significantly associated with the presence of ILDs detected via PET/CT imaging (p = 0.002).

Introduction:Neurosarcoidosis is a rare granulomatous disorder, and treatment guidelines are mainly based on retrospective studies.Materials and methods:This retrospective study was performed to provide a detailed description of the clinical characteristics and treatment outcomes of patients with neurosarcoidosis followed at Cliniques Universitaires Saint Luc in Belgium. The second objective of our study was to perform a comparative literature review of neurosarcoidosis, with a focus on treatment outcomes with the use of TNF-α antagonist.Results:Among 180 patients with sarcoidosis followed in our hospital, 22 patients with neurosarcoidosis were included in the final analysis. Our literature research identified 776 articles of which 35 articles met our inclusion criteria, including 1,793 patients diagnosed with neurosarcoidosis. In our cohort, the majority of patients (86%) were diagnosed with systemic sarcoidosis which was similar to that reported in the literature (83%). Serum CRP and calcemia were elevated only in 33 and 18% of patients, respectively. Serum lysozyme and angiotensin-converting enzyme were elevated in 79 and 16% of patients, respectively. Lumbar puncture and CSF fluid analysis were performed in 15/22 patients and were abnormal in all patients. Brain MRI was performed in 21/22 patients and showed abnormalities in 16 patients consisting of parenchymal lesions in 63%, hypothalamic-pituitary axis lesions in 38%, and meningeal enhancement in 31%. In both cohort patients, methotrexate was the most frequently used treatment (>45% of cases) with a favorable outcome in an average of 50% of patients. A TNF-α antagonist was administered in 9% of patients in our cohort and in 27% of patients in the literature review. The proportion of favorable outcomes in literature research was significantly higher in patients treated with TNF-α antagonists compared to methotrexate (p < 0.0001), mycophenolate mofetil (p < 0.0001), or azathioprine (p < 0.0001).Conclusion:The results of our cohort and literature review confirm that neurosarcoidosis occurred most frequently in the context of systemic sarcoidosis. Methotrexate is the most frequent second-line therapy. The effectiveness of therapy with TNF-α antagonists is well-demonstrated and associated with a better outcome. Their earlier use during the disease course among aggressive and/or refractory neurosarcoidosis should be considered.

BackgroundActivation of the renin-angiotensin-aldosterone system (RAAS) plays a critical role in the development of hypertension. Published evidence on a putative “memory effect” of AngII on the vascular components is however scarce.AimTo evaluate the long-term effects of transient exposure to AngII on the mouse heart and the arterial tissue.MethodsBlood pressure, cardiovascular tissue damage and remodeling, and systemic oxidative stress were evaluated in C57/B6/J mice at the end of a 2-week AngII infusion (AngII); 2 and 3 weeks after the interruption of a 2-week AngII treatment (AngII+2W and AngII +3W; so-called “memory” conditions) and control littermate (CTRL). RNAseq profiling of aortic tissues was used to identify potential key regulated genes accounting for legacy effects on the vascular phenotype. RNAseq results were validated by RT-qPCR and immunohistochemistry in a reproduction cohort of mice. Key findings were reproduced in a homotypic cell culture model.ResultsThe 2 weeks AngII infusion induced cardiac hypertrophy and aortic damage that persisted beyond AngII interruption and despite blood pressure normalization, with a sustained vascular expression of ICAM1, infiltration by CD45+ cells, and cell proliferation associated with systemic oxidative stress. RNAseq profiling in aortic tissue identified robust Acta2 downregulation at transcript and protein levels (α-smooth muscle actin) that was maintained beyond interruption of AngII treatment. Among regulators of Acta2 expression, the transcription factor Myocardin (Myocd), exhibited a similar expression pattern. The sustained downregulation of Acta2 and Myocd was associated with an increase in H3K27me3 in nuclei of aortic sections from mice in the “memory” conditions. A sustained downregulation of ACTA2 and MYOCD was reproduced in the cultured human aortic vascular smooth muscle cells upon transient exposure to Ang II.ConclusionA transient exposure to Ang II produces prolonged vascular remodeling with robust ACTA2 downregulation, associated with epigenetic imprinting supporting a “memory” effect despite stimulus withdrawal.

Background Dry weight is defined as the lowest tolerated post-dialysis weight at which there are minimal signs or symptoms of hypovolemia or hypervolemia. Achieving dry weight is a goal for each dialysis session. That improves blood pressure control and reduces cardiovascular risk in dialysis patients. Haemodialysis patients may experience weight loss likely related to a reduction of dry mass when catabolic reactions and inflammation occur. Our aim was to assess the impact of SARSCov-2 infection on haemodialysis patients and analyse factors associated with dry weight variations observed during the COVID-19 pandemic. Method(s): In this retrospective observational single-centre study, we analysed the clinical characteristics of all patients undergoing haemodialysis at the Pole Hospitalier Jolimont during COVID-19 pandemic from 1 March 2020 to 28 February 2022. We determined dry weight at day 1 after diagnosis of SARSCov-2 infection or at day 1 of a randomly assigned 28-days observation period and at 2, 3 and 4 weeks later. We compared infected and uninfected patients and examined the clinical features associated with SARSCov-2 infection and those associated with changes in dry weight. Result(s): Within the observation period, among the 162 haemodialysis patients, 47 patients were infected with SARSCov-2. Three patients were excluded because they have been infected before the first dialysis session and seventeen others due to missing data. Two patients were infected twice but we considered the second episodes as relevant and had therefore 144 observations. Dry weight variation ratio (dry weight variation divided by dry weight at day 1) was a continuous non normally distributed variable for which we performed Wilcoxon rank sum tests and Student's t-tests. Dry weight variations were bigger in patients infected with SARSCov-2 compared to non-infected patients: the mean dry weight variation ratio was - 2,4 +/- 2,2% (SD) in the infected dialysis patients and - 0,6 +/- 2,0% in the uninfected patients (p < 0.001). A very strong association was found between SARSCov-2 infection and loss of dry weight (0,5 kg and more) with odds ratio = 21,89;95% CI [7,17-66,85]. No difference was found whether infected patients were symptomatic or not (-2,6 +/- 2,2% vs - 2,3 +/- 2,3%;p = 0,662). Infected patients and non-infected patients significantly differ by the sex distribution (76% vs 52% males;p = 0,008). We performed a Cochran-Mantel-Haenszel stratified analysis and confirmed the association between loss of dry weight and SARSCov-2 infection after controlling for effect modification or confounding by sex. Furthermore, dry weight often varies during early haemodialysis sessions and a bias such as a short dialysis duration was also ruled out. Indeed, no correlation was found between the shortest dialysis durations (less than 2 months) and the dry weight variations observed in our population. Discussion(s): SARSCov-2 infection is associated with decreases of dry weight in haemodialysis patients. Systemic effects of SARSCov-2 infection are suspected since dry weight changes are quite similar both in symptomatic and asymptomatic infected dialysis patients. Only 2 patients in our population died from complications related to SARSCov-2 infection. Adapting dry weight may be a major element in lowering mortality in infected dialysis patients.

In medicine, a legacy effect is defined as the sustained beneficial effect of a given treatment on disease outcomes, even after cessation of the intervention. Initially described in optimized control of diabetes, it was also observed in clinical trials exploring intensification strategies for other cardiovascular risk factors, such as hypertension or hypercholesterolemia. Mechanisms of legacy were particularly deciphered in diabetes, leading to the concept of metabolic memory. In a more discreet manner, other memory phenomena were also described in preclinical studies that demonstrated long-lasting deleterious effects of lipids or angiotensin II on vascular wall components. Interestingly, epigenetic changes and reactive oxygen species (ROS) appear to be common features of “memory” of the vascular wall.