Acute systemic lupus erythematosus in puerperium—a diagnostic dilemma

Autoimmune hepatitis (AIH) is an autoimmune liver disease characterised by the presence of autoantibodies including antinuclear antibodies, anti-smooth muscle antibody and hypergammaglobulinaemia. Systemic lupus erythematosus (SLE) is a systemic disease that can affect multiple organs. Coexistence of AIH and SLE as an overlap syndrome occurs in about 1%–2.6% of the AIH cases. Since both conditions share common autoimmune features, their coexistence can pose a diagnostic dilemma which can result in a delay in treatment. We present here a challenging case of a middle-aged woman with AIH in remission who later developed new-onset fatigue, pleural effusion and splenomegaly.

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Management of Psychosis in Neuropsychiatric Lupus

Journal of Clinical Rheumatology and Immunology ◽

10.1142/s2661341719300015 ◽

2019 ◽

Vol 19 (01) ◽

pp. 9-17 ◽

Cited By ~ 1

Author(s):

Di Kang ◽

Chi Chiu Mok

Keyword(s):

Systemic Lupus Erythematosus ◽

Lupus Erythematosus ◽

Circumstantial Evidence ◽

Differential Diagnoses ◽

Neuropsychiatric Lupus ◽

Acute Psychosis ◽

Systemic Lupus ◽

Diagnostic Dilemma ◽

American College Of Rheumatology ◽

Symptomatic Control

Manifestations of neuropsychiatric systemic lupus erythematosus (NPSLE) are heterogeneous. Acute psychosis is an uncommon but well-recognized manifestation of NPSLE. With no specific biomarkers to date, the diagnosis of NPSLE relies on clinical acumen for circumstantial evidence and exclusion of important differential diagnoses. The attribution of psychosis to NPSLE is facilitated by the application attribution models. In particular, the American College of Rheumatology nomenclature, Systemic Lupus International Collaborating Clinics attribution models and Italian algorithm for the attribution of psychosis to NPSLE are revisited. The mainstay of treatment for psychosis attributable to NPSLE is immunosuppression and symptomatic control. In refractory cases, immunomodulatory and emerging biological agents may be considered. This article reviews the diagnostic dilemma, pathogenic mechanisms and treatment of psychosis in SLE patients.

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Acute Hepatitis in a Young Female With Systemic Lupus Erythematosus: A Diagnostic Dilemma

The American Journal of Gastroenterology ◽

10.14309/00000434-201710001-02328 ◽

2017 ◽

Vol 112 ◽

pp. S1271-S1272

Author(s):

Ranya Selim ◽

Mona Hassan ◽

Adrienne Lenhart ◽

Dorian Jones

Keyword(s):

Systemic Lupus Erythematosus ◽

Acute Hepatitis ◽

Lupus Erythematosus ◽

Young Female ◽

Systemic Lupus ◽

Diagnostic Dilemma

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Peripartum Cardiomyopathy and Systemic Lupus Erythematosus Carditis, a diagnostic dilemma

Nepalese Heart Journal ◽

10.3126/njh.v17i1.28810 ◽

2020 ◽

Vol 17 (1) ◽

pp. 45-47

Author(s):

Binod Poudel ◽

Prashanna Karki ◽

Aastha Lamsal ◽

Chandra Mani Poudel

Keyword(s):

Heart Failure ◽

Systemic Lupus Erythematosus ◽

Lupus Erythematosus ◽

Peripartum Cardiomyopathy ◽

Lower Limbs ◽

High Dose ◽

Systemic Lupus ◽

Diagnostic Dilemma ◽

Conventional Drug ◽

Multiple Episodes

A young woman at 8 months postpartum presented with dyspnoea, orthopnoea and swelling of lower limbs in which physical examination, chest radiography and echocardiogram were suggestive of acute congestive heart failure with left ventricle dilatation and dysfunction. A suspicion of peripartum cardiomyopathy was made and treated with conventional drug therapy but the patient continued to develop multiple episodes of heart failure. Over time she developed fever and polyarthritis following which autoantibodies, complement level and 24-hour urinary protein were done which helped us to make the diagnosis of Systemic Lupus Erythematosus (SLE) nephritis. The patient was started on high dose corticosteroids. However, after a week, patient developed cardiogenic shock following which intravenous pulse Cyclophosphamide was started and the patient improved clinically and biochemically.

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