Systemic lupus erythematosus with pitting oedema of the distal lower limbs

AbstractChronic intestinal pseudo-obstruction (CIPO) is a functional gastrointestinal disorder with symptoms of ileus. CIPO can either be idiopathic or secondary to other diseases such as systemic lupus erythematosus (SLE). SLE is involved in many parts of the gastrointestinal system with variable clinical presentations. Reports about reduplicated CIPO as a complication of SLE is infrequent. A 49-year-old female suffering from clinical symptoms of ileus has been hospitalized 3 times over 1 year. Her examination results showed no observation of mechanical obstruction. In August 2017, she came to the nephrology department due to edema in both lower limbs along with symptoms of ileus. After thorough examination, she was diagnosed with secondary CIPO related to SLE. Results of renal biopsy confirmed to be lupus nephritis (Class III-(A) + V). The symptoms of ileus are gradually improved after treatment of full-dose intravenous corticosteroid for 5 days.

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Systemic lupus erythematosus flare up as acute spinal subarachnoid hemorrhage with bilateral lower limb paralysis

Clinics and Practice ◽

10.4081/cp.2018.1069 ◽

2018 ◽

Author(s):

Xiang Yang ◽

Seidu A. Richard ◽

Jiagang Liu ◽

Siqing Huang

Keyword(s):

Systemic Lupus Erythematosus ◽

Subarachnoid Hemorrhage ◽

Lupus Erythematosus ◽

Neurological Complications ◽

Cord Compression ◽

Normal Function ◽

Lower Limbs ◽

Systemic Lupus ◽

Thoracic Spinal Cord ◽

Thoracic Spinal

Subarachnoid hemorrhage (SAH) is an uncommon complication of systemic lupus erythematosus (SLE). Solitary association of fatal spinal SAH as a complication of SLE, has not been encountered much in literature although coexisting acute cerebral and spinal SAH have been associated with SLE. We present a 39-year old female with initial diagnosis of SLE eight years ago who suddenly developed a productive cough, acute abdomen and paralysis of the lower limbs. Magnetic resonance imaging of the spine revealed thoracic spinal SAH with varying degrees of thoracic spinal cord compression. The hemorrhage was total evacuated via surgery. She regained normal function of her lower limbers after the operation with no further neurological complications. One of the rare but fatal complications of SLE is solitary spinal SAH without cranial involvement. The best and most appropriate management of this kind of presentation is surgical decompression of the hematoma with total hemostasis. The cause of hemorrhage should be identified intra-operatively and treated appropriately.

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A rare form of anemia in systemic lupus erythematosus

Reumatismo ◽

10.4081/reumatismo.2017.982 ◽

2017 ◽

Vol 69 (3) ◽

pp. 119

Author(s):

C.A. Mansoor ◽

R. Narayan

Keyword(s):

Systemic Lupus Erythematosus ◽

Pernicious Anemia ◽

Lupus Erythematosus ◽

Healthy Woman ◽

Underlying Mechanism ◽

Lower Limbs ◽

Deficiency Anemia ◽

Systemic Lupus ◽

Rare Form ◽

Rare Association

Mechanisms responsible for anemia in systemic lupus erythematosus (SLE) can be immune or non-immune. A 27-year-old previously healthy woman was admitted with echymotic patches over the lower limbs for six months, multiple joint pain and fatigue for 2 months. She had severe pallor and multiple echymotic patches over the lower limbs. She was diagnosed with SLE with pernicious anemia and iron deficiency anemia. The rare association of SLE with pernicious anemia was reported previously in few patients. Treatment of SLE along with B12 supplementation is necessary for such patients. Since etiology for anemia in SLE can be of various kinds, a detailed workup for identifying the underlying mechanism is necessary.

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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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Lymphoedema of lower limbs in systemic lupus erythematosus

BMJ ◽

10.1136/bmj.l970 ◽

2019 ◽

pp. l970

Author(s):

Junna Ye ◽

Zhuochao Zhou ◽

Jialin Teng ◽

Chengde Yang

Keyword(s):

Systemic Lupus Erythematosus ◽

Lupus Erythematosus ◽

Lower Limbs ◽

Systemic Lupus

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A young girl with chronic isolated cervical lymphadenopathy found to have lupus lymphadenopathy, progressing to develop lupus nephritis: a case report

Journal of Medical Case Reports ◽

10.1186/s13256-021-02949-5 ◽

2021 ◽

Vol 15 (1) ◽

Author(s):

K. P. Jayawickreme ◽

S. Subasinghe ◽

S. Weerasinghe ◽

L. Perera ◽

P. Dissanayaka

Keyword(s):

Systemic Lupus Erythematosus ◽

Lymph Node ◽

Lupus Nephritis ◽

Diagnostic Criteria ◽

Lupus Erythematosus ◽

Cervical Lymphadenopathy ◽

Lymph Node Biopsy ◽

Lower Limbs ◽

Systemic Lupus ◽

Node Biopsy

Abstract Background Systemic lupus erythematosus is a rare autoimmune disorder, with the prevalence in Asia ranging from 30 to 50/100,000. The diagnosis of systemic lupus erythematosus is made according to the 2019 European League Against Rheumatism/American College of Rheumatology classification criteria, and it does not contain lymphadenopathy as diagnostic criteria. However, lupus lymphadenopathy has an estimated prevalence of 5–7% at the onset of disease, and 12–15% at any stage of the disease. Case presentation A 19-year-old Sinhalese girl had neck nodules since the age of 5 years, which increased in size and became tender since 1 year. She had alopecia and joint stiffness for 6 months. She presented with a 5-day history of worsening joint pain, fever, and painful, enlarging cervical nodules. She had tender cervical lymphadenopathy, and a vasculitic rash on both lower limbs. She had pancytopenia, an erythrocyte sedimentation rate of 92, positive antinuclear antibody titer, and high anti-double-stranded deoxyribonucleic acid (DNA), with low C3 and C4 complements. She had a high reticulocyte count of 5%, with direct and indirect antiglobulin tests being positive, indicating autoimmune hemolytic anemia. Lymph node biopsy showed moderate reactive follicular hyperplasia, with scattered plasma cells and immunoblasts, with varying degree of coagulative necrosis, suggestive of lupus lymphadenopathy. On immunohistochemistry of the lymph node biopsy, Bcl2 was negative, excluding lymphoma. Contrast-enhanced computed tomography of abdomen and chest was normal with no hepatosplenomegaly or lymphadenopathy. Skin biopsy showed leukocytoclastic vasculitis. Later, with development of generalized edema, she was found to have impaired renal function, and renal biopsy showed lupus nephritis. She was started on hydroxychloroquine, prednisolone, and mycophenolate mofetil, and her symptoms improved and lymphadenopathy regressed. Conclusion In the case of cervical lymphadenopathy in a patient with systemic lupus erythematosus, the possibilities of lupus lymphadenopathy, Kikuchi–Fujimoto disease, and lymphoma should all be considered, after excluding secondary infection due to immunosuppression. Histology confirms the differentiation of these pathologies. It is important to differentiate the cause for lymphadenopathy in systemic lupus erythematosus as the outcome and treatment varies. Lupus lymphadenopathy is usually generalized, but isolated cervical lymphadenopathy could also rarely be the first presentation of systemic lupus erythematosus. Lupus lymphadenopathy can be the only presenting feature, and needs a high index in suspecting systemic lupus erythematosus, though it is not included in the diagnostic criteria.

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Acute Neuromuscular Responses to Whole-Body Vibration of Systemic Lupus Erythematosus Individuals: A Randomized Pilot Study

Applied Sciences ◽

10.3390/app11010138 ◽

2020 ◽

Vol 11 (1) ◽

pp. 138

Author(s):

Carla F. Dionello ◽

Patrícia L. Souza ◽

Pedro V. Rosa ◽

Andreza Santana ◽

Renata Marchon ◽

...

Keyword(s):

Systemic Lupus Erythematosus ◽

Lupus Erythematosus ◽

Muscle Activation ◽

Whole Body Vibration ◽

Lower Limbs ◽

Whole Body ◽

Systemic Lupus ◽

Body Vibration ◽

Neuromuscular Responses ◽

Risk Factors For Falls

Background: Glucocorticoid induced osteoporosis (GIOP) is one of the most important causes of morbidity in lupus individuals. Whole body vibration exercises (WBVE) may be a safe alternative to prevent and amend muscular and bone damage, and decrease muscle related risk factors for falls. It is possible to evaluate neuromuscular responses to the WBVE through surface electromyography (sEMG). Objective: To analyze and compare the acute responses of the WBVE on sEMG of lower limbs of female systemic lupus erythematosus (SLE) individuals with chronic glucocorticoid use with and without bone impairments and non-lupus controls. Methods: All patients (non-lupus and with SLE) had a dual-energy X-ray absorptiometry (DXA) scan (body composition, bone composition right hip, lumbar segment and whole body). After DXA, they were divided into three groups: SLE with osteopenia (OPIA) (SLE OPIA), SLE without OP or OPIA (SLE) and non-lupus individuals as control (CG). Twenty-seven women were submitted to WBVE, on different frequencies with the same amplitude. The experiment was performed over two days, 48 h apart. The individuals stood at a half squat position on a vertical vibrating platform at different frequencies with the same amplitude on both days. Vastus lateralis (VL), gastrocnemius medialis (GM) and tibialis anterioris (TA) sEMG analyses were undertaken simultaneously while performing the exercises, in a randomized manner. Results: There were no differences between sarcopenia index among groups, despite the bone impairment of the SLE OPIA group. The greatest muscle activation occurred in the lower frequency applied for VL. A group x frequency difference was found only for GM (p = 0.034; η2 = 0.272). Conclusion: The results indicate that lupus individuals have similar neuromuscular activity to the WBVE as non-lupus controls. Moreover, this suggests that WBVE is a safe and viable physical exercise for lupus individuals with chronic glucocorticoid induced osteoporosis.

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Encephalopathy with upper body hypertonia and myoclonus in patient with systemic lupus erythematosus and anti-CASPR2

Lupus ◽

10.1177/0961203316657431 ◽

2016 ◽

Vol 26 (1) ◽

pp. 84-87 ◽

Cited By ~ 1

Author(s):

A Castro ◽

J C Romeu ◽

R Geraldes ◽

J A Pereira da Silva

Keyword(s):

Systemic Lupus Erythematosus ◽

Nervous System ◽

Lupus Erythematosus ◽

Fdg Pet ◽

Limbic Encephalitis ◽

Brain Mri ◽

Lower Limbs ◽

Upper Body ◽

Systemic Lupus ◽

Specific Antibodies

Systemic lupus erythematosus (SLE) may involve the nervous system but there are no specific biomarkers of neuroSLE. Limbic encephalitis has been rarely associated with SLE. We present a case of a 22-year-old black woman where typical SLE psychosis evolved to an encephalopathy with atypical features, normal MRI, electroencephalogram slowing and frontal and occipito-temporal hypometabolism on fluorodeoxyglucose positron emission tomography (FDG PET). Memory deficits, bizarre behaviour, psychosis, neuromyotonia and movement disorders have been described in autoimmune central nervous system disorders and associated with specific antibodies. Brain MRI may be normal and cortical brain hypometabolism on FDG PET scans has been reported. We have not found any report of limbic encephalitis or other SLE neurological manifestation associated to positive titres of anti-CASPR2 antibodies and this may warrant systematic investigation. In the rare cases of limbic encephalitis associated with SLE no specific antibodies were documented. Anti-CASPR2 antibodies have been associated not only with limbic encephalitis but also with neuromyotonia and Morvan syndrome. Although our patient had a specific pattern of tone abnormalities with an impressive cervical and upper limb hypertonicity and flaccid lower limbs, no myotonic discharges were found. We did not find any association between myoclonus and anti-CASPR2 antibodies. We cannot exclude that a non determined autoantibody could have played a role; however, clinical and FDG PET improvement supports an antibody-mediated injury, in this case of neuroSLE.

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Fulminant systemic vasculitis in systemic lupus erythematosus. Case report and review of the literature

Lupus ◽

10.1177/0961203314546018 ◽

2014 ◽

Vol 23 (13) ◽

pp. 1426-1429 ◽

Cited By ~ 5

Author(s):

G Medina ◽

D González-Pérez ◽

C Vázquez-Juárez ◽

M Sánchez-Uribe ◽

M A Saavedra ◽

...

Keyword(s):

Systemic Lupus Erythematosus ◽

Lupus Erythematosus ◽

Systemic Vasculitis ◽

Clinical Manifestations ◽

Rapidly Progressive Glomerulonephritis ◽

Lower Limbs ◽

Systemic Lupus ◽

Life Threatening ◽

History Of ◽

Level Hospital

Vasculitis in systemic lupus erythematosus (SLE) has a broad spectrum of clinical manifestations from cutaneous to visceral involvement and its prognosis ranges from mild to life-threatening. We report the case of a previously healthy 17-year-old woman with eight months' history of arthralgias and myalgias. Subsequently, she developed facial and lower limbs edema, and hair loss. Two weeks before admission to a secondary level hospital, she developed fever up to 40 ℃ followed by abdominal pain, rectal bleeding, hematemesis and blisters on both legs, reason for which she was hospitalized. With active bullous SLE with rapidly progressive glomerulonephritis suspected, she was treated with methylprednisolone pulses without response. After one week of treatment, she was transferred to a tertiary level hospital. On admission she presented acute arterial insufficiency of the lower extremities, respiratory failure with apnea, metabolic acidosis and shock; six hours later she died. Autopsy findings showed active diffuse lupus nephritis and diffuse systemic vasculitis that involved vessels from the skin, brain, myocardium, spleen, iliac and renal arteries. In addition, serositis of the small intestine and colon, acute and chronic pericarditis, pericardial effusion and myocarditis were found. Immunologic tests confirmed SLE diagnosis. In this case the fulminant course was the result of SLE high disease activity, visceral vasculitis of several organs and late diagnosis, referral and treatment. Early diagnosis, and opportune referral to the rheumatologist for intensive treatment can improve the outlook in these patients.

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