scholarly journals An Elderly Gentleman with Acute Lupus Pneumonitis as the Initial Manifestation of Systemic Lupus Erythematosus

2021 ◽  
Vol 2021 ◽  
pp. 1-5
Author(s):  
Gina Ferrero ◽  
Kate Chernow ◽  
Marissa Karpoff ◽  
Pamela Traisak ◽  
David Feinstein ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Rheumatic Disease ◽  
Gastrointestinal Bleeding ◽  
Lupus Erythematosus ◽  
Late Onset ◽  
Systemic Autoimmune Disease ◽  
High Dose ◽  
Systemic Lupus ◽  
Rheumatic Manifestations ◽  
Lupus Pneumonitis

Systemic lupus erythematosus is a systemic autoimmune disease, with presentations that vary within a population and across the lifespan of an individual. The disease afflicts childbearing women more than men and uncommonly presents in the geriatric population. Lupus pneumonitis is rare, with a reported incidence of 1–4%. Herein, we discuss the case report of an elderly gentleman with biopsy-proven acute lupus pneumonitis (ALP) as an initial presentation of lupus. After starting high-dose steroids, the patient initially improved, though unfortunately endured a non-ST elevation myocardial infarction and recurrent gastrointestinal bleeding. Despite multiple interventions and a prolonged hospital course, his gastrointestinal bleeding persisted. He elected to go on home hospice and ultimately passed away due to ongoing gastrointestinal bleeding. As with our patient, elderly patients can pose a diagnostic dilemma with regard to late-onset lupus; multiple comorbidities and growing evidence that late-onset lupus may manifest with distinct clinical patterns from younger cohorts complicate diagnosis in these patients. It is critical to maintain a broad differential, which includes unusual rheumatic manifestations when management of common comorbidities fails to alleviate symptoms for an elderly patient. Failure to do so may result in delayed diagnosis of rheumatic disease and increased side effects related to treatment. Additionally, this case serves as a reminder that due to the complexity of rheumatic disease and the additional challenge of older patients with baseline comorbidities, sometimes palliative care options may be appropriate.

scholarly journals Acute diffuse alveolar haemorrhage accompanied by gastrointestinal bleeding in a patient with serious systemic lupus erythematosus: A case report

2018 ◽  
Vol 46 (5) ◽  
pp. 2046-2053 ◽  
Author(s):  
Jing Du ◽  
Ying Wang ◽  
Yan-chun Li ◽  
Tong-Tong Wang ◽  
Yong-lie Zhou ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Case Report ◽  
Gastrointestinal Bleeding ◽  
Lupus Erythematosus ◽  
Intensive Treatment ◽  
Alveolar Haemorrhage ◽  
High Dose ◽  
Diffuse Alveolar Haemorrhage ◽  
Systemic Lupus ◽  
Left Heart Failure

Systemic lupus erythematosus (SLE) is an autoimmune disease that affects many organs, but multisystem dysfunction is rare. Here, we report a case of a 29-year-old woman who was initially diagnosed with SLE complications including lupus nephritis, lupus encephalopathy, renal hypertension, thrombocytopenia, anaemia and hyperkalaemia. She recovered following treatment with high dose methylprednisolone, intravenous immunoglobulin (IVIG) and continuous renal replacement therapy (CRRT). However, a few days after hospital discharge, she developed gastrointestinal bleeding. Although intensive treatment was administered, the patient deteriorated rapidly and had a progressive decline in oxygen saturation followed by diffuse alveolar haemorrhage and acute left heart failure. Inotropic therapy, mechanical ventilation, blood transfusion, CRRT, antibiotics, intravenous glucocorticoids and other support therapies were initiated and gradually the patient’s vital signs stabilized and haemoptysis subsided. This case report emphasises that complications of SLE can occur at any stage of the disease, especially in patients with active SLE. Therefore, it is important for clinicians to be aware of the rare presentations of SLE and its complex management. For multisystem dysfunction, early intensive treatment with high dose corticosteroids and cyclophosphamide is advocated.

Autoimmune hepatitis complicated by late-onset systemic lupus erythematosus

2007 ◽  
Vol 37 (9) ◽  
pp. 771-774 ◽  
Author(s):  
Atsushi Takahashi ◽  
Tsuyoshi Rai ◽  
Michio Onizawa ◽  
Kyoko Monoe ◽  
Yukiko Kanno ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Autoimmune Hepatitis ◽  
Lupus Erythematosus ◽  
Late Onset ◽  
Systemic Lupus ◽  
Onset Systemic Lupus Erythematosus

scholarly journals Systemic lupus erythematosus in a multiethnic US cohort: Clinical features, course, and outcome in patients with late-onset disease

2006 ◽  
Vol 54 (5) ◽  
pp. 1580-1587 ◽  
Author(s):  
Ana M. Bertoli ◽  
Graciela S. Alarcón ◽  
Jaime Calvo-Alén ◽  
Mónica Fernández ◽  
Luis M. Vilá ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Clinical Features ◽  
Lupus Erythematosus ◽  
Late Onset ◽  
Systemic Lupus

scholarly journals Severe pleuritis and pericarditis associated with very-late-onset systemic lupus erythematosus

2018 ◽  
Vol 19 (2) ◽  
pp. 53-56
Author(s):  
Hiroaki Ikushima ◽  
Akihiko Mitsutake ◽  
Takuto Hideyama ◽  
Tatsuya Sato ◽  
Junko Katsumata ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Lupus Erythematosus ◽  
Late Onset ◽  
Systemic Lupus ◽  
Onset Systemic Lupus Erythematosus

scholarly journals Diffuse Bullous Eruptions in an Elderly Woman: Late-Onset Bullous Systemic Lupus Erythematosus

2016 ◽  
Vol 8 (3) ◽  
pp. 278-282 ◽  
Author(s):  
Prajwal Boddu ◽  
Mojtaba Nadiri ◽  
Owais Malik
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Lupus Erythematosus ◽  
Late Onset ◽  
Clinical History ◽  
The Elderly ◽  
Direct Immunofluorescence ◽  
Systemic Lupus ◽  
Diverse Range ◽  
American College Of Rheumatology ◽  
Type Vii Collagen

Vesiculobullous eruptions in the elderly represent a diverse range of varying pathophysiologies and can present a significant clinical dilemma to the diagnostician. Diagnosis requires a careful review of clinical history, attention to detail on physical and histomorphological examination, and appropriate immunofluorescence testing. We describe the case of a 73-year-old female who presented to our hospital with a painful blistering skin rash developed over 2 days. Examination of the skin was remarkable for numerous flaccid hemorrhagic bullae on a normal-appearing nonerythematous skin involving both the upper and lower extremities. Histopathology of the biopsy lesion showed interface change at the epidermo-dermal region with subepidermal blister formation, mild dermal fibrosis, and sparse interstitial neutrophilic infiltrate. Immunohistological analysis was significant for positive IgG basement membrane zone antibodies with a dermal pattern of localization on direct immunofluorescence and positive IgG antinuclear antibodies on indirect immunofluorescence. Evidence of antibodies to type VII collagen suggested the diagnosis of epidermolysis bullosa acquisita versus bullous systemic lupus erythematosus (BSLE). A diagnosis of BSLE was made based on positive American College of Rheumatology criteria, acquired vesiculo-bullous eruptions with compatible histopathological and immunofluorescence findings. This case illustrates one of many difficulties a physician encounters while arriving at a diagnosis from a myriad of immunobullous dermatoses. Also, it is important for internists and dermatologists alike to be aware of and differentiate this uncommon and nonspecific cutaneous SLE manifestation from a myriad of disorders presenting with vesiculobullous skin eruptions in the elderly.

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