scholarly journals Severe refractory thrombocytopenia in a woman positive for coronavirus disease 2019 with lupus and antiphospholipid syndrome

Lupus ◽  
2020 ◽  
Vol 29 (11) ◽  
pp. 1472-1474 ◽  
Author(s):  
Alina Hayden ◽  
Aishwarya Vyas-Lahar ◽  
Vincent Rella ◽  
Alla Rudinskaya
Keyword(s):  
Antiphospholipid Syndrome ◽  
Lupus Erythematosus ◽  
Platelet Transfusion ◽  
Scattered Data ◽  
High Dose ◽  
Systemic Lupus ◽  
Current Case ◽  
Inflammatory State ◽  
History Of ◽  
New Challenges

The coronavirus disease 2019 (COVID-19) pandemic has created new challenges that necessitate prompt responses in unexpected clinical situations. Multiple extrapulmonary manifestations and complications of COVID-19 have already been described, but only scattered data are present on immunologic manifestations. We present a case of severe refractory thrombocytopenia in a 51-year-old woman with a history of long-standing systemic lupus erythematosus and antiphospholipid syndrome who presented with hemoptysis in the setting of COVID-19 infection. The patient failed to respond to initial treatment with intravenous immunoglobulin, high-dose steroids, and platelet transfusion, but responded to eltrombopag, with prompt improvement of a platelet count. The current case report provides clinical data of relevance to the largely unexplored question of the immunologic complications of COVID-19 in patients with a pre-existing inflammatory state.

scholarly journals Tocilizumab for massive refractory pleural effusion in an adolescent with systemic lupus erythematosus

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Arianna De Matteis ◽  
Emanuela Sacco ◽  
Camilla Celani ◽  
Andrea Uva ◽  
Virginia Messia ◽  
...  
Keyword(s):  
Pleural Effusion ◽  
Lupus Erythematosus ◽  
High Dose ◽  
Common Symptom ◽  
Systemic Lupus ◽  
Malar Rash ◽  
Case Presentation ◽  
Double Stranded Dna ◽  
First Case ◽  
History Of

Abstract Background Pleural effusion in systemic lupus erythematous (SLE) is a common symptom, and recent studies demonstrated that IL-6 has a pivotal role in its pathogenesis. Case presentation We report a case of a 15 years old Caucasian boy with a history of persistent pleural effusion without lung involvement or fever. Microbiological and neoplastic aetiologies were previously excluded. Based on the presence of pleuritis, malar rash, reduction of C3 and C4 levels and positivity of antinuclear antibody (ANA) and anti-double stranded DNA (dsDNA), the diagnosis of juvenile SLE (JSLE) was performed. Treatment with high dose of intravenous glucocorticoids and mycophenolate mofetil was started with partial improvement of pleural effusion. Based on this and on adults SLE cases with serositis previously reported, therapy with intravenous tocilizumab (800 mg every two weeks) was started with prompt recovery of pleural effusion. Conclusion To the best of our knowledge, this is the first case of JSLE pleuritis successfully treated with tocilizumab.

Psychiatric Problems in Systemic Lupus Erythematosus

1976 ◽  
Vol 128 (5) ◽  
pp. 442-445 ◽  
Author(s):  
A. MacNeill ◽  
D. M. Grennan ◽  
D. Ward ◽  
W. C. Dick
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Lupus Erythematosus ◽  
High Dose ◽  
Systemic Lupus ◽  
System Disease ◽  
History Of ◽  
Psychiatric Complications ◽  
A Minor ◽  
Psychiatric Manifestations ◽  
Psychiatric Problems

SummaryFour patients with systemic lupus erythematosus (SLE) are described in whom there were major psychiatric complications. Two of these patients had cerebral lupus with psychiatric manifestations of the disease together with other features of disease activity and responding to treatment with high dose steroids. The first of these had had a ten-year history of recurrent episodes of depression before other features of the disease became evident; in the second patient recurrent psychotic episodes occurred after the onset of typical multi-system disease. The third patient had had a minor cerebro-vascular accident four years before other features of SLE became manifest, and cerebral deterioration later on in her life was probably due to hypertensive cerebro-vascular disease secondary to the renal disease of SLE. The fourth patient, a young man, had had recurrent episodes of depression and aggressive behaviour for several years and committed suicide at the age of 33.

scholarly journals Risk Factors of Glucocorticoid-Induced Diabetes Mellitus in Systemic Lupus Erythematosus

2013 ◽  
Vol 2 (2) ◽  
pp. 39-43
Author(s):  
Mojdeh Zabihi Yeganeh ◽  
Saeideh Sadeghi
Keyword(s):  
Diabetes Mellitus ◽  
Systemic Lupus Erythematosus ◽  
Mycophenolate Mofetil ◽  
Family History ◽  
Old Age ◽  
Lupus Erythematosus ◽  
Glucocorticoid Therapy ◽  
High Dose ◽  
Systemic Lupus ◽  
History Of

Background: The aim of this study was to investigate the prevalence and associated factors of glucocorticoid-induced Diabetes mellitus (GIDM) in patients with systemic lupus erythematosus (SLE) under glucocorticoid therapy.Methods: Patients with SLE who had received high-dose glucocorticoid therapy (prednisolone≥1 mg/kg/day) at Rasoul Akram and Firoozgar hospitals were recruited during 2006-2011.Results: A total of 81 patients with SLE were evaluated. 21 patients (25.9%) of them developed GIDM after high-dose glucocorticoid therapy. Univariate analysis of data showed that old age, family history of diabetes mellitus (DM) and use of Mycophenolate mofetil were factors that would increase the likelihood of GIDM.Conclusion: In summary, GIDM was developed among 25.9% of patients with SLE after high-dose glucocorticoid therapy. Old age, family history of DM and use of Mycophenolate mofetil were determined to be factors responsible for increasing the risk of developing GIDM.

scholarly journals Invasive Aspergillosis Masquerading as Catastrophic Antiphospholipid Syndrome

2013 ◽  
Vol 22 (5) ◽  
pp. 448-451 ◽  
Author(s):  
Kathryn S. Robinett ◽  
Bethany Weiler ◽  
Avelino C. Verceles
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Invasive Aspergillosis ◽  
Antiphospholipid Syndrome ◽  
Lupus Erythematosus ◽  
Signs And Symptoms ◽  
Subdural Hemorrhage ◽  
Systemic Lupus ◽  
Catastrophic Antiphospholipid Syndrome ◽  
Oral Ulcers ◽  
History Of

A 25-year-old woman with a history of systemic lupus erythematosus who was taking steroids came to the hospital because of vague signs and symptoms of weight loss, constipation, and oral ulcers. Multiorgan dysfunction developed, and catastrophic antiphospholipid syndrome was suspected. She was treated with an intravenous infusion of heparin, but she experienced a subdural hemorrhage and died on day 10 of the hospitalization. An autopsy revealed disseminated invasive aspergillosis. This case illustrates that invasive aspergillosis is a frequently missed diagnosis and should be part of the differential diagnosis for any patient who is immunosuppressed, including patients with autoimmune diseases such as systemic lupus erythematosus.

Catastrophic antiphospholipid syndrome associated with systemic lupus erythematosus: a case-based review

2020 ◽  
Author(s):  
Jesus Garcia-Diaz ◽  
Mara Escudero-Salamanca ◽  
Ricardo Alvarez-Santana ◽  
Nilda Espinola-Zavaleta
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Antiphospholipid Syndrome ◽  
Lupus Erythematosus ◽  
Underlying Disease ◽  
Rapid Progression ◽  
Systemic Lupus ◽  
Catastrophic Antiphospholipid Syndrome ◽  
Good Clinical Condition ◽  
History Of

Antiphospholipid syndrome (APS) can occur as a primary disease or secondary to an underlying disease, such as systemic lupus erythematosus, or other systemic autoimmune diseases. Catastrophic APS refers to a rapid progression of the disease with the development of thrombotic events that affect three or more organs. This is the case of a 22-year-old woman without history of pregnancy. She developed a catastrophic APS associated with systemic lupus erythematosus, with kidney damage (focal lupus nephritis III), pulmonary embolism, and Libman–Sacks mitral valve endocarditis. Accurate diagnosis and optimal medical treatment (anticoagulants, corticosteroids, antimalarials, diuretics) improved her disease, and the patient was discharged in good clinical condition and continues her multidisciplinary follow-up in the outpatient clinic of our institution.

Antiphospholipid antibodies and complement components levels in patients with systemic lupus erythematosus and antiphospholipid syndrome

2021 ◽  
Author(s):  
Ф.А. Чельдиева ◽  
А.А. Шумилова ◽  
А.М. Лила ◽  
Т.М. Решетняк
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Antiphospholipid Syndrome ◽  
Complement System ◽  
Lupus Erythematosus ◽  
Antiphospholipid Antibodies ◽  
Vascular Pathology ◽  
Systemic Lupus ◽  
Complement Components ◽  
History Of ◽  
The Complement System

Введение. Антифосфолипидный синдром (АФС) — аутоиммунная патология сосудов, клинически проявляющаяся рецидивирующими тромбозами сосудов любой локализации и калибра и акушерской патологией — рецидивирующими потерями плода. В последние 2 десятилетия в патогенетических аспектах АФС обсуждается роль системы комплемента. Цель исследования: определить связь между клинико-лабораторными проявлениями АФС и уровнем компонентов комплемента. Материалы и методы. Обследованы 111 пациентов: 87 (78%) женщин и 24 (22%) мужчины; 31 (28%) пациент был с первичным АФС (пАФС), 63 (57%) — с АФС в сочетании с системной красной волчанкой (СКВ) и 17 (15%) — с СКВ без АФС. У всех пациентов определяли антитела к кардиолипину (аКЛ) классов IgG и IgM и антитела к β2-гликопротеину 1 (аβ2-ГП1) классов IgG и IgM иммуноферментным анализом (ИФА), а также уровни С3 и С4 компонентов комплемента нефелометрическим методом. Результаты. У 72 пациентов в анамнезе были зарегистрированы тромбозы: у 23 пациентов с пАФС, у 44 с СКВ + АФС, у 5 с СКВ без АФС. Снижение уровня С3 было выявлено у 61 (55%) пациента из 111: у 14 (23%) пациентов с пАФС, у 35 (57%) с СКВ + АФС, у 12 (20%) с СКВ. Снижение С4 установлено у 37 (33%) из 111 пациентов: у 4 (11%) с пАФС, у 24 (65%) с СКВ + АФС, у 9 (24%) с СКВ. Снижение уровня С3 значимо чаще определено у пациентов c пАФС, позитивных по IgG-аКЛ и IgG-аβ2-ГП1 (р < 0,05). Снижение уровня С4 также ассоциировалось с позитивностью IgG-аКЛ и IgG-аβ2-ГП1 у пациентов с пАФС. У пациентов с СКВ + АФС гипокомплементемия С3 ассоциировалась с IgM-аКЛ и IgM-аβ2-ГП1, а снижение уровня С4 компонента комплемента существенно чаще зарегистрировано у пациентов с IgG-аКЛ (р = 0,002) и IgG-аβ2-ГП1 (р = 0,0001). Гипокомплементемия у пациентов с СКВ без антифосфолипидных антител имела место более чем в половине случаев: у 12 из 17 (71%) выявлено снижение С3 компонента комплемента и у 9 (53%) — снижение С4. Заключение. Зарегистрировано снижение С3 больше чем у половины (55%) и снижение С4 у трети (33%) обследованных пациентов, что свидетельствует об активации системы комплемента при АФС. Наличие IgG-аКЛ и IgG-аβ2-ГП1 ассоциировалось с гипокомплементемией, что свидетельствует о значимости этих антител в механизме активации комплемента и запуске гиперкоагуляции через систему комплемента. Background. Antiphospholipid syndrome (APS) is an autoimmune vascular pathology that is clinically manifested by recurrent vascular thrombosis and pregnancy loss. The role of complement system in the pathogenesis of APS is discussed in the last 2 decades. Objectives: to find out the relationships between the clinical and laboratory manifestations of APS and the level of complement components. Patients/Methods. We examined 111 patients: 87 (78%) women and 24 (22%) men; among them were 31 (28%) patients with primary APS (pAPS), 63 (57%) with APS and systemic lupus erythematosus (SLE) and 17 (15%) with SLE without APS. In all patients, antibodies to cardiolipin (aCL) of IgG and IgM classes and antibodies to β2-glycoprotein 1 (aβ2-GP1) components by the nephelometric method. Results. 72 patients had a history of thrombosis: 23 patients with pAPS, 44 with SLE + APS, 5 with SLE without APS. Decreased C3 level was detected in 61 (55%) of 111 patients: in 14 (23%) patients with pAPS, in 35 (57%) with SLE + APS, and in 12 (20%) with SLE. Decreased C4 level was observed in 37 (33%) of 111 patients: in 4 (11%) with pAPS, in 24 (65%) with SLE + APS, and in 9 (24%) with SLE. Decreased C3 level was significantly more often registered in pAPS-patients positive for IgG-aCL and IgG-aβ2-GP1 (p < 0.05). Decreased C4 level was also associated with positivity for IgG-aCL and IgG-aβ2-GP1 in pAPS-patients. In patients with SLE + APS, C3 hypocomplementemia was associated with IgM-аCL and IgM-аβ2-ГП1 and decreased C4 level was significantly more often registered in patients with IgG-aCL (p = 0.002) and IgG-аβ2-ГП1 (р = 0,0001). Hypocomplementemia in patients with SLE without antiphospholipid antibodies occurred in more than half of the cases: decreased C3 level was revealed in 12 of 17 (71%) patients, and decreased C4 level — in 9 (53%) patients. Conclusions. Decreased level of C3 was registered in more than half (55%) and a decreased level of C4 — in a third (33%) of examined patients, that indicated the complement system activation in APS. The presence of IgG-aCL and IgG-aβ2-GP1 was associated with hypocomplementemia that evidenced the significance of these antibodies in the mechanism of complement activation and the triggering of hypercoagulation through the complement system.

scholarly journals Takayasu’s Arteritis with Systemic Lupus Erythematosus: A Rare Association

2015 ◽  
Vol 2015 ◽  
pp. 1-3
Author(s):  
Dhrubajyoti Bandyopadhyay ◽  
Vijayan Ganesan ◽  
Debarati Bhar ◽  
Diptak Bhowmick ◽  
Sibnarayan Sasmal ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Antiphospholipid Syndrome ◽  
Lupus Erythematosus ◽  
Joint Pain ◽  
Takayasu’S Arteritis ◽  
Takayasu's Arteritis ◽  
Systemic Lupus ◽  
Rare Association ◽  
History Of

We report the case of a 24-year-old nondiabetic, nonhypertensive lady with history of fatigue, dyspnoea and limb claudication. She has been diagnosed with Takayasu’s arteritis. Subsequently she developed rash, alopecia, joint pain, and various other laboratory abnormalities which led to a diagnosis of SLE. Takayasu’s arteritis (TA) rarely coexists with systemic lupus erythematosus (SLE). The absence of specific SLE markers in patients with TA who subsequently develop SLE suggests that the coexistence of these conditions may be coincidental. The antiphospholipid syndrome in patients with SLE may mimic the occlusive vasculitis of TA.

Catastrophic antiphospholipid syndrome presented as ruptured papillary muscle during puerperium in a patient with systemic lupus erythematosus

Lupus ◽  
2021 ◽  
Vol 30 (6) ◽  
pp. 1017-1021
Author(s):  
Inês Rueff Rato ◽  
Ana Rita Barbosa ◽  
David João Afonso ◽  
Sara Beça
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Antiphospholipid Syndrome ◽  
Papillary Muscle ◽  
Lupus Erythematosus ◽  
Brain Mri ◽  
Left Ventricular ◽  
High Dose ◽  
Systemic Lupus ◽  
Catastrophic Antiphospholipid Syndrome ◽  
Adequate Treatment

Introduction Catastrophic antiphospholipid syndrome (CAPS) is a rare and serious phenomenon that requires prompt recognition and treatment. Case Presentation The authors present the case of a puerperal woman with systemic lupus erythematosus (SLE) admitted to the emergency room with headache, blurred vision, thoracic pain, and purpuric lesions on both ears. Echocardiogram revealed global decrease in left ventricular function while cardiac and inflammatory markers were elevated. Three days after admission she developed cardiogenic shock due to rupture of mitral papillary muscle which required emergent cardiac surgery, with replacement of the mitral valve; treatment with anticoagulation, high-dose glucocorticoids, and intravenous immunoglobulins were initiated. Cardiac and brain MRI revealed signs of ischemic lesions in both organs. Histopathology analysis of the placenta and papillary muscle showed signs of ischemia secondary to microvascular thrombosis. Based on the clinical demonstration of thrombosis in three organs, and the presence of lupus anticoagulant antibodies, a diagnosis of probable CAPS was established. Conclusion This case highlights the importance of a high level of suspicion of CAPS, particularly in patients with risk factors, and the value of immediate adequate treatment. Moreover, the rupture of a papillary muscle with histologically consistent signs of antiphospholipid syndrome expands the spectrum of involvement of this disease and should be considered as a rare but life-threatening possibility in patients with myocardial injury.

Sudden Sensorineural Hearing Loss in Systemic Lupus Erythematosus and Antiphospholipid Syndrome: A Clinical Review

2020 ◽  
Vol 16 (2) ◽  
pp. 84-91
Author(s):  
Julia L. Riera ◽  
María del R. Maliandi ◽  
Jorge L. Musuruana ◽  
Javier A. Cavallasca
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Hearing Loss ◽  
Sensorineural Hearing Loss ◽  
Antiphospholipid Syndrome ◽  
Lupus Erythematosus ◽  
Sudden Sensorineural Hearing Loss ◽  
Sensorineural Hearing ◽  
Clinical Feature ◽  
Systemic Lupus ◽  
Bilateral Involvement

Background: Sudden sensorineural hearing loss (SSNHL) is defined as a sudden loss of hearing, usually unilateral, of more than 30 dB in 3 contiguous frequencies of the tonal audiometry. SSNHL estimates an incidence ranging from 5 to 20 per 100.000 people per year. In approximately 75% of cases, a cause cannot be identified. However, it could be a clinical manifestation of Systemic lupus erythematosus (SLE) and Antiphospholipid Syndrome (APS). Objective: This review will focus on the clinical presentation, diagnosis, and management of the SLE and APS associated SSNHL. Methods: We searched in PubMed, Scopus, Lilacs, and Cochrane reviewing reports of Sudden sensorineural hearing loss in SLE and/or APS. Articles written in English and Spanish, and were available in full text, were included. Results: In patients with SLE, bilateral involvement was frequent. Antiphospholipid antibodies were positive in the majority of the patients. Corticosteroids were the mainstay of the treatment. The auditory prognosis was poor with total hearing loss recovery reached in only 22% of patients. : On the other hand, most of the patients with SSNHL and APS were males and presented associated symptoms such as vertigo, tinnitus and/or headache, 75% had bilateral disease. Lupus anticoagulant and aCL were found in equal proportions, all patients were anticoagulated, and aspirin was associated in 25% of the cases. Complete resolution or improvement of symptoms was observed in 25% of the patients. Conclusion: Sudden sensorineural hearing loss, can be a clinical feature of SLE and APS. Treating physicians should be aware of this devastating complication, especially when bilateral involvement occurs.

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