20-Year-old female with fever, cough, and dyspnea: Acute lupus pneumonitis during the pandemic of coronavirus disease 2019 (COVID-19)

Lupus ◽  
2021 ◽  
pp. 096120332110399
Author(s):  
Handan Yarkan Tuğsal ◽  
Seval İzdeş ◽  
Orhan Küçükşahin
Keyword(s):  
Lupus Erythematosus ◽  
Distress Syndrome ◽  
Rapid Onset ◽  
Young Female ◽  
High Dose ◽  
Radiological Findings ◽  
Neurologic Disorder ◽  
Double Stranded Dna ◽  
Antibody Tests ◽  
Lupus Pneumonitis

Acute lupus pneumonitis (ALP) is a rare first-presenting manifestation of systemic lupus erythematosus (SLE). The characteristic symptoms are rapid onset of fever, cough (sometimes with hemoptysis), and dyspnea. ALP may progress to acute respiratory distress syndrome (ARDS), and it is a potentially fatal disease unless treated. Coronavirus disease 19 (COVID-19) has overlaps with ALP in terms of clinical presentation, and laboratory and radiological findings. This report describes a case of a young female patient presenting with ARDS during the pandemic of COVID-19. She had pancytopenia, elevated CRP, ferritin, and liver indices resembling macrophage activation syndrome. She also had hepatosplenomegaly, a small spleen infarct, adenopathy, minimal pleural, and pericardial effusion. After excluding COVID-19 by PCR and antibody tests, and other infections by cultures, with the help of antinuclear antibody and anti–double-stranded DNA, SLE and ALP were diagnosed, and she was treated with high-dose steroid and intravenous immunoglobulin. In conclusion, if patients presenting with pneumonia or ARDS have one or more of the findings of arthritis, serositis, rash, oral/nasopharyngeal ulcerations, cytopenias, and renal or neurologic disorder, SLE and ALP should be considered in differential diagnoses. Because of the high mortality rate of ALP reaching up to 50%, early diagnosis and immunosuppressive therapy are of vital importance.

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.

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 Lupus, vaccinations and COVID-19: What we know now

Lupus ◽  
2021 ◽  
pp. 096120332110243
Author(s):  
Alice Mason ◽  
Himashi Anver ◽  
May Lwin ◽  
Christopher Holroyd ◽  
Saul N Faust ◽  
...  
Keyword(s):  
Lupus Erythematosus ◽  
Distress Syndrome ◽  
Viral Infections ◽  
Convincing Evidence ◽  
High Dose ◽  
Prospective Data ◽  
Increased Risk ◽  
Huge Impact ◽  
Poor Outcomes ◽  
Roll Out

Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), the virus causing Coronavirus disease 2019 (COVID-19), has had a huge impact on health services, with a high mortality associated with complications including pneumonia and acute respiratory distress syndrome. Patients with systemic lupus erythematosus (SLE) are at increased risk of viral infections, and recent data suggests they may be at an increased risk of poor outcomes with COVID-19. This may be particularly true for those on rituximab or high dose steroids. A huge international effort from the scientific community has so far resulted in the temporary authorisation of three vaccines which offer protection against SARS-CoV-2, with over 30 other vaccines being evaluated in ongoing trials. Although there has historically been concern that vaccines may trigger disease flares of SLE, there is little convincing evidence to show this. In general lupus patients appear to gain good protection from vaccination, although there may be reduced efficacy in those with high disease activity or those on immunosuppressive therapies, such as rituximab or high dose steroids. Recent concerns have been raised regarding rare clotting events with the AstraZeneca/Oxford vaccine and it is currently unknown whether this risk is higher for those patients with secondary antiphospholipid syndrome. With the possibility of annual COVID vaccination programmes in the future, prospective data collection and registries looking at the effect of vaccination on SLE disease control, the incidence of COVID-19 in SLE patients and severity of COVID-19 disease course would all be useful. As mass vaccination programmes begin to roll out across the world, we assess the evidence of the use of vaccines in SLE patients and in particular vaccines targeting SARS-CoV-2.

scholarly journals MO320LUPUS FLARE MIMICKING COVID-19 INFECTION: A CASE REPORT

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Meryem Sabah ◽  
Fatimzahra Jabrane ◽  
Hiba El oury ◽  
Mohamed Amine Khalfaoui ◽  
Nasreddine Chehab ◽  
...  
Keyword(s):  
Clinical Features ◽  
Lupus Erythematosus ◽  
Distress Syndrome ◽  
Medicine Department ◽  
Double Stranded Dna ◽  
Dna Antibodies ◽  
Low Levels ◽  
Adequate Management ◽  
Tomography Scan ◽  
New Onset

Abstract Background and Aims The world is in midst of the coronavirus disease 2019 (COVID-19) pandemic. Method Studies of the COVID-19 pathophysiology show that its defining character is an overt inflammatory response, similar to cytokine release syndrome, causing a dysregulated immune response. Systemic lupus erythematosus (SLE) is also a disease of immune dysregulation contributing to multisystem compromise. There is very little literature to suggest that COVID-19 could potentially mimick SLE presentation. We describe the case of a female patient who presented with typical Covid19 clinical features, later diagnosed as a new-onset SLE. Results A 51-year-old female presented with fever, dyspnea, cough and desaturation at the emergency room. Chest computed tomography scan showed bilateral areas of ground-glass opacities in a peripheral distribution. She was admitted in a Covid-19 ICU. She then progressed to severe acute respiratory distress syndrome, and worsening renal function with proteinuria and hematuria. Further investigations showed bilateral pleural effusions, ascites, leukopenia and thrombocytopenia, positive antinuclear and anti-double-stranded DNA antibodies, and low levels of C3 and C4. SARS-Cov-2 PCR was negative twice. After the establishment of the diagnosis, the patient was transferred to the internal medicine department where she received decongestive therapy, intravenous (IV) pulses of methylprednisolone, along with hydroxychloroquine. She improved sustainably and was discharged after two weeks. Conclusion A patient with new-onset lupus presented with clinical features typically seen in COVID-19 patients. The adequate management of the patient was delayed due to the misguided diagnosis.

scholarly journals Precision therapeutic targets for COVID-19

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Zachary A. Krumm ◽  
Grace M. Lloyd ◽  
Connor P. Francis ◽  
Lith H. Nasif ◽  
Duane A. Mitchell ◽  
...  
Keyword(s):  
Distress Syndrome ◽  
Replication Cycle ◽  
Spike Protein ◽  
Small Subset ◽  
High Dose ◽  
Drug Cocktail ◽  
Proteolytic Activation ◽  
Main Protease ◽  
Clinical Drugs ◽  
Length Of Hospitalization

AbstractBeginning in late 2019, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerged as a novel pathogen that causes coronavirus disease 2019 (COVID-19). SARS-CoV-2 has infected more than 111 million people worldwide and caused over 2.47 million deaths. Individuals infected with SARS-CoV-2 show symptoms of fever, cough, dyspnea, and fatigue with severe cases that can develop into pneumonia, myocarditis, acute respiratory distress syndrome, hypercoagulability, and even multi-organ failure. Current clinical management consists largely of supportive care as commonly administered treatments, including convalescent plasma, remdesivir, and high-dose glucocorticoids. These have demonstrated modest benefits in a small subset of hospitalized patients, with only dexamethasone showing demonstrable efficacy in reducing mortality and length of hospitalization. At this time, no SARS-CoV-2-specific antiviral drugs are available, although several vaccines have been approved for use in recent months. In this review, we will evaluate the efficacy of preclinical and clinical drugs that precisely target three different, essential steps of the SARS-CoV-2 replication cycle: the spike protein during entry, main protease (MPro) during proteolytic activation, and RNA-dependent RNA polymerase (RdRp) during transcription. We will assess the advantages and limitations of drugs that precisely target evolutionarily well-conserved domains, which are less likely to mutate, and therefore less likely to escape the effects of these drugs. We propose that a multi-drug cocktail targeting precise proteins, critical to the viral replication cycle, such as spike protein, MPro, and RdRp, will be the most effective strategy of inhibiting SARS-CoV-2 replication and limiting its spread in the general population.

Association of coexisting anti-ribosomal P and anti-dsDNA antibodies with histology and renal prognosis in lupus nephritis patients

Lupus ◽  
2021 ◽  
pp. 096120332098390
Author(s):  
Ayako Wakamatsu ◽  
Hiroe Sato ◽  
Yoshikatsu Kaneko ◽  
Takamasa Cho ◽  
Yumi Ito ◽  
...  
Keyword(s):  
Lupus Nephritis ◽  
Lupus Erythematosus ◽  
Renal Outcome ◽  
Class V ◽  
Double Stranded Dna ◽  
Number Of Patients ◽  
Renal Histology ◽  
Renal Prognosis ◽  
Incidence Of Ckd ◽  
Ribosomal P

Objectives Anti-ribosomal P protein autoantibodies (anti-P) specifically develop in patients with systemic lupus erythematosus. Associations of anti-P with lupus nephritis (LN) histological subclass and renal outcome remain inconclusive. We sought to determine the association of anti-P and anti-double-stranded DNA antibody (anti-dsDNA) with renal histology and prognosis in LN patients. Methods Thirty-four patients with LN, having undergone kidney biopsy, were included. The 2018 revised ISN/RPS classification system was used for pathophysiological evaluation. Chronic kidney disease (CKD) was defined as an estimated glomerular filtration rate < 60 mL/min/1.73 m2 for > 3 months. Results Six patients (17.6%) were positive for anti-P and 26 (76.5%) for anti-dsDNA. Among the six patients with anti-P, one did not have anti-dsDNA, but did have anti-Sm antibody, and showed a histological subtype of class V. This patient maintained good renal function for over 14 years. The remaining five patients, who had both anti-P and anti-dsDNA, exhibited proliferative nephritis and were associated with prolonged hypocomplementemia, and the incidence of CKD did not differ from patients without anti-P. Conclusion Although this study included a small number of patients, the results indicated that histology class and renal prognosis associated with anti-P depend on the coexistence of anti-dsDNA. Further studies with a large number of patients are required to confirm this conclusion.

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