Uncontrollable Seizures in an Epileptic

1977 ◽  
Vol 11 (10) ◽  
pp. 590-594
Author(s):  
John E. Zarek
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Lupus Erythematosus ◽  
Seizure Control ◽  
Underlying Disease ◽  
Blood Levels ◽  
Systemic Lupus ◽  
Drug Induced ◽  
Double Stranded Dna ◽  
History Of ◽  
History Of Epilepsy

A case of possible phenytoin-induced systemic lupus erythematosus is presented in a patient with a twenty-year history of epilepsy. The failure of seizure control in the presence of adequate anticonvulsant blood levels pointed to an underlying disease state. Drug-induced and idiopathic systemic lupus erythematosus are quite similar in clinical and laboratory manifestations. However, antibodies to native (double-stranded)-DNA seem to be consistent with the idiopathic form. A review of drug-induced systemic lupus erythematosus is presented.

Severe hydralazine-induced lupus presenting as systemic lupus erythematosus

Lupus ◽  
2020 ◽  
Vol 29 (5) ◽  
pp. 509-513 ◽  
Author(s):  
R L Rubin ◽  
R F Haluptzok ◽  
L M Davila
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Lupus Erythematosus ◽  
Systemic Autoimmune Disease ◽  
Systemic Lupus ◽  
Drug Usage ◽  
Drug Induced ◽  
Disease Etiology ◽  
History Of ◽  
Anti Inflammatory ◽  
Symptoms And Signs

Despite its long history of untoward side effects of a systemic autoimmune disease, drug-induced lupus can be difficult to recognize because of the disconnect between chronic drug usage and onset of symptoms. In this case, the patient was treated with hydralazine for two years when symptoms were initially reported, but a diagnosis of hydralazine-induced lupus was not considered for another half year. Despite treatment with steroidal and nonsteroidal anti-inflammatory medications during this period, rheumatologic symptoms and signs continued to deteriorate, consistent with the diagnosis of systemic lupus erythematosus. Not until the patient voluntarily discontinued hydralazine did symptoms begin to improve, fully resolving over the subsequent 6–12 months largely in the absence of anti-inflammatory medication. This patient demonstrates that failure to recognize a drug-induced disease etiology can result in substantial worsening of rheumatologic symptoms over the subsequent six months, ultimately satisfying criteria for systemic lupus erythematosus. While symptoms and signs largely normalized, some laboratory abnormalities and occasional arthralgia remained two years after discontinuing hydralazine, suggesting smoldering inflammatory disease.

scholarly journals Capecitabine-Induced Subacute Cutaneous Lupus Erythematosus in a Patient with Systemic Lupus Erythematosus

2018 ◽  
Vol 2 (1) ◽  
pp. 59-63
Author(s):  
Alyx Rosen ◽  
Evan Darwin ◽  
Jennifer N Choi
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Lupus Erythematosus ◽  
Cutaneous Lupus Erythematosus ◽  
Metastatic Breast ◽  
Subacute Cutaneous Lupus Erythematosus ◽  
Systemic Lupus ◽  
Drug Induced ◽  
Increased Risk ◽  
History Of ◽  
Cutaneous Lupus

Capecitabine is a fluoropyrimidine chemotherapy prodrug of 5-fluorouracil (5-FU) used in the treatment of metastatic breast and colorectal cancers. Drug-induced subacute cutaneous lupus erythematosus (DI-SCLE) is a rare side effect of capecitabine therapy, with eight cases previously reported. We report a case of DI-SCLE in a patient with a documented history of systemic lupus erythematosus (SLE). This is the second documented case of DI-SCLE in a patient with a past medical history of SLE, and provides evidence that there may be an increased risk of DI-SCLE in these patients. Further research should examine whether patients with SLE are at greater risk for this adverse event. 

The impact of biological treatments on the anti-dsDNA and anti-nucleosome tests

Lupus ◽  
2017 ◽  
Vol 27 (1) ◽  
pp. 40-48 ◽  
Author(s):  
M Infantino ◽  
V Grossi ◽  
M Benucci ◽  
F Li Gobbi ◽  
A Damiani ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Lupus Erythematosus ◽  
Predictive Value ◽  
Inflammatory Arthritis ◽  
Diagnostic Performance ◽  
Systemic Lupus ◽  
Drug Induced ◽  
Dna Test ◽  
Double Stranded Dna ◽  
Dna Antibodies

Background Anti-double stranded DNA antibodies are a very heterogeneous group of antibodies, quite specific for systemic lupus erythematosus. Newer technologies, such as addressable laser bead immunoassays (ALBIA), show great potential as a diagnostic application. The production of anti-double stranded DNA antibodies is often encountered in inflammatory arthritis; however, literature reports that the actual onset of drug induced lupus in patients treated with biological drugs is a rare event. False positive results for anti-double stranded DNA and anti-nucleosome antibodies detected in patients with inflammatory arthritis treated with different biologics prompted the investigation of full autoantibody profiles to evaluate each biomarker’s diagnostic performance in systemic lupus erythematosus. The aim of the study was to compare the diagnostic performance of anti-double stranded DNA antibody and anti-nucleosome antibody methods and to evaluate the value of simultaneously measuring anti-double stranded DNA and anti-nucleosome antibodies, along with other anti-nuclear antibody analytes, as biomarkers for systemic lupus erythematosus, using a more appropriate control cohort including inflammatory arthritis patients with a non-clinical drug induced lupus. Methods Anti-double stranded DNA and anti-nucleosome antibody levels were evaluated in 247 patient samples: 70 systemic lupus erythematosus, 177 disease controls (including 97 inflammatory arthritis during treatment with different biologics) using the Bio-Rad BioPlex® 2200. Results Anti-nucleosome antibodies demonstrated greater clinical sensitivity and specificity than anti-double stranded DNA antibodies. At the manufacturers’ cut-off range, considering the two markers as a single or combined test, the “anti-double stranded DNA test or anti-nucleosome antibodies” was the most sensitive combination (0.400) with the best negative likelihood ratio (0.62) and negative predictive value (0.803). Conclusion Anti-nucleosome antibodies are a more sensitive and specific biomarker of systemic lupus erythematosus than anti-double stranded DNA antibodies. Anti-nucleosome antibodies and anti-double stranded DNA antibodies are independent and complementary markers of systemic lupus erythematosus diagnosis and, therefore, are strongly suggested as combined tests (positive predictive value = 0.938). Moreover, the combined use of the two tests may help to overcome the decreased specificity percentage of the anti-double stranded DNA test, when considering an inflammatory arthritis cohort under biological therapies. The ALBIA method for anti-nuclear specificity detection allows a full autoantibody assessment, resulting in a much higher clinical specificity for systemic lupus erythematosus in the presence of ≥3 positive markers and significantly more positive likelihood ratio when ≥2 positive markers are present.

SYSTEMIC LUPUS ERYTHEMATOSUS IN CHILDHOOD

PEDIATRICS ◽  
1963 ◽  
Vol 32 (2) ◽  
pp. 257-264
Author(s):  
Jerry C. Jacobs
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Clinical Features ◽  
Lupus Erythematosus ◽  
Medical Center ◽  
Controlled Study ◽  
Systemic Lupus ◽  
Drug Induced ◽  
History Of

The clinical features of 35 children with systemic lupus erythematosus seen at the Columbia-Presbyterian Medical Center between 1930 and 1961 have been summarized. Seven of the more recent 25 patients gave a history of seizures and treatment with anticonvulsant medicaments prior to the onset of lupus and are believed to represent cases of drug-induced disease. The mechanism whereby drugs induce this disorder in susceptible patients receiving anticonvulsant medicaments remains unknown. While there is little question that steroids have improved the prognosis in systemic lupus erythematosus, further controlled study of varying therapeutic regimens is needed.

scholarly journals Systemic Lupus Erythematosus in a Patient with Ulcerative Colitis: Co-Existing or Drug-Induced?

2019 ◽  
Vol 19 (02) ◽  
pp. 67-69
Author(s):  
Frances Feisi Sun ◽  
Nga Lai Chan ◽  
Tsz Ching Chan ◽  
Ka Long Leung ◽  
Yuk Wo Aaron Siu ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Ulcerative Colitis ◽  
Inflammatory Bowel Disease ◽  
Lupus Erythematosus ◽  
Bowel Disease ◽  
Systemic Lupus ◽  
Drug Induced ◽  
Drug History ◽  
History Of ◽  
Inflammatory Bowel

We report a 49-year-old lady with ulcerative colitis (UC) who subsequently developed systemic lupus erythematosus (SLE) ten years later. By reviewing the drug history and serum autoimmune panel, we hypothesize that systemic lupus erythematosus may occur in a patient with a history of inflammatory bowel disease as a coexisting disease, or triggered by drugs used in inflammatory bowel disease, such as disease-modifying anti-rheumatic drugs (DMARDs). This case raises the discussion that patients with Inflammatory bowel disease (IBD) may have a genetic predisposition for developing other autoimmune diseases, and explores the possibility of drugs used in the treatment of IBD as a trigger for SLE development. Being able to differentiate the two has important implications in management and prognosis.

Negative Double Stranded DNA and Anti-Smith Antibodies in Lupus Nephritis

2012 ◽  
Vol 4 (2) ◽  
pp. 55-57
Author(s):  
Gagangeet Sandhu ◽  
Anip Bansal ◽  
Aditi Ranade ◽  
Ritu Aggarwal ◽  
Gopal Narayanswami ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Autoimmune Disease ◽  
Lupus Nephritis ◽  
Lupus Erythematosus ◽  
Systemic Lupus ◽  
Drug Induced ◽  
Serological Screening ◽  
Double Stranded Dna ◽  
Dsdna Antibodies

Systemic lupus erythematosus (SLE) is an autoimmune disease in which auto-antibodies are generated against a variety of intracellular antigens. Anti-Smith (Sm) and anti-double stranded DNA (dsDNA) antibodies in particular are considered to be nephritogenic and their role and correlation with lupus nephritis (LN) has been well established. We present here a case in which the patient had diffuse proliferative full house severe LN, yet negative ds-DNA and anti-Sm antibodies. Although extremely rare, a few subsets of patients with drug-induced LN (hydralazine) have been described in the literature to have negative dsDNA and anti-Sm antibodies on serological screening. Our patient, however, had no evidence of drug induced LN. On further review, and similar to our case, we found only 6 additional well documented cases of non-drug induced severe LN with negative dsDNA antibodies.

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.

Letters to the Editor

PEDIATRICS ◽  
1964 ◽  
Vol 33 (1) ◽  
pp. 144-145
Author(s):  
JERRY C. JACOBS
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Lupus Erythematosus ◽  
Room Temperature ◽  
Signs And Symptoms ◽  
Anticonvulsant Drugs ◽  
Systemic Lupus ◽  
Letters To The Editor ◽  
Drug Induced ◽  
History Of

All of our "drug-induced" patients had signs and symptoms suggestive of systemic lupus erythematosus (SLE), with positive L-E preps done on lightly heparinized blood after a 1-hour incubation at room temperature (a relatively insensitive method). The only differentiating features in these patients were a history of seizures prior to the onset of other manifestations of SLE and treatment with anticonvulsant drugs. The purpose of our paper was to show that such patients, as a group, have a more favorable course than others, providing the offending agent is withdrawn.

scholarly journals Acute interstitial nephritis and drug-induced systemic lupus erythematosus due to chlorthalidone and amiodarone: A case report

2020 ◽  
Vol 8 ◽  
pp. 2050313X2091002 ◽  
Author(s):  
Umut Selamet ◽  
Ramy M Hanna ◽  
Anthony Sisk ◽  
Lama Abdelnour ◽  
Lena Ghobry ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Interstitial Nephritis ◽  
Lupus Erythematosus ◽  
Kidney Biopsy ◽  
Kidney Injury ◽  
Acute Interstitial Nephritis ◽  
Systemic Lupus ◽  
Drug Induced ◽  
Systemic Manifestations

Drug-induced lupus erythematosus has features distinct from primary systemic lupus erythematosus. It can occur with a wide variety of agents that result in the generation of anti-histone or other types of antibodies. Systemic manifestations of drug-induced systemic lupus erythematosus may include renal dysfunction due to circulating immune complexes or due to other immune reactions to the culprit medication(s). Acute interstitial nephritis occurs due to DNA–drug or protein–drug complexes that trigger an allergic immune response. We report a patient who developed acute kidney injury, rash, and drug-induced systemic lupus diagnosed by serologies after starting chlorthalidone and amiodarone. A renal biopsy showed acute interstitial nephritis and not lupus-induced glomerulonephritis. It is important to note that systemic lupus erythematosus and acute interstitial nephritis can occur together, and this report highlights the role of the kidney biopsy in ascertaining the pathological diagnosis and outlining therapy in drug-induced lupus erythematosus.

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