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

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.

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Pseudo-pseudo Meigs’ syndrome: a rare presentation of systemic lupus erythematosus

Reumatismo ◽

10.4081/reumatismo.2019.1140 ◽

2019 ◽

Vol 71 (2) ◽

pp. 108-112 ◽

Cited By ~ 1

Author(s):

G. Tansir ◽

P. Kumar ◽

A. Pius ◽

S.K. Sunny ◽

M. Soneja

Keyword(s):

Systemic Lupus Erythematosus ◽

Pleural Effusion ◽

Autoimmune Disease ◽

Lupus Erythematosus ◽

Abdominal Distension ◽

Ca 125 ◽

Systemic Lupus ◽

Rare Presentation ◽

The Past ◽

History Of

Systemic lupus erythematosus (SLE) is a chronic inflammatory multisystem autoimmune disease. Ascites when associated with pleural effusion and raised CA-125 levels in SLE patient, is known as pseudo-pseudo Meigs’ syndrome (PPMS). This is the case of a 22-year-old lady who presented with complaints of abdominal distension for one month and had a history of spontaneous abortion in the past. Abdominal imaging did not reveal any tumor and after extensive workup a diagnosis of PPMS was made. She was successfully treated with steroids, hydroxychloroquine and cyclophosphamide.

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

Lupus ◽

10.1177/0961203320940389 ◽

2020 ◽

Vol 29 (11) ◽

pp. 1472-1474 ◽

Cited By ~ 2

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.

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Psychiatric Problems in Systemic Lupus Erythematosus

The British Journal of Psychiatry ◽

10.1192/bjp.128.5.442 ◽

1976 ◽

Vol 128 (5) ◽

pp. 442-445 ◽

Cited By ~ 19

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.

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Systemic Lupus Erythematosus with Uncommon Manifestations

Journal Of Medicine & Health ◽

10.28932/jmh.v3i1.3066 ◽

2021 ◽

Vol 3 (1) ◽

pp. 73-82

Author(s):

Limdawati Kwee

Keyword(s):

Systemic Lupus Erythematosus ◽

Respiratory Failure ◽

Pleural Effusion ◽

Lupus Erythematosus ◽

Good Prognosis ◽

Systemic Lupus ◽

Hematological Disorders ◽

Study Approach ◽

Organ Systems ◽

History Of

The systemic lupus erythematosus (SLE) is an autoimmune disease characterized by theformation of autoantibodies that attack various organ systems. Patients with SLE who presentwith pleural effusion are so rare that they are often not diagnosed early. Whereas with earlydiagnosis and proper management, the rate of recurrence and complications can decrease, thequality of life for people with SLE will also be better. This research is descriptive qualitativeresearch with a case study approach. This case report discusses a young woman who presentedwith respiratory failure resulting from a massive pleural effusion. The patient is known to have ahistory of chronic hematological disorders in the form of thrombocytopenia. During treatment,the patient developed psychiatric disorders in the form of delirium and hallucinations. The patientwas then diagnosed as SLE based on the 2018 EULAR / ACR criteria with the degree of disease activity classified as severe. The patient responded well to steroid induction therapy,azathioprine, and hydroxychloroquine. It was concluded that the diagnosis of SLE should beconsidered in cases of pleural effusion with a history of chronic thrombocytopenia and psychiatricdisorders. Early and appropriate management of severe SLE will provide a good prognosis. Keywords: systemic lupus erythematosus; respiratory failure; pleural effusion; neuropsychiatricSLE

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Predictors of Incident Seizure in Systemic Lupus Erythematosus

The Journal of Rheumatology ◽

10.3899/jrheum.150135 ◽

2016 ◽

Vol 43 (3) ◽

pp. 565-575 ◽

Cited By ~ 12

Author(s):

XiangYang Huang ◽

Laurence S. Magder ◽

Michelle Petri

Keyword(s):

Risk Factors ◽

Systemic Lupus Erythematosus ◽

Disease Activity ◽

Lupus Erythematosus ◽

Renal Involvement ◽

Multivariable Analysis ◽

Clinical Manifestations ◽

Systemic Lupus ◽

Malar Rash ◽

History Of

Objective.The risk factors for incident seizures in systemic lupus erythematosus (SLE) were prospectively determined in a cohort study.Methods.A total of 2203 patients with SLE followed longitudinally in the Hopkins Lupus Cohort were analyzed. Demographic variables, clinical manifestations, laboratory tests, and SLE disease activity were recorded at each quarterly visit. Adjusted estimates of association of risk factors for onset of seizure were derived using pooled logistic regression. We examined incident seizures in 3 ways: at the time of diagnosis, more than 45 days after the diagnosis of SLE, and after cohort entry.Results.Of 2203 patients with no history of seizure prior to SLE diagnosis, 157 (7.13%) had the first seizure occurrence at the time of (37 patients, 1.68%) or after diagnosis (120 patients, 5.45%) of SLE. The risk of seizure occurring around the time of SLE diagnosis was higher in patients with a history of malar rash (p = 0.002), proteinuria (p = 0.004), and psychosis (p < 0.001). Multivariable analysis of the first seizure occurring after the diagnosis of SLE showed that history of low C3 (p = 0.0078), psychosis (p < 0.0001), cranial or peripheral neuropathy (p = 0.0043), anti-Sm antibody (p = 0.0551), renal involvement (p = 0.0177), and current corticosteroid dose (p < 0.0001) were independently associated with a higher incidence of seizure. Disease activity was not predictive after adjusting for corticosteroids.Conclusion.Risk of seizure after diagnosis of SLE is increased in those patients with prior psychosis, neuropathy, proteinuria, anti-Sm, low C3, and use of corticosteroids.

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High-grade spheno-orbital meningioma in patients with systemic lupus erythematosus: Two case reports and literature review

Surgical Neurology International ◽

10.25259/sni_583_2020 ◽

2020 ◽

Vol 11 ◽

pp. 367

Author(s):

Sarah Bin Abdulqader ◽

Nasser Almujaiwel ◽

Wafa Alshakweer ◽

Gmaan Alzhrani

Keyword(s):

Systemic Lupus Erythematosus ◽

Female Patient ◽

Lupus Erythematosus ◽

World Health ◽

Histopathological Diagnosis ◽

High Grade ◽

Systemic Lupus ◽

Who Grade ◽

First Case ◽

History Of

Background: Spheno-orbital meningiomas (SOMs) are often benign. The association of meningioma and systemic lupus erythematosus (SLE) is rarely discussed in the literature. Here, we report two patients with high-grade, SOMs with a prolonged history of SLE and review the literature. Case Description: The first case is a 52-year-old female patient with a 15-year history of SLE diagnosis who was referred to our center with a 1-year history of proptosis and excessive tearing of the left eye. This patient was operated for the left SOM with histopathological diagnosis of the World Health Organization (WHO) Grade III rhabdoid meningioma. The second case is a 36-year-old female patient with a 12-year history of SLE diagnosis who presented to our clinic with a 5-year-history of progressive right eye proptosis and occasional headaches. She was operated for the right SOM with histopathological diagnosis of the WHO Grade II chordoid meningioma. Conclusion: Rhabdoid and chordoid SOMs are uncommon and no previous report discussed their occurrence in patients with SLE. The association of high-grade meningiomas and SLE deserves further exploration.

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

Galen Medical Journal ◽

10.31661/gmj.v2i2.51 ◽

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.

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Recurrent ascites in systemic lupus erythematosus treated with rituximab - a case report and review of pseudo-pseudo Meigs’ syndrome

Beyond Rheumatology ◽

10.4081/br.2021.47 ◽

2021 ◽

Vol 3 (1) ◽

Author(s):

Sarah Compton ◽

Sarah Luebker ◽

DeAnna Baker Frost

Keyword(s):

Systemic Lupus Erythematosus ◽

Case Report ◽

Pleural Effusion ◽

Large Volume ◽

Lupus Erythematosus ◽

Case Reports ◽

Ca 125 ◽

Initial Symptom ◽

Systemic Lupus ◽

First Case

Systemic lupus erythematosus (SLE) is a chronic autoimmune and inflammatory disease with multisystem consequences. Pseudo-pseudo Meigs’ syndrome (PPMS), or Tjalma syndrome, is a newly recognized manifestation of SLE that is characterized by increased CA-125 level, pleural effusion, and ascites without evidence of tumor. PPMS is relatively rare and likely under-recognized. To our knowledge, there are 11 published case reports about PPMS. In nearly half of the PPMS cases, ascites is the initial symptom of SLE. The pathophysiology of this syndrome is not completely understood but thought to be in part due to chronic inflammation, which is supported by symptoms abating with immunosuppression. We report a case of a 20-year-old woman with known SLE who developed recurrent large volume ascites, subsequently leading to the diagnosis of PPMS, requiring rituximab for additional immunosuppression. To our knowledge, this is the first case of using rituximab as a successful treatment for PPMS.

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Triple Valvulopathy and Jaccoud’s Arthropathy: A Case Report and Literature Review

Case Reports in Rheumatology ◽

10.1155/2016/4147068 ◽

2016 ◽

Vol 2016 ◽

pp. 1-2

Author(s):

Ali Naderi Mahabadi ◽

Bassam Alhaddad ◽

Stanley Ballou

Keyword(s):

Systemic Lupus Erythematosus ◽

Lupus Erythematosus ◽

Heart Valves ◽

Fatal Outcome ◽

Disease Recurrence ◽

Point Of View ◽

Systemic Lupus ◽

Rare Presentation ◽

First Case ◽

History Of

Cardiac involvement is fairly common in patients with systemic lupus erythematosus (SLE). It may involve all layers of the heart and coronary arteries as well as the heart valves. We report an extremely rare presentation of valvulitis and valvular dysfunction associated with systemic lupus erythematosus. This is the first case of lupus valvulitis which required three mechanical prosthetic valve replacements with disease recurrence leading to a fatal outcome. This is, in our point of view, the consequence of aggressive natural history of the disease and perhaps late diagnosis and treatment of underlying SLE which was unsuccessful.

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Uncontrollable Seizures in an Epileptic

Drug Intelligence & Clinical Pharmacy ◽

10.1177/106002807701101001 ◽

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.

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