scholarly journals Clinical features of lupus enteritis: a single-center retrospective study

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Long Chen ◽  
Qin He ◽  
Man Luo ◽  
Yuxiao Gou ◽  
Dan Jiang ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Abdominal Pain ◽  
Clinical Features ◽  
Lupus Erythematosus ◽  
Rare Complication ◽  
Complement C3 ◽  
Wall Thickening ◽  
High Dose ◽  
Multivariate Logistic Regression ◽  
Lupus Enteritis

Abstract Background Lupus enteritis (LEn) is a rare complication of systemic lupus erythematosus (SLE). Timely diagnosis and treatment of LEn are necessary to prevent the most serious consequences — intestinal perforation, gastrointestinal bleeding, and death. We compared the clinical features of SLE patients with and without LEn. Methods The clinical data of LEn inpatients at Suining Central Hospital from July 2012 to June 2020 were examined. These LEn patients were matched (1:2 ratio) with concurrently hospitalized SLE patients who did not have LEn. The two groups were compared using multivariate logistic regression. Results We compared SLE inpatients with LEn (n = 43) and SLE inpatients without LEn (n = 86) at our institution. Multivariate logistic regression showed that ascites (odds ratio [OR]: 9.961, 95%CI: 2.215–44.802, P = 0.003), hydronephrosis (OR: 28.060, 95%CI: 2.303–341.962, P = 0.009), leukopenia (OR: 5.890, 95%CI: 1.813–19.135, P = 0.003), reduced complement C3 level (OR: 4.791, 95%CI: 1.605–14.300, P = 0.005), and elevated immunoglobin (Ig)A level (OR: 4.040, 95%CI: 1.307–12.487, P = 0.015) were independently associated with LEn. Within the LEn group, abdominal pain was the most common abdominal symptom (88.4%), and increased mesenteric fat attenuation (74.4%) and bowel wall thickening (58.1%) were the most common computed tomography (CT) findings. Most LEn patients (88.4%) required high-dose glucocorticoid therapy (≥ 80 mg methylprednisolone/day), and cyclophosphamide was the most commonly used immunosuppressant (62.8%). Conclusions Abdominal pain was the most common clinical symptom of LEn. Abdominal CT provides important information for detection and diagnosis of LEn. Ascites, hydronephrosis, leukopenia, hypocomplementemia (C3), and increased IgA were independently associated with LEn.

Lupus Enteritis, a Severe and Potentially Fatal Complication of Systemic Lupus Erythematosus

2019 ◽  
Vol 152 (Supplement_1) ◽  
pp. S64-S64 ◽  
Author(s):  
Hany Meawad ◽  
Andrew Kobalka ◽  
Yaseen Alastal ◽  
Brooke Koltz
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Abdominal Pain ◽  
Lupus Erythematosus ◽  
Clinical Symptoms ◽  
Meckel’S Diverticulum ◽  
Severe Abdominal Pain ◽  
Meckel's Diverticulum ◽  
Systemic Lupus ◽  
Gi Symptoms ◽  
Lupus Enteritis

Abstract Objectives Systemic lupus erythematosus (SLE) is a chronic inflammatory autoimmune disease that can show wide manifestations in many organs. The gastrointestinal tract (GI) is commonly affected in SLE; symptoms are often related to the side effect of medications or to infections. One rare GI complication of SLE is lupus enteritis, a complex of manifestations including intestinal vasculitis and enteric ischemia, which presents with vague symptoms of severe abdominal pain, nausea, vomiting, and diarrhea. Methods We present the case of a 25-year-old female who was admitted to the hospital with complaints of abdominal pain, vomiting, diarrhea, and a history of SLE. Complicating the patient’s clinical picture and diagnosis was gastrointestinal bleeding requiring multiple blood product transfusions secondary to bleeding Meckel’s diverticulum, lupus flare, and positive stool culture for campylobacter antigen. Repeated upper and lower GI endoscopies with biopsy failed to identify the exact cause of bleeding and GI symptoms; the patient underwent exploratory laparotomy with right hemicolectomy to control bleeding. Microscopic examination revealed marked small vessel acute vasculitis consistent with lupus enteritis, ischemic enteritis, and Meckel’s diverticulum with gastric heterotopia. Results Our patient was subsequently aggressively treated; however, she developed further associated complications and died. Conclusion The pathologic diagnosis of lupus enteritis is challenging due to the nonspecific clinical symptoms and paucity of pathologic findings on most biopsy specimens. Lupus enteritis must be considered in the differential diagnosis of severe abdominal pain in lupus patients to aid in early diagnosis and treatment as this condition could be severe and potentially fatal.

scholarly journals Performance of cytokine models in predicting SLE activity

2019 ◽  
Vol 21 (1) ◽  
Author(s):  
Nopparat Ruchakorn ◽  
Pintip Ngamjanyaporn ◽  
Thanitta Suangtamai ◽  
Thanuchporn Kafaksom ◽  
Charin Polpanumas ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Regression Analysis ◽  
Disease Activity ◽  
Sensitivity And Specificity ◽  
Logistic Regression Analysis ◽  
Lupus Erythematosus ◽  
Activity Index ◽  
Multiple Logistic Regression Analysis ◽  
Negative Relationship ◽  
Complement C3

Abstract Background Identification of universal biomarkers to predict systemic lupus erythematosus (SLE) flares is challenging due to the heterogeneity of the disease. Several biomarkers have been reported. However, the data of validated biomarkers to use as a predictor for lupus flares show variation. This study aimed to identify the biomarkers that are sensitive and specific to predict lupus flares. Methods One hundred and twenty-four SLE patients enrolled in this study and were prospectively followed up. The evaluation of disease activity achieved by the SLE disease activity index (SLEDAI-2K) and clinical SLEDAI (modified SLEDAI). Patients with active SLE were categorized into renal or non-renal flares. Serum cytokines were measured by multiplex bead-based flow cytometry. The correlation and logistic regression analysis were performed. Results Levels of IFN-α, MCP-1, IL-6, IL-8, and IL-18 significantly increased in active SLE and correlated with clinical SLEDAI. Complement C3 showed a weakly negative relationship with IFN-α and IL-18. IL-18 showed the highest positive likelihood ratios for active SLE. Multiple logistic regression analysis showed that IL-6, IL-8, and IL-18 significantly increased odds ratio (OR) for active SLE at baseline while complement C3 and IL-18 increased OR for active SLE at 12 weeks. IL-18 and IL-6 yielded higher sensitivity and specificity than anti-dsDNA and C3 to predict active renal and active non-renal, respectively. Conclusion The heterogeneity of SLE pathogenesis leads to different signaling mechanisms and mediates through several cytokines. The monitoring of cytokines increases the sensitivity and specificity to determine SLE disease activity. IL-18 predicts the risk of active renal SLE while IL-6 and IL-8 predict the risk of active non-renal. The sensitivity and specificity of these cytokines are higher than the anti-dsDNA or C3. We propose to use the serum level of IL-18, IL-6, and IL-8 to monitor SLE disease activity in clinical practice.

Intussusception in Childhood Acute T Cell Lymphoblastic Leukemia: An Unusual Complication - Report of 2 Cases.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 4530-4530
Author(s):  
Jesika Shah ◽  
Dan Barlev ◽  
Arlene Sara Redner ◽  
Ashok Shende ◽  
Gungor Karayalcin
Keyword(s):  
Abdominal Pain ◽  
T Cell ◽  
Lymphoblastic Leukemia ◽  
Rare Complication ◽  
High Dose ◽  
High Dose Methotrexate ◽  
Consolidation Chemotherapy ◽  
Gastrointestinal Complications ◽  
Dose Methotrexate ◽  
Descending Colon

Abstract Clinically significant gastrointestinal complications in children with acute lymphoblastic leukemia (ALL) have been reported. However, intussusception is a very rare complication. In one study of 286 children with ALL gastrointestinal complications occurred in 5.6% of patients with intussusception seen in only 0.3% of patients. We describe two cases of intussusception during chemotherapy for T-cell leukemia. Patient #1 was an 8 year old girl on chemotherapy for T-cell ALL. Around week 9 following POG 9404 protocol of consolidation chemotherapy, patient presented with severe abdominal pain and vomiting, and had marked, diffuse tenderness of the abdomen with guarding and hypo-active bowel sounds. Abdominal radiograph showed thickening of the descending colon; abdominal sonogram was normal; abdominal computed tomography (CT) scan however, revealed a soft tissue and fluid-filled mass extending from the cecum to the descending colon. These findings were consistent with a large bowel intussusception, which was successfully reduced with a barium enema. Patient #2 was a 15 year old male receiving chemotherapy for T-cell ALL following POG 9404 protocol. At week 14 of consolidation chemotherapy, patient presented with a 2 day history of nausea and colicky peri-umbilical and right lower quadrant abdominal pain. An abdominal CT scan revealed an ileocolic intussusception without bowel obstruction and mild wall thickening of the cecum. Barium enema resulted in successful reduction of the intussusception. Interestingly, both our patients were treated with high dose methotrexate 5gm/m2 during this time period and both experienced delayed excretion of methotrexate. To our knowledge, there is no known reported association between high dose methotrexate and intussusception. We speculate that the two could be related. The increased use of high dose methotrexate therapy in T-cell ALL may result in a higher incidence of intussusception in this population. Although, intussusception in ALL is a very rare complication, awareness of this entity and early recognition with radiological intervention may prevent unnecessary surgery and the associated morbidity and mortality in these patients.

Genetic polymorphisms associated with clostridium difficile infection in multiple myeloma patients undergoing autologous stem cell transplantation.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 8522-8522
Author(s):  
Issam Hamadeh ◽  
Zainab Shahid ◽  
Manisha Bhutani ◽  
Jai Narendra Patel ◽  
Nury Steuerwald ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Stem Cell ◽  
Antibiotic Prophylaxis ◽  
Conditioning Regimen ◽  
High Dose ◽  
Host Immune System ◽  
Cell Transplant ◽  
Regression Analyses ◽  
Multivariate Logistic Regression ◽  
Buccal Swabs

8522 Background: CDI is the primary cause of infectious diarrhea in immunocompromised patients including those undergoing autologous stem cell transplant (SCT). Given the key role of gut microbiome and its interaction with host immune system, we investigated whether polymorphisms in innate immunity genes (identified through Ingenuity Pathway Analysis) were associated with CDI. Methods: We queried our database to identify MM patients who underwent an autologous SCT between April 2015-June 2019. Patients who had their buccal swabs collected through an IRB approved specimen collection protocol were included herein. Data were collected on age, conditioning regimen, CDI diagnosis, time from admission until CDI diagnosis, absolute neutrophil count (ANC) at time of CDI diagnosis, and antibiotic prophylaxis. Genomic DNA was extracted from buccal swabs and genotyped for 62 single nucleotide polymorphisms (SNPs) in ASPH , RLBP1L1, ATP7B, IL-8, FAK, TNFRSF14, CTH, TLR and IL-4. Univariate and multivariate logistic regression analyses were performed to assess association between CDI and presence of SNPs in these genes. Results: A total of 83 patients were identified (25 cases and 58 controls). Baseline characteristics were comparable between two groups. Median age was 67 years (range: 50-79). All patients received high dose melphalan as conditioning, and the same antibiotic prophylaxis during peri-transplant period. Median time from hospitalization until CDI diagnosis was 10 days (IQR:9 days), and median ANC was 0.7/mL (IQR:1.6/mL). Two SNPs (rs2227307 T > G in IL-8 and rs2234167 G > A in TNFRSF14) were significantly associated with CDI risk in both univariate and multivariate logistic regression analyses (Table). Conclusions: Our findings suggest that rs227307G (in IL-8) and rs2234167A (in TNFRSF14) alleles are potential risk factors for CDI after autologous SCT. Our findings, if validated in a larger cohort, would support genetic testing as a screening tool to identify patients who might benefit from prophylaxis against CDI. [Table: see text]

scholarly journals Clinical Features and Risk Factors for Active Tuberculosis in Takayasu Arteritis: A Single-Center Case-Control Study

2021 ◽  
Vol 12 ◽  
Author(s):  
Jiawei Zhou ◽  
Ruoyu Ji ◽  
Rui Zhu ◽  
Jingya Zhou ◽  
Jing Li ◽  
...  
Keyword(s):  
Risk Factors ◽  
Weight Loss ◽  
Logistic Regression ◽  
Regression Analysis ◽  
Clinical Features ◽  
Takayasu Arteritis ◽  
Multivariate Logistic Regression Analysis ◽  
Active Tuberculosis ◽  
Case Group ◽  
Multivariate Logistic Regression

BackgroundsTakayasu arteritis (TAK) is a chronic, granulomatous vasculitis correlated with tuberculosis (TB). The two diseases share similar pathological characteristics and clinical manifestations which increase the difficulty to diagnose. Active tuberculosis (ATB) has implications for treatment strategies in TAK patients. Therefore, the investigation of clinical features and potential risk factors of ATB in TAK patients is vital.MethodsThe study reviewed hospitalized patients diagnosed with TAK in our hospital from 2008, to 2021. TAK patients with ATB were enrolled as the case group. The control group was randomly selected in a 3:1 ratio. The clinical characteristics of TAK patients with and without ATB were compared. Multivariate logistic regression analysis was performed to determine risk factors for ATB in TAK patients.ResultsWe reviewed 1,789 patients and ultimately identified 30 (1.7%) ATB cases. TAK patients with ATB were more prone to develop symptoms including fever (p=0.001), fatigue (p=0.003), cough (p=0.037), expectoration (p<0.001), weight loss (p=0.003), and night sweating (p<0.001). Increased level of hypersensitive C reactive protein (hsCRP, p=0.001), decreased level of albumin (p=0.031), and higher positive rate of T-SPOT.TB test (p<0.001) were observed in the case group. Multivariate logistic regression analysis revealed that hsCRP >8 mg/L (OR 9.108; 95% CI, 1.096–75.711; p=0.041) and positive T-SPOT.TB result (OR 68.669; 95% CI, 7.291–646.738; p<0.001) were risk factors for ATB in TAK patients. The proportion of patients undergoing subsequent surgery for Takayasu arteritis was lower in patients with ATB (p<0.001).ConclusionOur study suggested that the diagnosis of ATB should be considered when TAK patients experienced symptoms including fever, fatigue, weight loss, etc. hsCRP >8 mg/L and positive T-SPOT.TB result were identified as independent risk factors for ATB in TAK patients.

scholarly journals Clinical Characteristics and Outcome of Primary Sjogren’s Syndrome: A Large Asian Indian Cohort

2015 ◽  
Vol 9 (1) ◽  
pp. 36-45 ◽  
Author(s):  
Pulukool Sandhya ◽  
Lakshmanan Jeyaseelan ◽  
Robert Hal Scofield ◽  
Debashish Danda
Keyword(s):  
Cluster Analysis ◽  
Logistic Regression ◽  
Regression Analysis ◽  
Clinical Features ◽  
Asian Indian ◽  
High Antibody ◽  
Multivariate Logistic Regression ◽  
Mild Disease ◽  
Antibody Positivity ◽  
Antibody Titers

Objective : To characterise the clinical features, immunological profile and outcome in a cohort of Asian Indian patients with primary Sjögren's syndrome (SS). Methods : Electronic medical records from a tertiary care teaching hospital in south India were screened for SS between 2004 and 2011. Patients fulfilling American European Consensus group (AECG) 2002 or American College of Rheumatology (ACR) 2012 classification criteria were included. Agglomerative hierarchical cluster analysis to identify patterns of associations between clinical and immunological features was done. Multivariate logistic regression to identify predictors of major systemic involvement was performed. Data on treatment and outcome were retrieved from electronic records. Results : Of 423 patients suspected to have SS, 332 fulfilled inclusion criteria. Only 8.3% of patients complained of sicca symptoms on their own at initial presentation. Younger age of onset, higher female to male ratio, paucity of cryoglobulinemia, Raynaud’s phenomenon and hyperglobulinemia were unique to this cohort. Cluster analysis revealed two subsets: The first cluster comprised of patients having a major systemic illness with high antibody titers and the second comprised of seronegative patients with mild disease. Over a third of SS cases had severe systemic manifestations necessitating treatment with immunosuppressants. In multivariate logistic regression analysis, anti-Ro and anti-La antibody positivity was associated with higher odds for systemic disease features (OR=2.67, P=0.03 and OR=3.25, P=0.003, respectively) whereas chronic pain was associated with lower odds (OR=0.4, p=0.032). Clinical improvement including symptomatic benefit in sicca and musculoskeletal features was noted with immunomodulators in the majority. Conclusion : Our cohort of patients with SS has characteristic clinical features; some of them are in contrast with previous observations reported in European patients. This cohort consisted of two distinct patient clusters. The first cluster was associated with major systemic illness and high antibody titers, where as the second cluster comprised of seronegative patients with mild disease. Association of antibody positivity with systemic features was further confirmed on logistic regression analysis.

Incidence of iatrogenic pneumothorax following acupuncture treatments in Taiwan

2019 ◽  
Vol 37 (6) ◽  
pp. 332-339
Author(s):  
Shun-Ku Lin ◽  
Jui-Ming Liu ◽  
Ren-Jun Hsu ◽  
Heng-Chang Chuang ◽  
Ying-Xue Wang ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Logistic Regression ◽  
Thoracic Surgery ◽  
Chronic Bronchitis ◽  
Rare Complication ◽  
Incidence Rates ◽  
Residential Area ◽  
Research Database ◽  
Multivariate Logistic Regression ◽  
History Of

Background: Pneumothorax is a rare complication of acupuncture and the risk factors are unclear. Objective: This study analysed the incidence of post-acupuncture pneumothorax requiring hospitalisation in a one-million-sample cohort derived from Taiwan’s National Health Insurance Research Database. Methods: We tracked this cohort between 1997 and 2012 and recorded all medical insurance information. Subjects were categorised according to gender, insurance amount, comorbidities, residential area, and number of acupuncture treatments. Pneumothorax risk was evaluated according to different demographic and medical variables by logistic regression analysis using an adjusted odds ratio (aOR) with a 95% confidence interval (95% CI). Results: Overall, 411 734 patients undergoing 5 407 378 acupuncture treatments were identified with data collected over the first 7 days after acupuncture. The incidence rates of iatrogenic pneumothorax were 0.87 per 1 000 000 acupuncture treatments overall and 1.75 per 1 000 000 acupuncture treatments in “at-risk” anatomical areas. Multivariate logistic regression demonstrated that a history of thoracic surgery (aOR 7.85, 95% CI 3.49 to 9.25), chronic bronchitis (aOR 2.61, 95% CI 1.03 to 6.87), emphysema (aOR 4.87, 95% CI 1.03 to 7.96), pneumonia (aOR 2.09, 95% CI 1.44 to 2.72), tuberculosis (aOR 3.65, 95% CI 1.39 to 9.56), and lung cancer (aOR 3.85, 95% CI 1.53 to 9.73) may increase the post-acupuncture risk of iatrogenic pneumothorax. Men had a higher risk of pneumothorax than women (aOR 3.41, 95% CI 1.36 to 8.57). The number of treatments was not associated with risk of pneumothorax. Conclusions: Patients with a history of lung disease including chronic bronchitis, emphysema, tuberculosis, lung cancer and pneumonia, and a history of thoracic surgery, might have an increased post-acupuncture risk of pneumothorax. This information may possibly help physicians avoid post-acupuncture pneumothorax.

Systemic lupus erythematosus-related acute pancreatitis

Lupus ◽  
2020 ◽  
Vol 30 (1) ◽  
pp. 5-14
Author(s):  
Alina Dima ◽  
Daniel Vasile Balaban ◽  
Ciprian Jurcut ◽  
Mariana Jinga
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Acute Pancreatitis ◽  
Abdominal Pain ◽  
Plasma Exchange ◽  
Lupus Erythematosus ◽  
High Dose ◽  
Systemic Lupus ◽  
Serum Lipase ◽  
Autoimmune Pathology ◽  
Short Disease Duration

Introduction Systemic lupus erythematosus (SLE) is a complex autoimmune pathology that can involve any organ. Lupus-related acute pancreatitis (AP) is, together with lupus mesenteric vasculitis, an important cause of SLE-induced acute abdominal pain. Methods A literature search was conducted using the terms “Pancreatitis” and “Lupus Erythematosus, Systemic” on PubMed/Medline and Web of Science from January 2007 to January 2020. Clinical characteristics, diagnostic approach, and treatment principles in SLE-related AP are presented in this review. Results Mainly retrospective reports were identified. The reported incidence of SLE-associated AP ranges from 0.9 to more than 5% of patients. A total of 264 SLE patients were found in the selected research, with a net female predominance (sex ratio 9:1) and mean age of 31.4 years. Abdominal pain was virtually present in all cases. AP occurrence was more frequent in SLE patients with short disease duration, high activity scores, and multiorgan involvement. The AP definition was based on currently available guidelines and after exclusion of any other known causes (including iatrogenic, i.e. drugs), a diagnosis of “idiopathic” SLE-related AP might be sustained. Management is difficult, as there is no standardized therapeutic approach. Of note, glucocorticoid use remains still controversial as, especially for high doses, subsequent pancreatic injury may occur. Monitoring serum lipase levels after high dose steroids might be considered. One study reported beneficial prognostic effect of plasma exchange. Moreover, AP in SLE might raise awareness about macrophage activation syndrome association. Mortality up to one third of AP cases in SLE was reported. Conclusion The SLE-related AP is a rare, but severe, life-threatening complication. Corticosteroids must be used with caution. Plasma exchange could be considered in selected cases.

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