A case of SLE with COVID-19 and multiple infections

AbstractThe coronavirus disease 2019 (COVID-19) has become a global pandemic, which is induced by infection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Patients with systemic lupus erythematosus (SLE) are susceptible to infections due to the chronic use of immunosuppressive drugs and the autoimmune disorders. Now we report a case of SLE infected with SARS-CoV-2, influenza A virus and Mycoplasma pneumoniae concurrently. The patient used hydroxychloroquine and prednisone chronically to control the SLE. After infection of SARS-CoV-2, she was given higher dose of prednisone than before and the same dosage of hydroxychloroquine. Besides, some empirical treatments such as antiviral, antibiotic and immunity regulating therapies were also given. The patient finally recovered from COVID-19. This case indicated that hydroxychloroquine may not be able to fully protect SLE patient form SARS-CoV-2. Intravenous immunoglobulin therapies and increased dose of corticosteroids might be adoptable for patient with both COVID-19 and SLE. Physicians should consider SARS-CoV-2 virus test when SLE patient presented with suspected infection or SLE flare under the epidemic of COVID-19.

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Extensive Longitudinal Transverse Myelitis after Influenza A Virus Infection in a Patient with Systemic Lupus Erythematosus

Case Reports in Rheumatology ◽

10.1155/2022/9506733 ◽

2022 ◽

Vol 2022 ◽

pp. 1-6

Author(s):

Suheiry Márquez ◽

Luis M. Vilá

Keyword(s):

Systemic Lupus Erythematosus ◽

Lupus Erythematosus ◽

Influenza A ◽

Viral Infections ◽

Early Recognition ◽

Rare Complication ◽

Oral Prednisone ◽

Transverse Myelitis ◽

Immunosuppressive Drugs ◽

Systemic Lupus

Transverse myelitis (TM) is a rare complication seen in 1–2% of patients with systemic lupus erythematosus (SLE). Viral infections may cause TM in these patients by causing a dysregulation of their immune system. We report a 30-year-old woman with SLE who had influenza A and a few days later developed urinary retention, bilateral lower extremity paralysis, upper extremity weakness, and optic nerve and macular edema. Magnetic resonance imaging showed C4-T12 hyperintense lesions consistent with TM. She was treated with intravenous methylprednisolone 1 g daily for 3 days and then 6 cycles of monthly intravenous cyclophosphamide. This treatment was followed by oral prednisone. She had a remarkable clinical response. Visual acuity improved to her baseline, and muscle strength almost fully recovered. Clinicians should be aware that viral infections, including influenza, may induce TM. This case highlights the importance of early recognition and prompt treatment with immunosuppressive drugs in such cases.

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A patient with systemic lupus erythematosus and lupus nephritis: A 12-year follow-up

Vojnosanitetski pregled ◽

10.2298/vsp1108705j ◽

2011 ◽

Vol 68 (8) ◽

pp. 705-708

Author(s):

Natasa Jovanovic ◽

Jasmina Markovic-Lipkovski ◽

Stevan Pavlovic ◽

Biljana Stojimirovic

Keyword(s):

Systemic Lupus Erythematosus ◽

Nephrotic Syndrome ◽

Mycophenolate Mofetil ◽

Lupus Nephritis ◽

Lupus Erythematosus ◽

Kidney Biopsy ◽

Immunosuppressive Drugs ◽

Systemic Lupus ◽

Younger Women ◽

The Right

Introduction. Systemic lupus erythematosus (SLE) is a chronic immunological disease causing a significant morbidity and mortality in younger women and involving several organs and systems, most often the kidneys, being consequently the incidence of lupus nephritis (LN) about 60%. Case report. We reported a 57 year-old patient with the diagnosed SLE in 1995. Pathohistological analysis of kidney biopsy revealed LN type V. The patient was treated with corticosteroid pulses and azathioprine during one year. A remission was achieved and maintained with prednisone, 15 mg daily. Nephrotic relapse was diagnosed in 2006 and the second kidney biopsy revealed recent kidney infarction due to extensive vasculitis. Soon, a cerebrovascul insult developed and CT-scan revealed endocranial infarctus. The patient was treated with corticosteroids and cyclophosphamide pulses (totally VI monthly pulses), and also with low-molecular heparine, anticoagulants and salicylates because of the right leg phlebothrombosis. After the pulses, the patient was adviced to take prednisone 20 mg daily and azothioprine 100 mg daily, and 6 months later mycophenolate mofetil because of persistent active serological immunological findings (ANA 1 : 320) and nephrotic syndrome. Mycophenolate mofetil was efficient in inducing and maintaining remission of nephrotic syndrome. Conclusion. The aim of LN treatment is to achieve and maintain remission, improve patients? outcome, reduce the toxicity of immunosuppressive drugs and the incidence of relapses. Mycophenolate mofetil was shown to be efficient in inducing and maintaining remission of nephrotic syndrome in the frame of LN.

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Changes in the blood level, efficacy, and safety of tacrolimus in pregnancy and the lactation period in patients with systemic lupus erythematosus

Lupus ◽

10.1177/0961203318809178 ◽

2018 ◽

Vol 27 (14) ◽

pp. 2245-2252 ◽

Cited By ~ 6

Author(s):

Y Hiramatsu ◽

S Yoshida ◽

T Kotani ◽

E Nakamura ◽

Y Kimura ◽

...

Keyword(s):

Systemic Lupus Erythematosus ◽

Lupus Erythematosus ◽

Immunosuppressive Drugs ◽

Lactation Period ◽

Second Trimester ◽

Efficacy And Safety ◽

Systemic Lupus ◽

Breastfed Infants ◽

Arterial Blood ◽

Trough Concentrations

Objectives We investigated the efficacy and safety of tacrolimus (TAC) by monitoring its serum concentration for mothers and infants in pregnant patients with systemic lupus erythematosus (SLE). Methods We measured trough concentrations of TAC in 25 pregnant patients with SLE to assess influence of TAC on the disease activity. Additionally, we measured the concentrations of TAC in umbilical arterial blood, breast milk, and breastfed infants to investigate the safety of TAC for the mothers and infants. Results The trough concentrations of TAC in the mothers significantly decreased in the second trimester as compared with those before pregnancy. However, the decrease in the trough concentrations of TAC did not lead to the deterioration of SLE. When examined, the doses of TAC were significantly lower in the second trimester and postpartum in the deteriorating group than those in the non-deteriorating group. There were no adverse events by TAC in mothers and fetuses. The concentrations of TAC in the umbilical cord blood were lower than those in the maternal blood. The relative infant dose in breastfed infants of TAC was < 1%. The level of TAC in infant bloods was below detectable limits. Conclusion These findings suggest that TAC is one of the most effective and safest immunosuppressive drugs for use in pregnant patients with SLE.

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The Early Protective Effect of Hydroxychloroquine on the Risk of Cumulative Damage in Patients with Systemic Lupus Erythematosus

The Journal of Rheumatology ◽

10.3899/jrheum.120572 ◽

2013 ◽

Vol 40 (6) ◽

pp. 831-841 ◽

Cited By ~ 60

Author(s):

Pooneh S. Akhavan ◽

Jiandong Su ◽

Wendy Lou ◽

Dafna D. Gladman ◽

Murray B. Urowitz ◽

...

Keyword(s):

Systemic Lupus Erythematosus ◽

Lupus Erythematosus ◽

Conditional Logistic Regression ◽

Univariate Analysis ◽

Damage Index ◽

Immunosuppressive Drugs ◽

Clinical Effects ◽

Systemic Lupus ◽

Steroid Dose ◽

Damage Accrual

Objective.To assess whether hydroxychloroquine (HCQ) prevents early damage in patients with systemic lupus erythematosus (SLE).Methods.We updated an existing systematic review of literature on clinical effects of HCQ in patients with SLE. We conducted a nested case-control study embedded in an inception cohort of patients with SLE. Systemic Lupus International Collaborating Clinics Damage Index (SDI) at 3 years was considered as our primary outcome. Patients with SDI > 0 at 3 years were considered cases and patients with SDI = 0 were controls. Cases and controls were first compared by univariate analysis. Then conditional logistic regression models adjusting for potential confounders were done to study the effect of HCQ on damage accrual.Results.Included in the analysis were 481 patients who had 3 or more years of followup. Out of this cohort, we could match 151 cases with 151 controls. Univariate analysis identified age, the use of any immunosuppressive drugs, HCQ, and cumulative dose of steroids as significant covariates associated with damage accrual. In multivariate analysis, the use of HCQ remained significantly associated with less damage (OR 0.34, 95% CI 0.132–0.867), while age (OR 1.05, 95% CI 1.027–1.078) and a variable combining SLE activity and steroid dose (OR 1.73, 95% CI 1.306–2.295) were associated with damage at 3 years.Conclusion.We demonstrated that HCQ use was associated with less damage at 3 years after diagnosis of SLE when attention was given and adjustment done for disease activity and steroid dose, duration of disease, and calendar year of diagnosis.

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Systemic lupus erythematosus—management

Oxford Textbook of Rheumatology ◽

10.1093/med/9780199642489.003.0118_update_004 ◽

2013 ◽

pp. 938-947

Author(s):

Ida Dzifa Dey ◽

David Isenberg

Keyword(s):

Systemic Lupus Erythematosus ◽

Immune Cells ◽

Lupus Erythematosus ◽

Immunosuppressive Drugs ◽

Systemic Lupus ◽

General Management ◽

Autoimmune Rheumatic Disease ◽

The Future

Systemic lupus erythematosus (SLE) is an autoimmune rheumatic disease with varied presentation and a disease course characterized by remission and flares. Over the last 50 years the prognosis of SLE has improved considerably. The introductions of corticosteroids and later of cytotoxic drugs, dialysis, and renal transplantation were the major contributors to this improvement. Nevertheless, the treatment and general management of lupus continues to present a challenge. While lupus may, for some patients, represent a relatively mild set of problems, many others require large doses of immunosuppressive drugs, which carry long-term concerns about side effects. New immunotherapeutic drugs, with actions more closely targeted to the immune cells and molecules involved in the pathogenesis of SLE, are being introduced and the future looks promising. The role of early atherosclerosis and cardiovascular disease as a cause of death in patients with SLE is increasingly recognized and will present further challenges in the future.

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History of systemic lupus erythematosus

10.1093/med/9780198739180.003.0001 ◽

2016 ◽

Author(s):

Manuel F. Ugarte-Gil ◽

Graciela S. Alarcón

Keyword(s):

Systemic Lupus Erythematosus ◽

Lupus Erythematosus ◽

Familial Aggregation ◽

English Literature ◽

Tenth Century ◽

Immunosuppressive Drugs ◽

Systemic Lupus ◽

History Of ◽

Definition Of

The first description of cutaneous ulcerations consistent with systemic lupus erythematosus (SLE) has been attributed to Hippocrates. The term lupus first appeared in English literature in the tenth century. Until the nineteenth century, however, this term was used to describe different conditions. Osler first recognized that organ involvement may occur with or without skin involvement. With the discovery of LE cells and autoantibodies, the use of lupus murine models, and the recognition of familial aggregation and the importance of genetic factors, the pathogenesis of SLE started to be unravelled and allowed the definition of classification criteria. In parallel, the discovery of cortisone, the use of immunosuppressive drugs and antimalarials, the control of hypertension, and the availability of renal replacement therapy improved the prognosis of SLE from a 4-year survival of 51% to a 5-year survival >90%. Advances in genetics and targeted therapies will lead to better intermediate and long-term outcomes.

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Systemic lupus erythematosus—management

10.1093/med/9780199642489.003.0118_update_003 ◽

2016 ◽

Author(s):

Ida Dzifa Dey ◽

David Isenberg

Keyword(s):

Systemic Lupus Erythematosus ◽

Lupus Erythematosus ◽

Immunosuppressive Drugs ◽

Systemic Lupus ◽

General Management ◽

Autoimmune Rheumatic Disease ◽

The Future ◽

Early Atherosclerosis

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Predictors of Remission and Low Disease Activity State in Systemic Lupus Erythematosus: Data from a Multiethnic, Multinational Latin American Cohort

The Journal of Rheumatology ◽

10.3899/jrheum.180433 ◽

2019 ◽

Vol 46 (10) ◽

pp. 1299-1308 ◽

Cited By ~ 3

Author(s):

Manuel F. Ugarte-Gil ◽

Daniel Wojdyla ◽

Guillermo J. Pons-Estel ◽

Rosana Quintana ◽

José A. Gómez-Puerta ◽

...

Keyword(s):

Systemic Lupus Erythematosus ◽

Disease Activity ◽

Lupus Erythematosus ◽

Maintenance Dose ◽

Renal Involvement ◽

Immunosuppressive Drugs ◽

Older Age ◽

Systemic Lupus ◽

Low Disease Activity ◽

Activity State

Objective.To determine the predictors of remission and low disease activity state (LDAS) in patients with systemic lupus erythematosus (SLE).Methods.Three disease activity states were defined: Remission = SLE Disease Activity Index (SLEDAI) = 0 and prednisone ≤ 5 mg/day and/or immunosuppressants (maintenance dose); LDAS = SLEDAI ≤ 4, prednisone ≤ 7.5 mg/day and/or immunosuppressants (maintenance dose); and non-optimally controlled state = SLEDAI > 4 and/or prednisone > 7.5 mg/day and/or immunosuppressants (induction dose). Antimalarials were allowed in all groups. Patients with at least 2 SLEDAI reported and not optimally controlled at entry were included in these analyses. Outcomes were remission and LDAS. Multivariable Cox regression models (stepwise selection procedure) were performed for remission and for LDAS.Results.Of 1480 patients, 902 were non-optimally controlled at entry; among them, 196 patients achieved remission (21.7%) and 314 achieved LDAS (34.8%). Variables predictive of a higher probability of remission were the absence of mucocutaneous manifestations (HR 1.571, 95% CI 1.064–2.320), absence of renal involvement (HR 1.487, 95% CI 1.067–2.073), and absence of hematologic involvement (HR 1.354, 95% CI 1.005–1.825); the use of immunosuppressive drugs before the baseline visit (HR 1.468, 95% CI 1.025–2.105); and a lower SLEDAI score at entry (HR 1.028, 95% CI 1.006–1.051 per 1-unit decrease). These variables were predictive of LDAS: older age at entry, per 5-year increase (HR 1.050, 95% CI 1.004–1.098); absence of mucocutaneous manifestations (HR 1.401, 95% CI 1.016–1.930) and renal involvement (HR 1.344, 95% CI 1.049–1.721); and lower SLEDAI score at entry (HR 1.025, 95% CI 1.009–1.042).Conclusion.Absence of mucocutaneous, renal, and hematologic involvement, use of immunosuppressive drugs, and lower disease activity early in the course of the disease were predictive of remission in patients with SLE; older age was predictive of LDAS.

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Current Paradigms of Tolerogenic Dendritic Cells and Clinical Implications for Systemic Lupus Erythematosus

Cells ◽

10.3390/cells8101291 ◽

2019 ◽

Vol 8 (10) ◽

pp. 1291 ◽

Cited By ~ 2

Author(s):

Ritprajak ◽

Kaewraemruaen ◽

Hirankarn

Keyword(s):

Systemic Lupus Erythematosus ◽

Dendritic Cells ◽

Autoimmune Diseases ◽

Lupus Erythematosus ◽

Ex Vivo ◽

Immunosuppressive Drugs ◽

Clinical Implications ◽

Systemic Lupus ◽

Tolerogenic Dendritic Cells

Tolerogenic dendritic cells (tolDCs) are central players in the initiation and maintenance of immune tolerance and subsequent prevention of autoimmunity. Recent advances in treatment of autoimmune diseases including systemic lupus erythematosus (SLE) have focused on inducing specific tolerance to avoid long-term use of immunosuppressive drugs. Therefore, DC-targeted therapies to either suppress DC immunogenicity or to promote DC tolerogenicity are of high interest. This review describes details of the typical characteristics of in vivo and ex vivo tolDC, which will help to select a protocol that can generate tolDC with high functional quality for clinical treatment of autoimmune disease in individual patients. In addition, we discuss the recent studies uncovering metabolic pathways and their interrelation intertwined with DC tolerogenicity. This review also highlights the clinical implications of tolDC-based therapy for SLE treatment, examines the current clinical therapeutics in patients with SLE, which can generate tolDC in vivo, and further discusses on possibility and limitation on each strategy. This synthesis provides new perspectives on development of novel therapeutic approaches for SLE and other autoimmune diseases.

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No evidence of vertical transmission of SARS-CoV-2 after induction of labour in an immune-suppressed SARS-CoV-2-positive patient

BMJ Case Reports ◽

10.1136/bcr-2020-235581 ◽

2020 ◽

Vol 13 (6) ◽

pp. e235581 ◽

Cited By ~ 6

Author(s):

Koen Grimminck ◽

Lindy Anne Maria Santegoets ◽

Frederike Charlotte Siemens ◽

Pieter Leendert Alex Fraaij ◽

Irwin Karl Marcel Reiss ◽

...

Keyword(s):

Systemic Lupus Erythematosus ◽

Severe Acute Respiratory Syndrome ◽

Vertical Transmission ◽

Lupus Erythematosus ◽

Pregnant Patient ◽

Positive Patient ◽

Induction Of Labour ◽

Systemic Lupus ◽

Short Overview ◽

Respiratory Problem

We present a case of a 38+1 weeks pregnant patient (G1P0) with a proven COVID-19 infection, who was planned for induction of labour because of pre-existent hypertension, systemic lupus erythematosus, respiratory problem of coughing and mild dyspnoea without fever during the COVID-19 pandemic in March 2020. To estimate the risk of vertical transmission of Severe Acute Respiratory Syndrome CoronaVirus 2 (SARS-CoV-2) during labour and delivery, we collected oropharyngeal, vaginal, urinary, placental and neonatal PCRs for SARS-CoV-2 during the period of admission. All PCRs, except for the oropharyngeal, were negative and vertical transmission was not observed. Labour and delivery were uncomplicated and the patient and neonate were discharged the next day. We give a short overview of the known literature about SARS-CoV-2-related infection during pregnancy, delivery and outcome of the neonate.

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