scholarly journals Listeria monocytogenes meningoencephalitis in a patient with Systemic Lupus Erythematosus

2020 ◽  
Vol 42 (3) ◽  
pp. 375-379
Author(s):  
Maria Eduarda Vilanova da Costa Pereira ◽  
Diego Ennes Gonzalez ◽  
Fernanda Badiani Roberto ◽  
Renato Demarchi Foresto ◽  
Gianna Mastroianni Kirsztajn ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Listeria Monocytogenes ◽  
Lupus Erythematosus ◽  
Invasive Mechanical Ventilation ◽  
Altered Mental Status ◽  
Neurological Status ◽  
Pulse Therapy ◽  
Infectious Complications ◽  
Systemic Lupus ◽  
Ventilation Monitoring

Abstract Introduction: Infectious complications are common in systemic lupus erythematosus. Although uncommon, central nervous system infections do occur and have significant lethality, with several etiological agents. Methods: We report on the case of a 29-year-old woman recently diagnosed with systemic lupus erythematosus with hematological, cutaneous, serous and renal manifestations (class IV lupus nephritis), who underwent corticosteroid pulse therapy and mycophenolate induction therapy. After 3 months of evolution, she developed headache and altered mental status. Computed tomography showed an area of hypoattenuation in the left frontal white matter and her cerebrospinal fluid examination showed pleocytosis and hyperproteinorrhachia. Peripheral blood and CSF culture identified Listeria monocytogenes. The patient presented deterioration of her neurological status, requiring invasive mechanical ventilation, monitoring of intracranial pressure and, despite all the intensive support, persisted in a comatose state and developed multiple organ failure, evolving to death due to nosocomial bloodstream infection. Discussion: Infection from L. monocytogenes usually occurs after eating contaminated food, manifesting itself with diarrhea and, occasionally, invasively, such as neurolisteriosis. Further investigation with CSF analysis and MRI is necessary, and the diagnosis consists of isolating the bacteria in sterile body fluid. Conclusion: The case presents a patient whose diagnosis of meningoencephalitis became an important differential with neuropsychiatric disorder. The poor outcome reinforces the need to remember this infectious condition as a serious complication in the natural history of SLE.

scholarly journals AB0818 ADVERSE EVENTS UNDER B-CELL DIRECTED THERAPIES IN A LARGE SINGLE-CENTER COHORT OF PATIENTS WITH RHEUMATOID ARTHRITIS, SYSTEMIC LUPUS ERYTHEMATOSUS, ANCA-ASSOCIATED VASCULITIS AND RENAL DISEASES

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 1433.1-1433
Author(s):  
J. G. Rademacher ◽  
V. Korendovych ◽  
P. Korsten
Keyword(s):  
Rheumatoid Arthritis ◽  
Systemic Lupus Erythematosus ◽  
Adverse Events ◽  
B Cell ◽  
Clinical Data ◽  
Lupus Erythematosus ◽  
Infectious Complications ◽  
Single Center ◽  
Systemic Lupus ◽  
Anca Associated Vasculitis

Background:The anti-CD20 antibody rituximab (RTX) is approved for the treatment of rheumatoid arthritis (RA) and ANCA-associated vasculitis (AAV). In addition, RTX is used in a wide range of autoimmune diseases. Belimumab (BEL) is an anti-BAFF antibody approved for the treatment of non-renal systemic lupus erythematosus (SLE) in Europe. These agents are generally well-tolerated but severe adverse events (AEs) can occur. The frequency of and factors associated with AEs are currently unknown.Objectives:To identify adverse events with the use of B-cell directed therapies in a large population of RA, AAV, and SLE.Methods:This is a single-center retrospective cohort study using routine clinical data over a ten-year period (2010-2020). We recorded epidemiological and clinical data of patients receiving either BEL or RTX. Data included age, gender, type of disease, number and efficacy of infusions, patient-years and concomitant treatment. Patient records were screened for AEs, such as infections, anaphylaxis, occurrence of malignant disease, laboratory abnormalities and immunoglobulin (Ig) deficiency. Between group comparisons were performed.Results:Database screening yielded 445 patients treated with RTX and 23 with BEL. After exclusion of patients with incomplete data, 425 RTX and 23 BEL patients were analyzed.Our preliminary analysis of a sample of 60 of these 448 patients (184 patient-years) resulted in 43 patients (72%) with RA, 8 patients with AAV (13%), 5 patients with a renal disease, and 4 patients with mixed connective tissue disease, as well 23 SLE patients. 46 (77%) were female. In RA, a median of 13 treatments of 1000 mg were administered, corresponding to 3.37 patient-years per patient. Primary non-response occurred in 2 patients, secondary non-response in 13 patients. For AAV, a median of 8.4 treatments were given (3.3 patient-years), no treatment failure was detected. SLE patients received a median of 15 treatments.15 patients had infectious complications during treatment, 11 needed treatment. Herpes zoster infection occurred in 3 patients with RA. Three of the 8 patients with AAV had an infection requiring treatment. In SLE patients, only 2 developed infectious complications, and no Ig-deficiency occurred.Lymphopenia was the most common laboratory abnormality detected in 25 patients with RTX, 19 of whom had RA. Ig deficiency was common in RA, affecting 30% of patients. Deficiency of IgM and IgG was recognized in 5 patients each; 1 patient had low levels IgA.Neither the maintenance prednisolone dosage nor Ig deficiency were associated with risk for infection. However, lymphopenia appeared to be associated with risk for infection.Conclusion:Our preliminary data observe a 184 patient-year period. RTX and BEL were generally associated with few AEs. RA patients frequently had laboratory abnormalities (lymphopenia, Ig-deficiency) which did not necessarily translate to clinical events. Infections were more common in AAV, BEL was the best tolerated B-cell directed agent. Overall, our data are reassuring, but we suggest a more careful vigilance in AAV patients.Disclosure of Interests:Jan-Gerd Rademacher: None declared, Viktor Korendovych: None declared, PETER KORSTEN Speakers bureau: Abbvie, Sanofi Aventis, GSK, Chugai, Boehringer-Ingelheim, Novartis, Consultant of: Lilly, Gilead, Boehringer-Ingelheim, Novartis, GSK, Grant/research support from: GSK

scholarly journals Pulmonary hemorrhage as a manifestation of systemic lupus erythematosus

2004 ◽  
Vol 59 (1) ◽  
pp. 47-50 ◽  
Author(s):  
Bruno Hollanda Santos ◽  
Rodrigo Ribeiro Santos ◽  
Celeide Fátima Santos ◽  
Adriana Maria Kakehasi ◽  
Hermann Alexandre Vivacqua Von Tiesenhausen
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Connective Tissue ◽  
Lupus Erythematosus ◽  
Pulmonary Hemorrhage ◽  
Pulse Therapy ◽  
Loss Of Consciousness ◽  
Systemic Lupus ◽  
Sudden Loss ◽  
American College Of Rheumatology ◽  
High Level

The authors report a case of a 19-year-old woman admitted for the investigation of fever and hemolytic anemia for the previous 2 months. As an inpatient, she had convulsions and sudden loss of consciousness, developing hemoptysis, hypoxia, and respiratory insufficiency. Examination showed pericardial effusions on the echocardiogram and bilateral alveolar condensations on the thoracic radiograph. A hypothetical diagnosis of systemic lupus erythematosus was made, and measurement of the antinuclear factor was requested along with daily pulse therapy methylprednisolone, in spite of which the outcome was fatal. Afterwards, the result of the antinuclear factor test was positive, with a titer of 1:5120, showing a fine punctiform pattern, fulfilling the criteria for systemic lupus erythematosus according to the American College of Rheumatology. Secondary pulmonary hemorrhage in this connective tissue disease is an uncommon but serious complication that involves a high level of mortality in spite of intensive treatment, as is also reported in the literature.

Central nervous system manifestations after steroid pulse therapy in systemic lupus erythematosus

2002 ◽  
Vol 161 (9) ◽  
pp. 503-504 ◽  
Author(s):  
Yuichi Tabata ◽  
Ichiro Kobayashi ◽  
Nobuaki Kawamura ◽  
Motohiko Okano ◽  
Kunihiko Kobayashi
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Central Nervous System ◽  
Nervous System ◽  
Lupus Erythematosus ◽  
Pulse Therapy ◽  
Steroid Pulse Therapy ◽  
Systemic Lupus ◽  
Steroid Pulse

Systemic Lupus Erythematosus and Peritoneal Dialysis: Outcomes and Infectious Complications

2001 ◽  
Vol 21 (2) ◽  
pp. 143-148 ◽  
Author(s):  
Jenq-Wen Huang ◽  
Kuan-Yu Hung ◽  
Chung-Jen Yen ◽  
Kwan-Dun Wu ◽  
Tun-Jun Tsai
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Lupus Erythematosus ◽  
Infectious Complications ◽  
Control Group ◽  
Systemic Lupus ◽  
Exit Site ◽  
Age And Gender ◽  
Exit Site Infection ◽  
Technique Survival ◽  
And Gender

Objective Systemic lupus erythematosus (SLE) is the most common secondary glomerulonephritis resulting in end-stage renal disease (ESRD) among young adults in Taiwan. Studies of the infectious complications and outcomes among such SLE patients undergoing peritoneal dialysis (PD) are limited. Design A retrospective age- and gender-matched case control study. Setting A university teaching hospital. Patients There were 23 SLE patients with ESRD receiving PD for more than 3 months during the past 15 years. Another 46 age- and gender-matched non-SLE nondiabetic patients receiving PD were selected as the control group in this study. Intervention All patients underwent PD as renal replacement therapy and were regularly followed up at this hospital. Main Outcome Measures Technique survival and incidences of exit-site infection (ESI) and peritonitis in these patients. Results The SLE patients had a lower predialysis serum albumin than the control group (3.16 ± 0.50 g/dL vs 3.52 ± 0.50 g/dL, p < 0.01). The incidences of exit-site infection (ESI) and peritonitis were higher for SLE patients than for control patients ( p < 0.01 and p < 0.001, respectively). Kaplan–Meier survival analysis indicated that SLE patients had shorter time intervals to first infectious complications, and poorer technique survival. Infection was the major cause of dropout and mortality in the SLE patients. The SLE patients had a reduced chance of receiving a renal transplant. The use of steroids by SLE patients was associated with a higher incidence of peritonitis ( p = 0.04), but association with ESI was insignificant. In a Cox regression model, the underlying SLE was the only risk factor for technique failure and time interval to first infectious complication. Conclusion SLE patients undergoing PD are more susceptible to infection than age- and gender-matched non-SLE nondiabetic patients and have poorer technique survival. Systemic lupus erythematosus itself may further compromise the immunity of uremic patients.

scholarly journals Multiple Thromboses in a Patient with Systemic Lupus Erythematosus after Splenectomy

2012 ◽  
Vol 2012 ◽  
pp. 1-3
Author(s):  
Deng-Ho Yang
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Lupus Erythematosus ◽  
Vena Cava ◽  
Fetal Loss ◽  
Pulse Therapy ◽  
Multiple Organ ◽  
Renal Infarction ◽  
Systemic Lupus ◽  
Adequate Treatment ◽  
History Of

Antiphospholipid syndrome is a disorder presenting with arterial or venous thrombus and a history of fetal loss. Early diagnosis and adequate treatment is important to prevent multiple organ failures. Here, we described a woman with a two-year history of systemic lupus erythematosus with severe nephrotic syndrome, manifested multiple thrombi over the portal vein and the inferior vena cava, combined with acute renal infarction. The patient underwent splenectomy 10 months ago. Initially, she received anticoagulant treatment and low-dose glucocorticoid, but multiple organ failure progressed. After emergency plasma exchange followed by glucocorticoid pulse therapy, the patient recovered.

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