Infectious complications as predictors of adverse outcome in a patient with systemic lupus erythematosus (clinical case)

A case of lung damage in systemic lupus erythematosus (SLE) in a 33-year-old woman is described. This case is of clinical interest due to the complexity of diagnosis due to the fact that SLE is a disease with diverse clinical manifestations involving many organs and systems, which often makes it difficult to timely recognize the onset of the disease. SLE still remains a challenge and requires special attention to the patient s history, clinical and laboratory parameters of the patient, as well as specific immunological examinations.

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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

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2021-eular.1214 ◽

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

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Stage one adenocarcinoma of uterine cervix in a patient with systemic lupus erythematosus – a clinical case

Menopausal Review ◽

10.5114/pm.2020.101950 ◽

2020 ◽

Vol 19 (4) ◽

pp. 188-191

Author(s):

Latchezar Tantchev ◽

Angel Yordanov ◽

Veselin Marinov ◽

Andrey Kotzev

Keyword(s):

Systemic Lupus Erythematosus ◽

Lupus Erythematosus ◽

Uterine Cervix ◽

Clinical Case ◽

Systemic Lupus

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TORCH-Infection and Its Possible Role in Syntropic Liver Damage in Patients with Systemic Lupus Erythematosus (literature review and clinical case description)

Lviv clinical bulletin ◽

10.25040/lkv2013.04.043 ◽

2013 ◽

Vol 4 (4) ◽

pp. 43-51

Author(s):

U. Abrahamovych ◽

◽

M. Abrahamovych ◽

N. Drobinska ◽

◽

...

Keyword(s):

Systemic Lupus Erythematosus ◽

Literature Review ◽

Liver Damage ◽

Lupus Erythematosus ◽

Clinical Case ◽

Case Description ◽

Systemic Lupus ◽

Torch Infection

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Systemic Lupus Erythematosus and Peritoneal Dialysis: Outcomes and Infectious Complications

Peritoneal Dialysis International ◽

10.1177/089686080102100206 ◽

2001 ◽

Vol 21 (2) ◽

pp. 143-148 ◽

Cited By ~ 27

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.

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P629 An uncommon cause for a frequent problem

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jez319.313 ◽

2020 ◽

Vol 21 (Supplement_1) ◽

Author(s):

H Miranda ◽

H Santos ◽

I Almeida ◽

M Santos ◽

C Sousa ◽

...

Keyword(s):

Systemic Lupus Erythematosus ◽

Emergency Department ◽

Ischemic Stroke ◽

Mitral Regurgitation ◽

Physical Examination ◽

Lupus Erythematosus ◽

Clinical Case ◽

Systemic Lupus ◽

Brain Ct ◽

Valvular Surgery

Abstract Introduction Libman-Sacks endocarditis is the most characteristic cardiac manifestation of the autoimmune disease systemic lupus erythematosus. Embolic phenomena, although uncommon, can also complicate valvular abnormalities and can cause neurologic and systemic complications. Case Report Man, 52 years old. Active smoker and with previous peptic ulcer history. Admitted to our emergency department due to sudden onset of confusion and incoherent speech. The physical examination showed only a Glasgow Coma Scale of 9 and the presence of expressive aphasia. Normal pulmonary and cardiac auscultation, without any other pathological findings on physical examination. Investigations showed a normal EKG, chest X-Ray and arterial-blood gas test. Blood test showed only the presence of thrombocytopenia, leucocytosis and renal disfunction. Brain CT revealed left-sided thalamic lacunar lesion. We assumed an ischemic stroke and admitted the patient in our emergency department. Neurological deterioration in the first 24h. A new brain CT was performed and showed multiple lesions in the middle cerebral artery territory. The echocardiogram was performed and showed the presence of multiples vegetations in both mitral leaflets with moderate to severe mitral regurgitation associated. We assume an ischemic stroke in the context of possible infective endocarditis. Medical therapy was optimized and empirical antimicrobial therapy was started (ampicillin + gentamicin + flucoxacillin). The patient never had fever during hospital stay. Duke criteria with only 1 major criteria. Persistent negative microbiological cultures with decreasing inflammatory parameters. Blood tests revealed a progressive increase level of INR (2-4) and renal function deterioration. Patient began with massive episodes of diarrhea and sudden decrease of haemoglobin level (sudden reduction of 3g/dl). Endoscopic studies were performed and multiple ischemic lesions of embolic etiology and small vessel disease had been described. Serology test revealed a positive IgG for Mycoplasma pneumoniae. Autoimmune lab tests showed positivity for lupus anticoagulant, anticardiolipin and anti–beta-2 glycoprotein I. We discussed the clinical case with our autoimmune experts team and the diagnosis of Systemic Lupus Erythematosus + Antiphospholipid Syndrome + Libman-Sacks Endocarditis was assumed. The patient started immunosuppressive therapy (Azathioprine + Mycophenolate Mofetil + Prednisolone). Despite the used therapy the size of vegetation persisted and mitral regurgitation didn’t improve. In this context, the patient was presented to our cardiac surgery team and underwent surgical intervention (vegetation removal + mitral valve repair). Evaluation one year after surgery revealed progressive functional and echocardiographic improvement. Conclusion The authors presented a didactic clinical case where valvular surgery was required thanks to a hemodynamically significant valvular dysfunction and embolic events.

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Clinical case of systemic lupus erythematosus in a middle-aged male patient

Therapy ◽

10.18565/therapy.2020.2.140-144 ◽

2020 ◽

Vol 2_2020 ◽

pp. 140-144

Author(s):

Dashkevich O.V. Dashkevich ◽

Chufistova N.N. Chufistova ◽

Keyword(s):

Systemic Lupus Erythematosus ◽

Male Patient ◽

Lupus Erythematosus ◽

Clinical Case ◽

Middle Aged ◽

Systemic Lupus ◽

Middle Aged Male

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SYSTEMIC LUPUS ERYTHEMATOSUS: REVIEW OF MODERN METHODS OF DIAGNOSIS, TREATMENT AND DESCRIPTION OF THE CLINICAL CASE

Acta medica Eurasica ◽

10.47026/2413-4864-2021-1-57-65 ◽

2021 ◽

pp. 57-65

Author(s):

Nadezhda V. Zhuravleva ◽

Louise M. Karzakova ◽

Tatyana L. Smirnova ◽

Sergey I. Kudryashov ◽

Tatyana S. Lutkova ◽

...

Keyword(s):

Systemic Lupus Erythematosus ◽

Rheumatoid Factor ◽

Lupus Erythematosus ◽

Clinical Case ◽

Skin Lesions ◽

Blood Analysis ◽

Federal State ◽

Systemic Lupus ◽

Initial Examination ◽

Immunological Disorders

A clinical case of systemic lupus erythematosus (SLE) is presented. Since childhood the patient had preclinical lupus: leukopenia, anemia, photoallergy, vasculitis, and serological changes a-SS-A (+++), but at that time the findings did not meet the criteria for SLE. At the initial examination of the woman at the age of 24 years, a clinical blood test revealed hemoglobin 101 g/l, leukopenia 3.2×109/l, ESR 41 mm/h, hyper-γ-globulinemia 29%. The immunological blood analysis revealed a-DNA (+++), a-SS-A (+++), aSm (+++), aRNP (+++). The diagnosis was "Systemic lupus erythematosus of chronic (at the beginning) course, activity of the 1st degree (2 points by the SLEDA scale): with hematological disorders (leukopenia), immunological disorders (ANA+)". Metypred was administered at a dose of 16 mg/day, followed by the dose reduction to 6 mg/day and Plaquenil 400 mg/day. The woman received inpatient and outpatient treatment, repeatedly consulted in the Federal State Budgetary Institution "V.A. Nasonova Research Institute" under the Russian Academy of Medical Sciences. At the age of 26, the diagnosis was made: "Systemic lupus erythematosus, grade 2 activity with skin lesions of the type of subacute cutaneous lupus, cheilitis, lymphadenopathy", blood tests revealed leukopenia, lymphopenia, anemia, as well as immunological disorders: a-n DNA 93.4 u/ml, aSm > 200 u/ml, aRo > 200 u/ml, C3 0.63 g/l, rheumatoid factor 69.5 mIU/ml, ANA (Нер-2) 1/640 Sp. A complex therapy was performed with the use of Metypred, Cyclophosphane and Azathioprine. Against the background of the therapy, the patient's condition is stable, but immunological disorders are preserved: persistent high positivity for aRo-SS-A and the presence of the rheumatoid factor. The case demonstrates the need for an in-depth examination of women with anemia of unknown origin in combination with leukopenia to exclude systemic diseases of the connective tissue.

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CLINICAL OBSERVATION OF UNTREATED SYSTEMIC LUPUS ERYTHEMATOSUS WITH INFECTIOUS COMPLICATIONS AND FATAL OUTCOME

Clinical Medicine and Pharmacology ◽

10.12737/2409-3750-2020-6-3-33-36 ◽

2020 ◽

Vol 6 (3) ◽

pp. 33-36

Author(s):

B. Barieva

Keyword(s):

Systemic Lupus Erythematosus ◽

Lupus Erythematosus ◽

Fatal Outcome ◽

Clinical Situation ◽

Infectious Complications ◽

Multiple Organ ◽

Rapid Progression ◽

Systemic Lupus ◽

Diagnostic Difficulties ◽

Omental Bursa

Among rheumatic diseases, a special place is occupied by systemic lupus erythematosus (SLE), this is due to its variety of clinical nonspecific manifestations, which leads to diagnostic difficulties in the early stages.This article presents a clinical case of severe SLE, previously not diagnosed and untreated, with the rapid progression of multiple organ failure (damage to the lungs, cardiovascular system, kidneys), which led to death. Previously, the patient was treated in the oncology and surgical departments with an abscess of the omental bursa and steatopancreonecrosis, later she was hospitalized in the hematology department with three-growth pancytopenia and hemolytic anemia, and from there transferred to the rheumatology department. This clinical situation demonstrates the importance of timely diagnosis, diagnosis and treatment of SLE.

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