Lymphadenopathy as a prodrome for systemic lupus erythematous

2021 ◽  
Vol 17 ◽  
Author(s):  
Neha Kinariwalla ◽  
Kelly Steed ◽  
Prabjot S. Mundi
Keyword(s):  
Abdominal Pain ◽  
Lymph Nodes ◽  
Maximum Diameter ◽  
High Dose ◽  
Systemic Lupus Erythematous ◽  
Systemic Lupus ◽  
Cervical Lymph Nodes ◽  
Gradual Improvement ◽  
Rebound Tenderness ◽  
Night Sweats

: A 41-year-old woman presented to the hospital with one month of fever, chills, lymphadenopathy, abdominal pain, a bilateral upper extremity rash, and malaise. The patient had no significant prior medical history and was physically active, kickboxing twice a week and working 16-hour days. She reported increased difficulty getting out of bed over the span of one month. Physical exam was notable for tender, palpable posterior cervical lymph nodes that were mobile and about 1 cm in maximum diameter. There was mild abdominal tenderness to deep palpation without guarding or rebound tenderness. A computerized tomography (CT) scan of the abdomen and pelvis was notable for diffuse mesenteric fat stranding and prominent right retroperitoneal lymph nodes. The patient was readmitted two months later with worsening fatigue, abdominal pain, subjective fever, night sweats, and swelling and tenderness of her wrists and fingers despite ibuprofen. After extensive infectious, hematologic and autoimmune evaluations, a diagnosis of systemic lupus erythematous (SLE) was made and treatment with high-dose steroids and hydroxychloroquine, which resulted in gradual improvement in symptoms. This report highlights fevers and generalized lymphadenopathy as a subtle prodrome of SLE.

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.

scholarly journals Lupus causing small bowel obstruction

2018 ◽  
pp. bcr-2018-225886 ◽  
Author(s):  
Yunfei Yang ◽  
Anne-Marie Bartsch ◽  
Eve Fryer ◽  
Daniel Hancu
Keyword(s):  
Abdominal Pain ◽  
Small Bowel ◽  
Renal Involvement ◽  
Emergency Admission ◽  
Recurrent Abdominal Pain ◽  
Systemic Lupus Erythematous ◽  
Systemic Lupus ◽  
Short Gut Syndrome ◽  
Bowel Involvement ◽  
History Of

A 20-year-old female patient was admitted to hospital in 2015 with 1 year history of recurrent abdominal pain, distension, borborygmi and nausea. The patient had a background of systemic lupus erythematous (SLE) diagnosed 4 years before, with skin, joint and renal involvement. The initial investigations have shown a long segment of ileal inflammation with upstream obstruction. Differential diagnoses were mainly SLE enteritis or concomitant Crohn’s. Patient failed the initial conservative management and had a laparotomy with small bowel (SB) resection and ileostomy. The histology was suggestive of autoimmune enteritis. Although bowel involvement is a frequent feature of SLE, surgery for obstruction is extremely rare. Postoperatively, she had an emergency admission and was diagnosed with SB volvulus with perforation. She underwent further resection and stoma refashioning in 2016. As a consequence, she developed short gut syndrome. Eventually, the stoma was reversed and parenteral nutrition was stopped and weight became stable.

An Unusual Presentation of Acute Biphenotypic Leukemia without Bone Marrow Involvement

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 3995-3995
Author(s):  
Ulas D Bayraktar ◽  
Maricer Escalon
Keyword(s):  
Bone Marrow ◽  
Flow Cytometry ◽  
Lymph Nodes ◽  
Bone Marrow Involvement ◽  
Whole Body ◽  
Medium Size ◽  
High Dose ◽  
Axillary Lymph ◽  
Cervical Lymph Nodes ◽  
Biphenotypic Leukemia

Abstract Acute biphenotypic leukemia (ABL) represents a minority of acute leukemia cases (around 5%) in which blasts co-express markers of different lineages (myeloid, T-cell or B-cell). ABL without bone marrow involvement is exceedingly rare. Case report: An 18-year-old man presented with slowly enlarging, non-tender cervical lymph nodes. He had no other symptoms. Family history included Hodgkin’s disease in his mother and maternal great aunt, histiocytosis X in his maternal cousin, and non-Hodgkin’s lymphoma in his paternal grandfather. Physical exam revealed multiple small cervical and axillary lymph nodes. Laboratory analyses including complete blood count, peripheral blood smear, complete metabolic profile, mononucleosis screen, and hepatitis and HIV serologies were unremarkable. Histopathological examination of the left cervical lymph node revealed rare germinal centers with an interfollicular proliferation of generally medium size cells with a fine blastic chromatin pattern and scant cytoplasm. CD34 was positive in more than half of the cells. Between 30% and 80% of the cells were positive for TdT (Figure 1), CD3, CD4, and CD7. Myeloperoxidase (Figure 2) and lysozyme were positive in about 20% of the cells. Flow cytometry revealed an immature myeloid cell population coexpressing CD33, CD13, CD7, and CD34. Chromosomal analysis revealed a complex karyotype. Bone marrow exam was unremarkable and no evidence of leukemia was observed. Flow cytometry of the bone marrow aspirate revealed only 4% of the cells to be CD34+. Whole body PET scan showed extensive uptake in bilateral axillae, neck, and inguinal regions without any extranodal involvement. The patient received hyper-CVAD regimen (alternating cycles of cyclophosphamide, vincristine, adriamycin, dexamethasone and high dose methotrexate, cytarabine) for 8 cycles and remains in remission five months after the end of hyper-CVAD protocol. To our knowledge, this is the third case reported in the literature with acute biphenotypic leukemia not involving the bone marrow. However, our case cannot accurately be referred to as leukemia since the bone marrow is not involved; neither can it be named as lymphoblastic lymphoma because of its myeloid differentiation. Therefore, we will refer to it as extramedullary granulocytic sarcoma with biphenotypic features. Figure 1 Figure 1. Figure 2 Figure 2.

scholarly journals Successful Treatment of Urticarial Vasculitis in a Patient With Systemic Lupus Erythematosus With Rituximab

2020 ◽  
Vol 13 ◽  
pp. 117954412096737
Author(s):  
Samar Alharbi ◽  
Jorge Sanchez-Guerrero
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Mycophenolate Mofetil ◽  
Lupus Erythematosus ◽  
Leukocytoclastic Vasculitis ◽  
Discoid Lupus Erythematosus ◽  
High Dose ◽  
Systemic Lupus Erythematous ◽  
Systemic Lupus ◽  
Urticarial Vasculitis ◽  
Dose Prednisone

Urticarial vasculitis is an eruption of erythematous wheals that clinically resemble urticaria but histologically show changes of leukocytoklastic vasculitis. In association with connective tissue disease it is most commonly seen complicating Systemic lupus erythematous (SLE) and, less often, Sjogren’s syndrome. Here, we report a 25-year-old woman who developed SLE in 1998. In May 2013 she presented with urticarial vasculitis; her skin biopsy was consistent with leukocytoclastic vasculitis. She also developed bilateral uveitis. She had most of the clinical and laboratory characteristics of hypocomplementic urticarial vasculitis syndrome (HUVS) which is difficult to be differentiated from SLE. She was treated with high-dose prednisone, Mycophenolate Mofetil (MMF), colchicine, and Dapsone but failed. We decided to give her Rituximab (RTX), her urticarial vasculitis and uveitis symptoms improved significantly. Unfortunately, later on she presented with severe discoid lupus. We started her on thalidomide and responded well. Our case highlights that Rituximab is a good option for severe refractory urticarial vasculitis and thalidomide is effective in treatment of discoid lupus erythematosus (DLE), and can be used safely in specialist rheumatological practice.

scholarly journals Systemic lupus Erythematous as an Unusual Cause of Intussusception in Sudanese Woman: Case report

2021 ◽  
Author(s):  
Salwa Dafa Allah Salih Mohammadeen ◽  
Amar F.Eldow ◽  
Rania Eisa Abdelmutalib ◽  
Sara galal osman hamza ◽  
Elnour Mohammed Elagib ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Abdominal Pain ◽  
Case Report ◽  
Chest Pain ◽  
Skin Rash ◽  
Hair Loss ◽  
Joint Pain ◽  
Abdominal Distension ◽  
Systemic Lupus Erythematous ◽  
Systemic Lupus

A middle-aged Sudanese woman has been presented complained about multiple joint pain, skin rash, chest pain, hair loss, severe abdominal pain associated with abdominal distension, bloody diarrhoea and vomiting. Lab investigation and computed tomography (CT) abdomen revealed the patient have an intussusception on top of SLE. The patient was treated

scholarly journals Management of Low-Risk Thyroid Cancers: Is Active Surveillance a Valid Option? A Systematic Review of the Literature

2021 ◽  
Vol 10 (16) ◽  
pp. 3569
Author(s):  
Renato Patrone ◽  
Nunzio Velotti ◽  
Stefania Masone ◽  
Alessandra Conzo ◽  
Luigi Flagiello ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Life Expectancy ◽  
Lymph Nodes ◽  
Active Surveillance ◽  
The United States ◽  
Low Risk ◽  
Maximum Diameter ◽  
American Thyroid Association ◽  
Cervical Lymph Nodes ◽  
Thyroid Cancers

Thyroid cancer is the most common endocrine malignancy, representing 2.9% of all new cancers in the United States. It has an excellent prognosis, with a five-year relative survival rate of 98.3%.Differentiated Thyroid Carcinomas (DTCs) are the most diagnosed thyroid tumors and are characterized by a slow growth rate and indolent course. For years, the only approach to treatment was thyroidectomy. Active surveillance (AS) has recently emerged as an alternative approach; it involves regular observation aimed at recognizing the minority of patients who will clinically progress and would likely benefit from rescue surgery. To better clarify the indications for active surveillance for low-risk thyroid cancers, we reviewed the current management of low-risk DTCs with a systematic search performed according to a PRISMA flowchart in electronic databases (PubMed, Web of Science, Scopus, and EMBASE) for studies published before May 2021. Fourteen publications were included for final analysis, with a total number of 4830 patients under AS. A total of 451/4830 (9.4%) patients experienced an increase in maximum diameter by >3 mm; 609/4830 (12.6%) patients underwent delayed surgery after AS; metastatic spread to cervical lymph nodes was present in 88/4213 (2.1%) patients; 4/3589 (0.1%) patients had metastatic disease outside of cervical lymph nodes. Finally, no subject had a documented mortality due to thyroid cancer during AS. Currently, the American Thyroid Association guidelines do not support AS as the first-line treatment in patients with PMC; however, they consider AS to be an effective alternative, particularly in patients with high surgical risk or poor life expectancy due to comorbid conditions. Thus, AS could be an alternative to immediate surgery for patients with very-low-risk tumors showing no cytologic evidence of aggressive disease, for high-risk surgical candidates, for those with concurrent comorbidities requiring urgent intervention, and for patients with a relatively short life expectancy.

Benign thyroid inclusions in cervical lymph nodes

JAMA ◽  
1965 ◽  
Vol 194 (1) ◽  
pp. 1-4 ◽  
Author(s):  
A. D. Nicastri
Keyword(s):  
Lymph Nodes ◽  
Cervical Lymph Nodes ◽  
Benign Thyroid

Role of Clinical Palpation in Evaluation of Cervical Lymph Node in Oral Squamous Cell Carcinoma

2013 ◽  
Vol 1 (2) ◽  
pp. 02-06
Author(s):  
SM Anwar Sadat ◽  
Sufia Nasrin Rita ◽  
Shoma Banik ◽  
Md Nazmul Hasan Khandker ◽  
Md Mahfuz Hossain ◽  
...  
Keyword(s):  
Squamous Cell Carcinoma ◽  
Lymph Node ◽  
Oral Squamous Cell Carcinoma ◽  
Lymph Nodes ◽  
Cell Carcinoma ◽  
Squamous Cell ◽  
Predictive Value ◽  
Cervical Lymph Node ◽  
Betel Quid ◽  
Cervical Lymph Nodes

A cross sectional study of 29 cases of oral squamous cell carcinoma with or without  cervical lymph node metastasis was done among Bangladeshi patients from January 2006 to December 2007. Majority of the study subjects (34.5%) belonged to the age group of 40-49 years. 58.6% of the study subjects were male, while remaining 41.4% of them were female. 51.7% of the lesions were located in the alveolar ridge where the other common sites were buccal mucosa (27.6%) and retro molar area (13.8%). Half of the study subjects (51.7%) were habituated to betel quid chewing followed by 37.9% and 10.3% were habituated to smoking and betel quid-smoking respectively. Grade I lesions was most prevalent (75.9%) in the study subjects.  Majority of cases presented with Stage IV lesions (55.2%). The sensitivity, specificity, positive predictive value, negative predictive value & accuracy of clinical palpation method for determining metastatic cervical lymph nodes were 93.33%, 64.29%, 73.68%, 90% and 79.3% respectively. Careful and repeated clinical palpation plays important role in evaluation of cervical lymph nodes though several modern techniques may help additionally in the management of oral cancer.DOI: http://dx.doi.org/10.3329/updcj.v1i2.13978 Update Dent. Coll. j. 2011: 1(2): 02-06

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