Reply to “Calcified Splenic Lesions: Silicosis and Systemic Lupus Erythematosus Should Be Considered in the Differential Diagnosis”

2020 ◽  
Vol 215 (6) ◽  
pp. W64-W64
Author(s):  
Nikita Consul ◽  
Sidra Javed-Tayyab ◽  
Khaled M. Elsayes
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Differential Diagnosis ◽  
Lupus Erythematosus ◽  
Systemic Lupus

scholarly journals Autoantibodies in Neuropsychiatric Systemic Lupus Erythematosus (NPSLE): Can They Be Used as Biomarkers for the Differential Diagnosis of This Disease?

2021 ◽  
Author(s):  
Elias Manca
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Central Nervous System ◽  
Nervous System ◽  
Differential Diagnosis ◽  
Human Body ◽  
Lupus Erythematosus ◽  
Neuropsychiatric Symptoms ◽  
Systemic Lupus ◽  
Neuropsychiatric Systemic Lupus Erythematosus ◽  
The Central Nervous System

AbstractSystemic lupus erythematosus is a complex immunological disease where both environmental factors and genetic predisposition lead to the dysregulation of important immune mechanisms. Eventually, the combination of these factors leads to the production of self-reactive antibodies that can target any organ or tissue of the human body. Autoantibodies can form immune complexes responsible for both the organ damage and the most severe complications. Involvement of the central nervous system defines a subcategory of the disease, generally known with the denomination of neuropsychiatric systemic lupus erythematosus. Neuropsychiatric symptoms can range from relatively mild manifestations, such as headache, to more severe complications, such as psychosis. The evaluation of the presence of the autoantibodies in the serum of these patients is the most helpful diagnostic tool for the assessment of the disease. The scientific progresses achieved in the last decades helped researchers and physicians to discover some of autoepitopes targeted by the autoantibodies, although the majority of them have not been identified yet. Additionally, the central nervous system is full of epitopes that cannot be found elsewhere in the human body, for this reason, autoantibodies that selectively target these epitopes might be used for the differential diagnosis between patients with and without the neuropsychiatric symptoms. In this review, the most relevant data is reported with regard to mechanisms implicated in the production of autoantibodies and the most important autoantibodies found among patients with systemic lupus erythematosus with and without the neuropsychiatric manifestations.

scholarly journals PSEUDOTUMOR CEREBRI AS A DIFFERENTIAL DIAGNOSIS FOR VISION LOSS IN SYSTEMIC LUPUS ERYTHEMATOSUS: CASE REPORT

2019 ◽  
Author(s):  
MARCO FELIPE MACÊDO ALVES ◽  
CAIO FELIPE FARIAS BARROS ◽  
JARDELINA BRENA ROCHA LEITE ◽  
MARINA ACEVEDO ZARZAR DE MELO ◽  
PEDRO JOSÉ GALVÃO FREIRE ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Differential Diagnosis ◽  
Case Report ◽  
Lupus Erythematosus ◽  
Vision Loss ◽  
Pseudotumor Cerebri ◽  
Systemic Lupus ◽  
Systemic Lupus Erythematosus Case

scholarly journals Liver involvement in patients with systemic lupus erythematosus

2021 ◽  
Vol 59 (2) ◽  
pp. 164-172
Author(s):  
A. P. Panova ◽  
V. G. Avdeev ◽  
T. N. Krasnova ◽  
T. P. Rozina ◽  
E. P. Pavlikova ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Differential Diagnosis ◽  
Lupus Erythematosus ◽  
Liver Diseases ◽  
Liver Enzymes ◽  
Liver Steatosis ◽  
Liver Involvement ◽  
Systemic Lupus ◽  
Viral Hepatitis C ◽  
Lupus Hepatitis

Liver involvement in systemic lupus erythematosus is common and in most cases clinical course is asymptomatic, that makes diagnosis difficult. Determination of the cause of the liver involvement is important to select treatment and to evaluate the prognosis of the disease.The aim of the research was to characterize the clinical features of liver involvement in patients with systemic lupus erythematosus and identify the most significant clinical and laboratory parameters for the differential diagnosis of lupus hepatitis.Materials and methods. The study included 313 patients with systemic lupus erythematosus observed in the E.M. Tareev Clinic of Rheumatology, Internal Medicine and Occupational Diseases of I.M. Sechenov First Moscow State Medical University (Sechenov University) in the period from 2001 to 2019. The verification of diagnosis of systemic lupus erythematosus was based on the criteria of the American College of Rheumatology (1997). Patients examination included complete blood count, biochemical and immunological blood tests and an abdominal ultrasonography. In 13 cases hepatic autoantibodies (ASMA, anti-LKM-1, LC-1, SLA-LP, AMA-M2) were analyzed, in 4 – magnetic resonance cholangiopancreatography and in 6 – liver biopsy were made.Results. Liver involvement were represented by an increase of liver enzymes in 58 (18.5%) cases. Chronic viral hepatitis C was diagnosed in 4 (1.3%) patients. Drug-induced hepatitis was found in 17 (5.4%) patients. Autoimmune liver diseases occured in 2 (0.6%) patients. In 2 (0.6%) patients, liver damage was associated with thrombotic microangiopathy (atypical hemolytic uremic syndrome, hereditary thrombophilia). In 15 (4.8%) cases, the most likely diagnosis was NAFLD. Lupus hepatitis was the most likely cause in 18 (5.7%) patients. Differential diagnosis in cases of liver involvement in patients with systemic lupus erythematosus requires assessment of risk factors for various liver diseases, age of the patients, level of liver enzymes, lupus activity, ultrasound signs of liver steatosis and secondary antiphospholipid syndrome.Determining the cause of the liver involvement for the patients with the systemic lupus erythematosus allows establishing better treatment tactic and improvement of the prognosis.

scholarly journals PITYRIASIS LICHENOID AND ACUTE VARIOLIFORM AS A DIFFERENTIAL DIAGNOSIS OF SEVERE CUTANEOUS ACTIVITY IN SYSTEMIC LUPUS ERYTHEMATOSUS: A CASE REPORT

2021 ◽  
Author(s):  
Raquel Maria de Morais Pereira ◽  
Lorena Praia de Souza Bezerra ◽  
Barbara Carneiro Seabra ◽  
Jessica Carvalho da Silva ◽  
Thayana Evelyn Uchoa ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Differential Diagnosis ◽  
Case Report ◽  
Lupus Erythematosus ◽  
Systemic Lupus

Systemic lupus erythematosus—clinical features and aetiopathogenesis

2013 ◽  
pp. 923-937
Author(s):  
Caroline Gordon
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Differential Diagnosis ◽  
Autoimmune Disease ◽  
Clinical Features ◽  
Lupus Erythematosus ◽  
Immune Complexes ◽  
Clinical Manifestations ◽  
Systemic Lupus ◽  
Life Threatening ◽  
Symptoms And Signs

Systemic lupus erythematosus (SLE or lupus) is a multisystem, autoimmune disease associated with the formation of autoantibodies that form pathological immune complexes and activate a number of inflammatory pathways. The disease is characterized by remissions and relapses (flares) that can present with a variety of clinical manifestations. The symptoms and signs may range from mild features that can be treated easily to organ and even life threatening manifestations requiring potent immunosuppression. This chapter will review the epidemiology and pathology of lupus, then the clinical features including differential diagnosis and investigation of adult patients with SLE. Finally the classification, diagnosis, monitoring and outcome of lupus patients will be discussed.

Discovery of new serum biomarker panels for systemic lupus erythematosus diagnosis

Rheumatology ◽  
2020 ◽  
Vol 59 (6) ◽  
pp. 1416-1425
Author(s):  
Hua-Zhi Ling ◽  
Shu-Zhen Xu ◽  
Rui-Xue Leng ◽  
Jun Wu ◽  
Hai-Feng Pan ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Logistic Regression ◽  
Differential Diagnosis ◽  
Healthy Volunteers ◽  
Lupus Erythematosus ◽  
Clinical Characteristics ◽  
Systemic Lupus ◽  
Control Groups ◽  
Systematic Screening ◽  
Systemic Lupus Erythematosus Diagnosis

Abstract Objective Clinical diagnosis of SLE is currently challenging due to its heterogeneity. Many autoantibodies are associated with SLE and are considered potential diagnostic markers, but systematic screening and validation of such autoantibodies is lacking. This study aimed to systematically discover new autoantibodies that may be good biomarkers for use in SLE diagnosis. Methods Sera from 15 SLE patients and 5 healthy volunteers were analysed using human proteome microarrays to identify candidate SLE-related autoantibodies. The results were validated by screening of sera from 107 SLE patients, 94 healthy volunteers and 60 disease controls using focussed arrays comprised of autoantigens corresponding to the identified candidate antibodies. Logistic regression was used to derive and validate autoantibody panels that can discriminate SLE disease. Extensive ELISA screening of sera from 294 SLE patients and 461 controls was performed to validate one of the newly discovered autoantibodies. Results A total of 31, 11 and 18 autoantibodies were identified to be expressed at significantly higher levels in the SLE group than in the healthy volunteers, disease controls and healthy volunteers plus disease control groups, respectively, with 25, 7 and 13 of these differentially expressed autoantibodies being previously unreported. Diagnostic panels comprising anti-RPLP2, anti-SNRPC and anti-PARP1, and anti-RPLP2, anti-PARP1, anti-MAK16 and anti- RPL7A were selected. Performance of the newly discovered anti-MAK16 autoantibody was confirmed by ELISA. Some associations were seen with clinical characteristics of SLE patients, such as disease activity with the level of anti-PARP1 and rash with the level of anti-RPLP2, anti-MAK16 and anti- RPL7A. Conclusion The combined autoantibody panels identified here show promise for the diagnosis of SLE and for differential diagnosis of other major rheumatic immune diseases.

Acute hypomania in systemic lupus erythematosus, differential diagnosis. A case report

2016 ◽  
Vol 33 (S1) ◽  
pp. S393-S393 ◽  
Author(s):  
D.K. Ochoa García ◽  
G.M. Chauca Chauca ◽  
L. Carrión Expósito
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Bipolar Disorder ◽  
Differential Diagnosis ◽  
Case Report ◽  
Lupus Erythematosus ◽  
Depressive Episode ◽  
Psychiatric Symptoms ◽  
Brain Mri ◽  
Systemic Lupus ◽  
Neuropsychiatric Sle

IntroductionIt is well known that seizures and psychosis are diagnostic criteria for systemic lupus erythematosus (SLE), however, there could be many other neuropsychiatric symptoms. The American College of Rheumatology Nomenclature provides case definitions for 19 neuropsychiatric syndromes seen in SLE (NPSLE), including cognitive impairment, psychosis, mood and anxiety disorders. Lack of specific manifestations difficult diagnosis and treatment.ObjectivesTo address the diagnostic difficulties that involve the appearance of hypomanic symptoms in the course of SLE treated with high doses of corticoids in a patient with a depressive episode history.MethodDescription of case report and literature revision. We report the case of a 22-year-old woman who presented irritable mood, sexual disinhibition, insomnia and inflated self-esteem. The patient was recently diagnosed with SLE and was on treatment with 50 mg/d prednisone. She had familiar history for bipolar disorder and was taking 20 mg/d paroxetine since the last 6 months after being diagnosed with major depressive episode.ResultsWe proposed differential diagnosis between psychiatric symptoms secondary to central nervous system SLE involvement, a comorbid bipolar disorder or prednisone-induced mood symptoms. Fluctuation of hypomanic symptoms during hospitalization, poor relationship with variation in corticosteroid doses, findings on brain MRI compatible with vasculitis and positive antibodies, oriented this case to a neuropsychiatric manifestation of LES.ConclusionsWe should keep in mind that symptoms of neuropsychiatric SLE may vary from more established manifestations of NPSLE to mild diffuses ones. More studies are needed to expand knowledge in the relationship between mood disorders and neuropsychiatric SLE.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Psychosis in patients with systemic lupus erythematosus

2011 ◽  
Vol 26 (S2) ◽  
pp. 895-895
Author(s):  
S. Yelmo Cruz ◽  
V. Barrau Alonso ◽  
M. Salinas Muñoz
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Differential Diagnosis ◽  
Psychiatric Disorders ◽  
Lupus Erythematosus ◽  
Oral Prednisone ◽  
Systemic Lupus ◽  
Cns Lupus ◽  
Positive Ratio ◽  
Low Levels ◽  
Blood Brain Barrier Damage

IntroductionSystemic Lupus Erythematosus (SLE) can affect central nervous system (CNS), leading to neurological and/or psychiatric disorders. The use of corticosteroids for the management of SLE may induce psychiatric disorders.ObjectivesDifferential diagnosis of the origin of psychosis in patients with SLE (CNS lupus vs. induced by corticosteroid therapy).Methods and resultsA 22 year old female patient presented asthenia, oral bleeding, epistaxis, metrorrhagia, bicytopenia, hypoalbuminemia, low complement, with anti-DNA > 300, ANA, IgG Anticardiolipin, Anti-Sm, anti-RNP, anti-Ro, Anti-La and Anti-Histone positive.A diagnosis of SLE was made. She presented also diffuse grade IV nephritis. There were administered 3 iv 6-methylprednisolone pulse therapies (750 mg/day) with a cycle of cyclophosphamide. Subsequently she continued with oral prednisone 60 mg/day. Four days after the end of the pulses, the patient developed anxiety, suspicion, injury delusions, auditory hallucinations and behavioral disinhibition. A MRI was normal. Risperidone was started up to 6 mg/day and oral prednisone was tapered. After a progressive improvement she was discharged.ResultsCorticosteroids induce psychiatric disorders in 3–10% of patients. Low levels of complement, hypoalbuminemia and a positive ratio (≥ 9) of albumin in CSF x103/serum albumin are indicators of blood brain barrier damage and psychosis induced by corticosteroids. The presence of ac Antiribosoma P, ac antineuronals, MRI or EEG abnormals suggest the diagnosis of CNS lupus (lupus psychosis)ConclusionsDifferential diagnosis between lupus psychosis vs. psychosis induced by corticosteroids is complicated. In case of doubt, some authors advocate increasing the dose of steroids and awaiting a clinical response. Others advocate rapid tapering and stopping steroids.

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