First-degree atrioventricular block: A rare manifestation in systemic lupus erythematosus

A 23-year-old woman with fever, oral ulcers, arthalgias and weight loss of 2-week duration suddenly developed blurred vision, with reduced visual acuity, cotton wool exudates and retinal vascular tortuosity. Laboratory testing revealed anaemia, lymphopaenia, positive antinuclear antibody and high anti-dsDNA antibody titre with low complement components. There was no evidence of infection, clinching the diagnosis of lupus retinopathy. Steroid therapy alone was highly effective and was also accompanied by a normalisation of haemoglobin and lymphocyte counts, after which azathioprine was added. Hydroxychloroquine was introduced after resolution of retinal changes. Immunosuppressive therapy was progressively tapered over the course of 12 months and then discontinued, and the patient remains in remission 48 months after the initial presentation. Our patient exemplifies a very rare manifestation of systemic lupus erythematosus. We emphasise the importance of its early detection and complexity of treatment in order to reduce visual morbidity.

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Complete atrioventricular block in a woman with systemic lupus erythematosus

International Journal of Cardiology ◽

10.1016/s0167-5273(01)00590-3 ◽

2002 ◽

Vol 82 (3) ◽

pp. 289-292 ◽

Cited By ~ 9

Author(s):

José Javier Gómez-Barrado ◽

Juan Carlos Garcı́a-Rubira ◽

Miguel Angel Polo Ostáriz ◽

Soledad Turégano Albarrán

Keyword(s):

Systemic Lupus Erythematosus ◽

Atrioventricular Block ◽

Lupus Erythematosus ◽

Complete Atrioventricular Block ◽

Systemic Lupus ◽

Complete Atrioventricular

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Neonatal Lupus and Complete Atrioventricular Block: Case Report in Mexico

Cardiology and Angiology An International Journal ◽

10.9734/ca/2021/v10i330168 ◽

2021 ◽

pp. 1-7

Author(s):

Carla Eugenia Arenas Alvarez ◽

Juan Carlos Marin Mireles ◽

Hebert Israel Flores Leal ◽

Ana Norma Griselda Becerril Gonzalez ◽

Carlos Mario Guzman Sanchez

Keyword(s):

Systemic Lupus Erythematosus ◽

Atrioventricular Block ◽

Gestational Age ◽

Lupus Erythematosus ◽

Fetal Echocardiography ◽

Fetal Mortality ◽

Complete Atrioventricular Block ◽

Systemic Lupus ◽

Neonatal Lupus ◽

Complete Atrioventricular

Aims: To describe a case of neonatal lupus and complete atrioventricular block in Mexico. Presentation of case: A 38 years old pregnant patient at 28 + 6 weeks of gestational age, diagnosed with systemic lupus erythematosus six years ago, under treatment with hydroxychloroquine and prednisone, this was suspended eight months prior to pregnancy; and resumed at week 20 of gestational age. The ultrasound scan showed alive fetus, female, polyhydramnios and bradycardia. Fetal echocardiography confirmed complete atrioventricular block, without organic and structural alterations at the cardiac level. Furthermore, the immunological panel reports, positive anti-Ro antibodies. At week 33 of gestational age, the patient was admitted to the obstetric emergency room, through colic type pain and 4 cm dilation of the cervix. Alive newborn got vaginally with a weight of 1,990 g, a height of 43 cm and APGAR 8-9. Echocardiography confirmed congenital complete third degree atrioventricular block; without structural abnormalities. Discussion: Patients with systemic lupus erythematosus, are more likely to have complications during pregnancy. Neonatal lupus is a rare disorder with an incidence of 1:10,000 - 1:20,000 newborns. This is caused by the transplacental passage of maternal autoantibodies anti-SSA / Ro and/or anti-SSB / La. Besides Atrioventricular block is a complication of neonatal lupus, occurring in approximately 2% of newborns of mothers who have SSA or SSB antibodies. The most interesting finding is that 20% fetal mortality has been for this cause. Conclusion: The described case is important for its rarity. Besides, the imaging findings and immunological panel emphasized the relevance about complete and adequate evaluation of the fetus, in the context of a mother with systemic lupus erythematosus.

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Chorea as a First Manifestation in Young Patients with Systemic Lupus Erythematosus who Was Initially Diagnosed with Rheumatic Fever

Clinical Medicine Insights Case Reports ◽

10.4137/ccrep.s9143 ◽

2012 ◽

Vol 5 ◽

pp. CCRep.S9143 ◽

Cited By ~ 2

Author(s):

Jamal A Albishri

Keyword(s):

Systemic Lupus Erythematosus ◽

Rheumatic Fever ◽

Lupus Erythematosus ◽

Young Patients ◽

Systemic Lupus ◽

Incorrect Diagnosis ◽

Rare Manifestation ◽

Specific Increase ◽

Anti Phospholipid Syndrome

Chorea is a rare manifestation of systemic lupus erythematosus (SLE). We report on a young patient with chorea who was diagnosed initially with rheumatic fever. Follow up and further evaluation confirmed the diagnosis of SLE and anti-phospholipid syndrome. Of special interest were the negative antiphospholipid (aPL) antibodies and the initial diagnosis of rheumatic fever which is still not uncommon problem in our region. The rarity of such presentation with joint and non specific increase of antistreptolysin O (ASO) titer might be the factors that led to an incorrect diagnosis. Early diagnosis and treatment of SLE and anti-phospholipid syndrome are very crucial and should be considered with such presentation.

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Chorea, a rare manifestation of systemic lupus erythematosus. Case report

Journal of the Neurological Sciences ◽

10.1016/j.jns.2019.10.1033 ◽

2019 ◽

Vol 405 ◽

pp. 139

Author(s):

D. Rebolledo Garcia ◽

P.Ó. González Vargas ◽

D.L. Uriostegui Cordero

Keyword(s):

Systemic Lupus Erythematosus ◽

Case Report ◽

Lupus Erythematosus ◽

Systemic Lupus ◽

Systemic Lupus Erythematosus Case ◽

Rare Manifestation

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Severe brady-arrhythmias in systemic lupus erythematosus: prevalence, etiology and associated factors

Lupus ◽

10.1177/0961203318770526 ◽

2018 ◽

Vol 27 (9) ◽

pp. 1415-1423 ◽

Cited By ~ 8

Author(s):

K Tselios ◽

D D Gladman ◽

P Harvey ◽

J Su ◽

M B Urowitz

Keyword(s):

Systemic Lupus Erythematosus ◽

Atrioventricular Block ◽

Lupus Erythematosus ◽

Disease Duration ◽

Systemic Lupus ◽

Bundle Branch Block ◽

Potential Risk Factors ◽

Septal Hypertrophy ◽

Artery Disease ◽

Echocardiographic Findings

Background Severe brady-arrhythmias, requiring a permanent pacemaker (PPM), have been sparsely reported in systemic lupus erythematosus (SLE). The aim of this study was to describe the characteristics of such arrhythmias in a defined lupus cohort. Patients and methods The database of the Toronto Lupus Clinic ( n = 1366) was searched for patients who received a PPM. Demographic, clinical, immunological and therapeutic variables along with electrocardiographic (ECG) and echocardiographic findings (based on the last available test prior to PPM) were analyzed. Patients with a PPM (cases) were compared with age-, sex- and disease duration-matched patients without a PPM (controls). Analysis was performed with SAS 9.0; p < 0.05 was considered significant. Results Eighteen patients were identified, 13 (0.95%) with complete atrioventricular block and 5 (0.37%) with sick sinus syndrome. Disease duration at PPM implantation was 22 ± 12 years. Compared to controls, cases had more frequently coronary artery disease, hypertension, dyslipidemia and longer antimalarial (AM) treatment duration. The prevalence of first-degree atrioventricular block, right bundle branch block, left anterior fascicular block and septal hypertrophy was also higher. AM treatment was significantly associated with brady-arrhythmias (OR = 1.128, 95% CI = 1.003–1.267, p = 0.044). Nine patients had prior heart disease and one received a PPM two years after renal transplantation. Eight patients did not have any potential risk factors; prolonged AM therapy (mean 22 years) might have been the cause. Conclusions Apart from known causes, prolonged AM treatment may be associated with severe brady-arrhythmias in SLE. Certain ECG and echocardiographic characteristics may represent indicators of an ongoing damage in the conduction system.

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