Systemic Lupus Erythematosus Flared up After Rifampicin During Active Pulmonary Tuberculosis

2017 ◽  
Vol 68 (9) ◽  
pp. 2160-2161
Author(s):  
Paraschiva Postolache ◽  
Edith Simona Ianosi ◽  
Gabriela Jimborean
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Pulmonary Tuberculosis ◽  
Lupus Erythematosus ◽  
Antinuclear Antibodies ◽  
Clinical Status ◽  
Immunosuppressive Drugs ◽  
Systemic Lupus Erythematous ◽  
Systemic Lupus ◽  
Active Pulmonary Tuberculosis ◽  
Antituberculous Treatment

The present study describes a systemic lupus erythematous (SLE) flared up after Rifampicin during active pulmonary tuberculosis (TB). A 20-year-old female was hospitalized for cough, weight loss, and apical infiltrates. Microscopy from bronchial lavage confirmed TB. After 1 week of antituberculous treatment we noted diffuse purpura, oral/nasal ulcers, leukopenia, nephritis, antinuclear antibodies, low complement (criteria for SLE). We excluded Rifampicin and introduced immunosuppressive drugs and other reserve antibiotics for TB. Clinical status improved after 2 weeks and TB cured after 9 months. Rifampicin may flare up a subjacent unknown SLE. SLE is a risk factor for TB.

Organized Intraglomerular Deposits in NZB Mouse Disease

1971 ◽  
Vol 29 ◽  
pp. 544-545
Author(s):  
Francis R. Comerford ◽  
Alan S. Cohen
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Lupus Erythematosus ◽  
Antinuclear Antibodies ◽  
Human Systemic Lupus Erythematosus ◽  
Systemic Lupus ◽  
Glomerular Lesion ◽  
Ultrastructural Studies ◽  
Dense Deposits ◽  
Experimental Nephritis ◽  
Glomerular Lesions

Mice of the inbred NZB strain develop a spontaneous disease characterized by autoimmune hemolytic anemia, positive lupus erythematosus cell tests and antinuclear antibodies and nephritis. This disease is analogous to human systemic lupus erythematosus. In ultrastructural studies of the glomerular lesion in NZB mice, intraglomerular dense deposits in mesangial, subepithelial and subendothelial locations were described. In common with the findings in many examples of human and experimental nephritis, including many cases of human lupus nephritis, these deposits were amorphous or slightly granular in appearance with no definable substructure.We have recently observed structured deposits in the glomeruli of NZB mice. They were uncommon and were found in older animals with severe glomerular lesions by morphologic criteria. They were seen most commonly as extracellular elements in subendothelial and mesangial regions. The deposits ranged up to 3 microns in greatest dimension and were often adjacent to deposits of lipid-like round particles of 30 to 250 millimicrons in diameter and with amorphous dense deposits.

scholarly journals A case of SLE with COVID-19 and multiple infections

Open Medicine ◽  
2020 ◽  
Vol 15 (1) ◽  
pp. 1054-1060
Author(s):  
Ruoqi Ning ◽  
Silu Meng ◽  
Fangxu Tang ◽  
Chong Yu ◽  
Dong Xu ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Severe Acute Respiratory Syndrome ◽  
Lupus Erythematosus ◽  
Influenza A ◽  
Immunosuppressive Drugs ◽  
Multiple Infections ◽  
Systemic Lupus ◽  
Suspected Infection ◽  
Global Pandemic ◽  
Chronic Use

AbstractThe coronavirus disease 2019 (COVID-19) has become a global pandemic, which is induced by infection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Patients with systemic lupus erythematosus (SLE) are susceptible to infections due to the chronic use of immunosuppressive drugs and the autoimmune disorders. Now we report a case of SLE infected with SARS-CoV-2, influenza A virus and Mycoplasma pneumoniae concurrently. The patient used hydroxychloroquine and prednisone chronically to control the SLE. After infection of SARS-CoV-2, she was given higher dose of prednisone than before and the same dosage of hydroxychloroquine. Besides, some empirical treatments such as antiviral, antibiotic and immunity regulating therapies were also given. The patient finally recovered from COVID-19. This case indicated that hydroxychloroquine may not be able to fully protect SLE patient form SARS-CoV-2. Intravenous immunoglobulin therapies and increased dose of corticosteroids might be adoptable for patient with both COVID-19 and SLE. Physicians should consider SARS-CoV-2 virus test when SLE patient presented with suspected infection or SLE flare under the epidemic of COVID-19.

Clinical and immunological characteristics of 150 systemic lupus erythematosus patients in Jamaica: a comparative analysis

Lupus ◽  
2017 ◽  
Vol 26 (13) ◽  
pp. 1448-1456 ◽  
Author(s):  
K C Maloney ◽  
T S Ferguson ◽  
H D Stewart ◽  
A A Myers ◽  
K De Ceulaer
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Lupus Nephritis ◽  
Disease Activity ◽  
Renal Biopsy ◽  
Diagnostic Criteria ◽  
Lupus Erythematosus ◽  
Antinuclear Antibodies ◽  
Damage Index ◽  
Systemic Lupus ◽  
Dsdna Antibodies

Background Epidemiological studies in systemic lupus erythematosus have been reported in the literature in many countries and ethnic groups. Although systemic lupus erythematosus in Jamaica has been described in the past, there has not been a detailed evaluation of systemic lupus erythematosus patients in urban Jamaica, a largely Afro-Caribbean population. The goal of this study was to describe the clinical features, particularly disease activity, damage index and immunological features, of 150 systemic lupus erythematosus subjects. Methods 150 adult patients (≥18 years) followed in rheumatology clinic at a tertiary rheumatology hospital centre (one of two of the major public referral centres in Jamaica) and the private rheumatology offices in urban Jamaica who fulfilled Systemic Lupus International Collaborating Clinics (SLICC) criteria were included. Data were collected by detailed clinical interview and examination and laboratory investigations. Hence demographics, SLICC criteria, immunological profile, systemic lupus erythematosus disease activity index 2000 (SLEDAI-2K) and SLICC/American College of Rheumatology (ACR) damage index (SDI) were documented. Results Of the 150 patients, 145 (96.7%) were female and five (3.3%) were male. The mean age at systemic lupus erythematosus onset was 33.2 ± 10.9. Mean disease duration was 11.3 ± 8.6 years. The most prevalent clinical SLICC criteria were musculoskeletal, with 141 (94%) of subjects experiencing arthralgia/arthritis, followed by mucocutaneous manifestations of alopecia 103 (68.7%) and malar rash 46 (30.7%), discoid rash 45 (30%) and photosensitivity 40 (26.7%). Lupus nephritis (biopsy proven) occurred in 42 (28%) subjects and 25 (16.7%) met SLICC diagnostic criteria with only positive antinuclear antibodies/dsDNA antibodies and lupus nephritis on renal biopsy. The most common laboratory SLICC criteria were positive antinuclear antibodies 136 (90.7%) followed by anti-dsDNA antibodies 95 (63.3%) and low complement (C3) levels 38 (25.3%). Twenty-seven (18%) met SLICC diagnostic criteria with only positive antinuclear antibodies/anti-dsDNA antibodies and lupus nephritis on renal biopsy. Mean SLEDAI score was 6.9 ± 5.1 with a range of 0–32. Organ damage occurred in 129 (86%) patients; mean SDI was 2.4 ± 1.8, with a range of 0–9. Conclusion These results are similar to the clinical manifestations reported in other Afro-Caribbean populations; however, distinct differences exist with respect to organ involvement and damage, particularly with respect to renal involvement, which appears to be reduced in our participants.

scholarly journals A patient with systemic lupus erythematosus and lupus nephritis: A 12-year follow-up

2011 ◽  
Vol 68 (8) ◽  
pp. 705-708
Author(s):  
Natasa Jovanovic ◽  
Jasmina Markovic-Lipkovski ◽  
Stevan Pavlovic ◽  
Biljana Stojimirovic
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Nephrotic Syndrome ◽  
Mycophenolate Mofetil ◽  
Lupus Nephritis ◽  
Lupus Erythematosus ◽  
Kidney Biopsy ◽  
Immunosuppressive Drugs ◽  
Systemic Lupus ◽  
Younger Women ◽  
The Right

Introduction. Systemic lupus erythematosus (SLE) is a chronic immunological disease causing a significant morbidity and mortality in younger women and involving several organs and systems, most often the kidneys, being consequently the incidence of lupus nephritis (LN) about 60%. Case report. We reported a 57 year-old patient with the diagnosed SLE in 1995. Pathohistological analysis of kidney biopsy revealed LN type V. The patient was treated with corticosteroid pulses and azathioprine during one year. A remission was achieved and maintained with prednisone, 15 mg daily. Nephrotic relapse was diagnosed in 2006 and the second kidney biopsy revealed recent kidney infarction due to extensive vasculitis. Soon, a cerebrovascul insult developed and CT-scan revealed endocranial infarctus. The patient was treated with corticosteroids and cyclophosphamide pulses (totally VI monthly pulses), and also with low-molecular heparine, anticoagulants and salicylates because of the right leg phlebothrombosis. After the pulses, the patient was adviced to take prednisone 20 mg daily and azothioprine 100 mg daily, and 6 months later mycophenolate mofetil because of persistent active serological immunological findings (ANA 1 : 320) and nephrotic syndrome. Mycophenolate mofetil was efficient in inducing and maintaining remission of nephrotic syndrome. Conclusion. The aim of LN treatment is to achieve and maintain remission, improve patients? outcome, reduce the toxicity of immunosuppressive drugs and the incidence of relapses. Mycophenolate mofetil was shown to be efficient in inducing and maintaining remission of nephrotic syndrome in the frame of LN.

Inhibition of Adenovirus DNA Synthesis In Vitro by Sera from Patients with Systemic Lupus Erythematosus

1982 ◽  
Vol 2 (12) ◽  
pp. 1492-1500
Author(s):  
Marshall S. Horwitz ◽  
Beth R. Friefeld ◽  
Harold D. Keiser
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Dna Synthesis ◽  
Lupus Erythematosus ◽  
Inhibitory Activity ◽  
Antinuclear Antibodies ◽  
Dna Binding Protein ◽  
Systemic Lupus ◽  
Double Stranded Dna ◽  
The Individual

Sera containing antinuclear antibodies from patients with systemic lupus erythematosus (SLE) and related disorders were tested for their effect on the synthesis of adenovirus (Ad) DNA in an in vitro replication system. After being heated at 60°C for 1 h, some sera from patients with SLE inhibited Ad DNA synthesis by 60 to 100%. Antibodies to double-stranded DNA were present in 15 of the 16 inhibitory sera, and inhibitory activity copurified with anti-double-stranded DNA in the immunoglobulin G fraction. These SLE sera did not inhibit the DNA polymerases α, β, γ and had no antibody to the 72,000-dalton DNA-binding protein necessary for Ad DNA synthesis. The presence of antibodies to single-stranded DNA and a variety of saline-extractable antigens (Sm, Ha, nRNP, and rRNP) did not correlate with SLE serum inhibitory activity. Methods previously developed for studying the individual steps in Ad DNA replication were used to determine the site of inhibition by the SLE sera that contained antibody to double-stranded DNA. Concentrations of the SLE inhibitor that decreased the elongation of Ad DNA by greater than 85% had no effect on either the initiation of Ad DNA synthesis or the polymerization of the first 26 deoxyribonucleotides.

Changes in the blood level, efficacy, and safety of tacrolimus in pregnancy and the lactation period in patients with systemic lupus erythematosus

Lupus ◽  
2018 ◽  
Vol 27 (14) ◽  
pp. 2245-2252 ◽  
Author(s):  
Y Hiramatsu ◽  
S Yoshida ◽  
T Kotani ◽  
E Nakamura ◽  
Y Kimura ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Lupus Erythematosus ◽  
Immunosuppressive Drugs ◽  
Lactation Period ◽  
Second Trimester ◽  
Efficacy And Safety ◽  
Systemic Lupus ◽  
Breastfed Infants ◽  
Arterial Blood ◽  
Trough Concentrations

Objectives We investigated the efficacy and safety of tacrolimus (TAC) by monitoring its serum concentration for mothers and infants in pregnant patients with systemic lupus erythematosus (SLE). Methods We measured trough concentrations of TAC in 25 pregnant patients with SLE to assess influence of TAC on the disease activity. Additionally, we measured the concentrations of TAC in umbilical arterial blood, breast milk, and breastfed infants to investigate the safety of TAC for the mothers and infants. Results The trough concentrations of TAC in the mothers significantly decreased in the second trimester as compared with those before pregnancy. However, the decrease in the trough concentrations of TAC did not lead to the deterioration of SLE. When examined, the doses of TAC were significantly lower in the second trimester and postpartum in the deteriorating group than those in the non-deteriorating group. There were no adverse events by TAC in mothers and fetuses. The concentrations of TAC in the umbilical cord blood were lower than those in the maternal blood. The relative infant dose in breastfed infants of TAC was < 1%. The level of TAC in infant bloods was below detectable limits. Conclusion These findings suggest that TAC is one of the most effective and safest immunosuppressive drugs for use in pregnant patients with SLE.

The Early Protective Effect of Hydroxychloroquine on the Risk of Cumulative Damage in Patients with Systemic Lupus Erythematosus

2013 ◽  
Vol 40 (6) ◽  
pp. 831-841 ◽  
Author(s):  
Pooneh S. Akhavan ◽  
Jiandong Su ◽  
Wendy Lou ◽  
Dafna D. Gladman ◽  
Murray B. Urowitz ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Lupus Erythematosus ◽  
Conditional Logistic Regression ◽  
Univariate Analysis ◽  
Damage Index ◽  
Immunosuppressive Drugs ◽  
Clinical Effects ◽  
Systemic Lupus ◽  
Steroid Dose ◽  
Damage Accrual

Objective.To assess whether hydroxychloroquine (HCQ) prevents early damage in patients with systemic lupus erythematosus (SLE).Methods.We updated an existing systematic review of literature on clinical effects of HCQ in patients with SLE. We conducted a nested case-control study embedded in an inception cohort of patients with SLE. Systemic Lupus International Collaborating Clinics Damage Index (SDI) at 3 years was considered as our primary outcome. Patients with SDI > 0 at 3 years were considered cases and patients with SDI = 0 were controls. Cases and controls were first compared by univariate analysis. Then conditional logistic regression models adjusting for potential confounders were done to study the effect of HCQ on damage accrual.Results.Included in the analysis were 481 patients who had 3 or more years of followup. Out of this cohort, we could match 151 cases with 151 controls. Univariate analysis identified age, the use of any immunosuppressive drugs, HCQ, and cumulative dose of steroids as significant covariates associated with damage accrual. In multivariate analysis, the use of HCQ remained significantly associated with less damage (OR 0.34, 95% CI 0.132–0.867), while age (OR 1.05, 95% CI 1.027–1.078) and a variable combining SLE activity and steroid dose (OR 1.73, 95% CI 1.306–2.295) were associated with damage at 3 years.Conclusion.We demonstrated that HCQ use was associated with less damage at 3 years after diagnosis of SLE when attention was given and adjustment done for disease activity and steroid dose, duration of disease, and calendar year of diagnosis.

scholarly journals Hubungan Derajat Aktivitas Penyakit Lupus Eritematosus Sistemik Berdasarkan Skor Mex-Sledai Dengan Kejadian Anemia Pada Penderita Lupus Eritematosus Sistemik Di Komunitas Odapus Lampung

2021 ◽  
Vol 3 (2) ◽  
pp. 192-202
Author(s):  
Rina Kirwiastiny ◽  
Ringgo Alfarisi ◽  
Hidayat Hidayat ◽  
Ageel Al-Aziz Marjaen
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Chronic Disease ◽  
Lupus Erythematosus ◽  
Deficiency Anemia ◽  
P Value ◽  
Systemic Lupus Erythematous ◽  
Systemic Lupus ◽  
Immune Disease ◽  
Cross Sectional ◽  
Sledai Score

ABSTRACT : RELATIONSHIP OF SYSTEMIC LUPUS ERYTHEMATOSUS ACTIVITIES BASED ON MEX-SLEDAI SCORE WITH INCIDENCE OF ANEMIA IN SYSTEMIC LUPUS ERYTHEMATOUS PATIENTS IN THE ODAPUS LAMPUNG COMMUNITY, 2020Background : Systemic Lupus Erytematosus (SLE) is a complex autoimmune disease characterized by the presence of autoantibodies against the cell nucleus and involving many organ systems in the body. Anemia in LES patients varies between chronic disease anemia, hemolytic anemia, blood loss, renal insufficiency, infection, myelodysplasia, and aplastic anemia. What often occurs in LES anemia is due to erythropoesis suppression due to chronic inflammation. Anemia in LES patients is an immune or non-immune disease. Anemia is a non-immune disease is anemia in chronic disease, iron deficiency anemia, sideroblastic anemia, anemia in kidney disease, anemia indicated by drugs, and anemia secondary to other diseases (eg sickle cell anemia).Research purposes : This study was to determine the degree of activity of systemic lupus erythematosus based on max-sledai and hemoglobin levels in systemic lupus erythematous patients in the ODAPUS Lampung community in 2020.Methode :The analytical observational method was used using a cross sectional approach. The research subjects were 30 respondents who used the total sampling technique from members of the ODAPUS Lampung community by conducting MEX-SLEDAI interviews and blood sampling conducted from November 2019 to February 2020. Statistical test used Fisher exact test.Results: From 30 study subjects, disease activity based on MEX-SLEDAI was above the average of 21 patients (70%). And the results of blood tests were 18 patients (60%) who were not anemia and 12 patients (40%) had anemia.Conclusion     : There was a significant relationship between the degree of activity of Systemic Lupus Erythematosus based on the MEX-SLEDAI score and the incidence of anemia with p value = 0.024 meaning the p value ≤ 0.05. Keywords      : LES; Incidence of Anemia; MEX-SLEDAI    INTISARI : HUBUNGAN DERAJAT AKTIVITAS PENYAKIT LUPUS ERITEMATOSUS SISTEMIK BERDASARKAN SKOR  MEXSLEDAI DENGAN KEJADIAN ANEMIA PADA PENDERITA LUPUS ERITEMATOUS SISTEMIK DI KOMUNITAS ODAPUS LAMPUNG  Latar belakang : Systemic Lupus Erytematosus (SLE) merupakan penyakit autoimun yang kompleks ditandai oleh adanya autoantibodi terhadap inti sel dan melibatkan banyak sistem organ dalam tubuh. Anemia pada pasien LES bervariasi antara anemia penyakit kronis, anemia hemolitik, kehilangan darah, insufisiensi ginjal, infeksi, mielodisplasia, dan anemia aplastik. Yang sering terjadi anemia pada LES disebabkan supresi eritropoesis karena inflamasi yang kronis.  Anemia pada pasien LES merupakan penyakit imun atau non-imun. Anemia merupakan penyakit non-imun adalah anemia pada penyakit kronik ,anemia defisiensi besi, anemia sideroblastik, anemia pada penyakit ginjal, anemia indikasi obat, dan anemia sekunder terhadap penyakit lain ( misalnya anemia sel sabit ).Tujuan Penelitian : Penelitian ini untuk mengetahui hubungan drajat aktivitas penyakit lupus eritematosus sistemik berdasarkan max-sledai dengan kadar hemoglobin pada penderita lupus eritematous sistemik di komunitas ODAPUS lampung tahun 2020.Metode : Digunakan metode observasional analitik menggunakan pendekatan cross sectional. Subjek penelitian sebanyak 30 responden yang menggunakan teknik total sampling dari anggota komunitas ODAPUS Lampung dengan melakukan wawancara MEX-SLEDAI dan pengambilan sampel darah yang dilakukan pada bulan November 2019 s/d Februari 2020. Uji statistic menggunakan Fisher exact test.Hasil : Dari 30 subjek penelitian didapatkan aktifitas penyakit berdasarkan MEX-SLEDAI di atas rata – rata sebanyak 21 pasien (70%). Dan hasil peneriksaan darah yaitu 18 pasien (60%) yang Tidak anemia dan yang mengalami Anemia ada 12 pasien (40%).Kesimpulan   : Terdapat hubungan bermakna antara derajat aktivitas penyakit Lupus Eritematosus Sistemik berdasarkan skor MEX-SLEDAI dengan Kejadian Anemia dengan p value =0.024 berarti nilai p value ≤ 0.05. Kata Kunci     : LES; Kejadian Anemia; MEX-SLEDAI

scholarly journals Immune deposit and vasculopathy in metabolic-active lung tissues of patients with pulmonary tuberculosis

2021 ◽  
Author(s):  
Hui Ma ◽  
Lin Wang ◽  
Zilu Wen ◽  
Xinchun Chen ◽  
Haiying Liu ◽  
...  
Keyword(s):  
Gene Expression ◽  
Systemic Lupus Erythematosus ◽  
Inflammatory Response ◽  
Pulmonary Tuberculosis ◽  
Autoimmune Diseases ◽  
Metabolic Activity ◽  
Lupus Erythematosus ◽  
Immune Complexes ◽  
Systemic Lupus ◽  
Dsdna Antibodies

ABSTRACTMetabolic activity in pulmonary lesion is associated with disease severity and relapse risk in tuberculosis. However, the nature of the metabolic activity associated with tuberculosis in humans remains unclear. Previous works indicate that tuberculosis bears resemblance transcriptionally with systemic lupus erythematosus in peripheral blood, except that the plasma cell component was absent in tuberculosis. Here we reported that the missing transcriptional component was present within the metabolic active tissues in the lung of patients with sputum culture-negative tuberculosis, within which increased levels of circulating immune complexes and anti-dsDNA antibodies were found relative to nearby non-metabolic active tissues. Histological examination revealed specific vascular deposition of immune complexes, neutrophil extracellular traps, and vascular necrosis in the metabolic-active tissue. Thus, tuberculosis-initiated metabolic activity was associated with hyperactive antibody responses and vascular pathology, and shared features with systemic lupus erythematosus and other autoimmune diseases. We discussed these observations in the context of earlier literatures demonstrating that similar effects could be induced in humans and animal models by complete freund’s adjuvant, the most potent antibody response inducer ever reported. Our small case series, if verified in a larger size study, might help inform host-directed therapies to alleviate disease progression and augment treatment efficacy.IMPORTANCEIn patients with pulmonary tuberculosis, lung tissues were destroyed by a hyperactive inflammatory response towards M. tuberculosis. The mechanisms underlying the inflammatory response are still poorly understood. Using 18F-FDG avidity as a surrogate marker of inflammation, we have identified that hyper-inflamed tissues possessed features associated with systemic lupus erythematosus: gene expression signatures of plasma cell and immunoglobulins and increased levels of anti-dsDNA antibodies, immune deposits, and vasculopathy. This observation might suggest an explanation to why patients with tuberculosis share more gene expression signatures with autoimmune diseases than infectious diseases and why they are more likely to develop autoimmune diseases. Defining the inflammatory responses at the lesion could help inform host-directed therapies to intervene disease progression or even accelerate cure.

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