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PubMedDate not supplied

Acute pancreatitis as the initial manifestation of systemic lupus erythematosus.

A 20-year-old female with three laboratory ARA criteria pro SLE (LE cells, FANA, and positive Coombs test with hemolytic anemia), not under steroid therapy, developed polyarthritis, erythematous rash and acute pancreatitis simultaneously. The latter regressed with high doses of 6-methylprednisolone. Twenty-five months after remission of pancreatitis, no new clinical manifestations (of SLE) have appeared. In another 74 cases of SLE with an average follow-up of 3 years and 8 months there were no other cases of pancreatitis.

Acute Disease↗
PubMedDate not supplied

[Immunologic anomalies in inflammatory diseases of connective tissue in children].

A comparison was made between the results of an analysis of humoral immunological changes in 64 cases of inflammatory diseases of the connective tissue of children (32 cases of ACJ, 5 cases of systemic lupus erythematosus, 2 cases of polymyositis, and 25 cases of systemic vasculitis), and data reported in recent literature, the authors conclude as follows:--changes of the immunological parameters that were tested support the hypothesis of a humoral immunopathogenic mechanism in systemic lupus erythematosus, in some of the manifestations of ACJ, and in systemic vasculitis;--of particular value for the immunological diagnosis of ACJ is the detection of FR in the patients' serum (and especially of FR from the IgG and the IgA class), as well as changes of immunological parameters of the articular fluid (the presence of FR, of immune complexes, a reduction of the titer intra-articular complement, the presence of ragocytes);--demonstration of humoral immunological changes (polyclonal hypergammaglobulinemia, the presence in the serum of circulating immune complexes, and of cryoglobulins, the low titer of serum complement in active stages, the presence of antinuclear antibodies, and especially of antinative DNA, the presence of LE cells in peripheral blood, and of a varied range of autoantibodies) is mandatory for the diagnosis of systemic lupus erythematosus;--in the present stage of our knowledge humoral immunologic changes are not an absolutely certified criterion for the diagnosis of polymyositis, and of some cases of systemic vasculitis (Henoch-Schoenlein purpura).

Antibody Formation↗
PubMed1989

[Clinical studies of 15 cases of progressive systemic sclerosis (PSS) associated with positive proteinuria and membranous glomerulonephritis].

In this study, we demonstrated that the patients with PSS who develop proteinuria during the course are much more prone to develop lung fibrosis, telangiectasia, serositis and esophageal hypomotility. They also exhibited positive LE cell phenomenon, lupus band test, thrombocytopenia and leukopenia. The mortality rate is significantly higher in proteinuria positive patients and abnormal clinical data described above seem to be the risk factors for the development of renal involvement in PSS.

Adult↗
PubMed1989

[Observation on the treatment of systemic lupus erythematous with a Gentiana macrophylla complex tablet and a minimal dose of prednisone].

Sixty-two cases of systemic lupus erythematous (SLE) treated with Tab. Gentiana macrophylla complex 5 tablets three times per day or 10 tablets twice per day and prednisone 10-30 mg per day were reported. As controls, 19 cases of SLE were treated with prednisone alone at the same time. The results showed complete remission in 86.46% (50/62) cases in the observation group and 31.57% (6/19) cases in the control group. Eight cases of SLE treated with Tab. Gentiana m. complex alone also achieved complete remission in 6 cases and improvement in 2. There was very significant statistical difference between the two groups (P less than 0.001). The Tab. Gentiana m. complex was more effective on the improvement of nephropathy, arthralgia, erythema and restoration of ESR, LE cells and CH50, C3 than prednisone alone. No apparent side effects of Tab. Gentiana m. complex were found in this observation.

Adolescent↗
PubMed1989

[A case of antigranulocyte antibody positive Felty's syndrome and its efficacy of plasmapheresis].

The patient is a 44-year-old female case of RA having a history of 10 years after onset, being admitted due to fever accompanied by granulocytopenia. By laboratory findings, WBC was 1,900/mm3, CRP 5+, RA 2+, RAHA 80 times, LE cells positive, antinuclear antibody strongly positive, granulocyte-specific antinuclear antibodies positive, and granulocyte specific cytotoxicity test strongly positive. Examination of bone marrow smears revealed, the cell numbers tended to decrease in the neutrophil maturity phase. The case was diagnosed as Felty's syndrome because of the obvious splenomegaly and leukopenia. Administration of 30 mg/day of prednisolone was not sufficient in effect, and plasmapheresis was conducted concomitantly. As a result, the granulocyte count increased and the granulocyte cytotoxicity titer was lowered. It is hence suggested that the antigranulocyte antibodies are responsible for the mechanism of granulocytopenia in this case, and the possibility of promotion of destruction in the periphery was inferred, and it is accordingly considered useful to combine administration of small dose of adrenocortical steroid preparation with plasmapheresis for the treatment of this disease.

Adult↗
PubMed1989

[An autopsy case of a patient with myasthenia gravis who showed various symptoms of collagen diseases and complicated with malignant thymoma].

A 37-year-old man suffered from photosensitivity and urinary casts with serological findings of positive anti-DNA antibody, LE cells and false positive VD reaction in September of 1979. He developed general fatigue, dyspnea and diplopia with ptosis of bilateral eyelids in November of 1979, which were improved by the anti-cholinesterase drugs. In January of 1980, he had an attack of unconsciousness and his chest X-ray film showed several tumorous shadows in the anterior mediastinum and middle and lower lung fields. Treating him with chemotherapy of VEMP, the pulmonary shadows disappeared. However, he developed severe muscle weakness with an elevated CPK (430 mU/ml) and a myogenic EMG pattern along with an increased anti-acetylcholine receptor antibody (243 n Mol/l), dysphagia and eyelid-ptosis. He died in September of 1985 and his autopsy disclosed a malignant thymoma of mixed type in the anterior mediastinum and an atrophy and fibrosis with infiltration of inflammatory cells in the striated muscles.

Adult↗
PubMedDate not supplied

Drug-induced systemic lupus erythematosus.

Systemic lupus erythematosus (SLE) induced by drugs, primarily hydralazine and procainamide, is reviewed and compared with idiopathic SLE, and the use of these drugs in patients with idiopathic SLE is discussed. The etiology of SLE is unclear, but genetic predisposition is an important factor. Although more than 25 drugs have been suggested as causes of SLE, the majority of confirmed cases of drug-induced SLE involve hydralazine or procainamide. Parts of these chemical compounds apparently interact with nucleoproteins, causing stimulation of antinuclear antibody (ANA) production. The average age of patients with drug-induced SLE is nearly twice that of patients with idiopathic SLE. Approximately half the patients with drug-induced SLE are women, compared with 92% of patients with idiopathic SLE. For SLE induced by hydralazine or procainamide, musculoskeletal symptoms (especially arthritis in the hands and wrists) are the most common clinical manifestation. In patients with SLE induced by these drugs, ANAs and LE cells are present, erythrocyte sedimentation rate is often elevated, and a false-positive serologic test for syphilis is seen more frequently than in idiopathic SLE. Baseline ANA status should be determined before therapy with these drugs, and patients should be observed carefully for signs and symptoms of SLE. Hydralazine-induced SLE may be dose related; limiting the daily dose to 200 mg is recommended. Some drugs have been shown to exacerbate idiopathic SLE; these include estrogen-containing oral contraceptives and ibuprofen. Hydralazine and procainamide are probably safe for use in patients with idiopathic SLE, but alternative therapy should be considered. The clinical and laboratory manifestations of drug-induced SLE are similar to those of idiopathic SLE, but central nervous system and renal involvement are rare in drug-induced SLE.

Adrenergic beta-Antagonists↗
PubMed1985

Antihypertensive activity of a new vasodilator, cadralazine, administered alone or in combination with a beta-blocker.

The antihypertensive activity of a new arterial dilator, cadralazine, was evaluated in 40 patients with mild-to-moderate arterial hypertension. Cadralazine was given once daily over 6 weeks, and blood pressure and heart rate were recorded 24-26 hours after dosing. Cadralazine dose was 10 mg daily initially, and 15 or 20 mg daily from the 3rd or 5th trial week according to a target diastolic pressure reduction to 95 mmHg or below. Slow-release metoprolol 200 mg once daily was added when heart rate increase exceeded 25% of the pretreatment value. Blood pressure showed a significant and progressive reduction throughout the study period, both in the patients receiving cadralazine as monotherapy (19 patients) and in those who added metoprolol (21 patients). The target diastolic pressure reduction was reached in 2 patients with the 10-mg dose, in 19 of the remaining 38 patients with the 15-mg dose, and in 13 of the other 19 patients with the 20-mg dose. Considering only those patients who did not add metoprolol, the target was reached in the 2 patients with the 10-mg dose, in 10 of the 19 patients with the 15-mg dose and in 7 of the 19 patients with the 20-mg dose. None of the laboratory tests showed clinically relevant changes. Neither LE cells nor antinuclear antibodies were found. In conclusion, cadralazine is a promising long-acting antihypertensive vasodilator. A clinically satisfactory antihypertensive effect is achieved mostly by a 15-mg or a 20-mg dose given once daily.(ABSTRACT TRUNCATED AT 250 WORDS)

Adrenergic beta-Antagonists↗
PubMedDate not supplied

[Systemic lupus erythematosus in pediatrics].

Herein we present our experience with 16 children in whom the diagnosis of SLE was established between May 1974 and April 1978. In eleven of them renal biopsy was performed. Five had family history of immunologic disease. Only one patient had history of anticonvulsant drug intake. The clinical picture resembles adult SLE, where the most frequent symptoms were arthritis, fever and dermatosis. Three patients showed focal proliferative glomerulonephritis; another 3, increased mesangial cellularity; 3 more presented diffuse proliferative glomerulonephritis and another one had membranous glomerulonephritis. LE cells, antinuclear antibodies, anti-DNA were present in various combinations in all patients. Treatment with an average dose of 22.8 mg/day of prednisone, plus immunosuppressive therapy in 9 patients, has allowed a 36 months survival in 13 patients. Progressive renal involvement and tuberculosis were the cause of death in 3 cases. Our results are compared with those in the literature.

Adolescent↗
PubMed1988

Antinuclear antibody-negative systemic lupus erythematosus (SLE) and severe renal involvement: close correlation between disease activity and appearance of circulating anticoagulant.

A 16-year-old girl meeting the criteria for SLE is described. Salient features of the clinical course included active glomerulonephritis with dense subepithelial deposits on electron microscopy, pulmonary embolism, axillary vein thrombosis, arthritis, serositis and fever. Disease activity correlated with the presence of lupus anticoagulant as measured by VDRL and partial thromboplastin time (PTT). Her serum was consistently negative to ANA, anti-DS-DNA, anti-SS-DNA, ENA, anti-Ro, anti-La, and LE cells for the entire 4-year course. She responded remarkably to prednisone and azathioprine. Reappearance of VDRL and elevated PTT preceded exacerbation of disease activity and served as a serological guide for modifying medical treatment.

Adolescent↗
PubMedDate not supplied

Plasma exchange and immunosuppressive therapy in a paediatric patient with systemic lupus erythematosus.

A case is reported of systemic lupus erythematosus (SLE) associated with steroid-resistant nephrotic syndrome. Serial plasma exchanges (PE) combined with prednisolone treatment induced complete normalization of the immunological findings: the anti-DNA antibody, antinuclear antibody, LE cell phenomenon and circulatory immune complexes became negative. The prostacyclin (PGI2) production-supporting activity in the plasma increased to the control range; inhibitors of PGI2 production were eliminated. The creatinine clearance normalized, the urinary protein excretion decreased significantly, and the facial erythema disappeared. Continued treatment with chlorambucil + low-dose prednisolone led to a complete and stable remission of the nephrotic syndrome, and the C3 complement normalized. The low level of PGI2 production-supporting activity in the plasma may be explained by the inhibitor of PGI2 production. PE + immunosuppressive therapy might have beneficial effects on the immunological changes and PGI2 metabolism, and also on the remission of SLE-nephrotic syndrome.

Autoantibodies↗
PubMed1986

Subclinical autoimmune disease and recurrent spontaneous abortion.

We describe a patient with no clinical complaints except 5 unexplained spontaneous abortions in whom investigations revealed a positive antinuclear factor, antibodies to native double-stranded DNA, LE cells, a positive Coombs' test, a positive lupus anticoagulant test, and anticardiolipin antibodies. Despite preeclampsia our patient successfully completed her 6th pregnancy after treatment with corticosteroids, subcutaneous heparin, and low dose aspirin throughout the pregnancy. Serial measurements of anticardiolipin antibody showed suppression of anticardiolipin antibody levels with corticosteroids. The response of the lupus anticoagulant was less obvious. No anticardiolipin antibodies were detected in the baby.

Abortion, Habitual↗
PubMed1986

[Rheumatic masking of bacterial endocarditis].

In 36 patients with bacterial endocarditis (BE) rheumatic symptoms were detected in 61.1%. Arthralgias and arthritides having some distinctive features typical of this disease, myalgia, rheumatoid factor and LE cells (less frequently) were observed in the overwhelming majority of the patients. The authors described 3 cases where rheumatic symptoms obscured a clinical picture of BE for a long time resulting in late diagnosis and inadequate therapy.

Adolescent↗
PubMed1973

Thymoma, myasthenia gravis, erythroblastopenic anemia and systemic lupus erythematosus in one patient.

A 50-year-old woman who initially had myasthenia gravis subsequently presented with thymoma, erythroblastopenic anemia and systemic lupus erythematosus during 17 years of follow-up. In a review of the literature no similar documented cases were found, although 14 patients were reported with three of the above diseases, two also having positive LE cell tests. An association of several autoimmune disorders in one patient may be more frequent than was previously believed.

Ambenonium Chloride↗
PubMed1966

Antinuclear antibodies and nuclear antigens.

The lupus erythematosus (LE) cell factor is one of a variety of heterogeneous antibodies directed against many nuclear antigens. These antinuclear antibodies are found in a wide variety of clinical disorders. As detected by immunofluorescence techniques, they are so frequently found in association with systemic lupus erythematosus that their absence essentially excludes that diagnosis. It is suggested that in certain situations other than systemic lupus, antinuclear antibodies may be the result of some inflammatory and destructive processes. Antinuclear antibodies may be detected in certain lower animals frequently in association with disease. In lower animals, immunization with nuclear antigens appropriately complexed* to protein carriers consistently results in the induction of antinuclear antibodies. In both man and animals, antinuclear antibodies are often detected without associated disease. Furthermore, antinuclear antibodies are not injurious to intact tissue culture cells. Nonetheless, antigen-antibody complexes consisting of nuclear antigens and antinuclear antibodies may contribute to the propagation of certain diseases, particularly lupus nephritis. The use of antinuclear antibodies as immunochemical tools holds great promise for the better understanding of such nuclear antigens as are found in viruses and in the nuclei of certain malignant cells.

Autoantibodies↗
PubMed1979

Nephrotic syndrome in procainamide induced lupus nephritis.

We report a case of the nephrotic syndrome occurring in a patient with procainamide induced LE. It was associated with bilateral pleural effusions, pericarditis, fever, positive LE cell preparation and a high titer of antinuclear antibodies. No anti-DNA antibodies were found. Renal biopsy showed mesangial proliferation with few IgM and C3 deposits and interstitial infiltrates; electron microscopy revealed subendothelial deposits. Clinical improvement occured after steroid therapy and there was no recurrence 24 months after withdrawal of prednisone.

Aged↗
PubMedDate not supplied

Procainamide-induced lupus erythematosus: report of a case with a large pericardial effusion and fluid analysis.

A patient with procainamide lupus erythematosus had a large pericardial effusion. As in other reported cases histology revealed a fibrinous mononuclear pericarditis and the pericardial fluid was a serosanguinous inflammatory exudate with a high LDH level and normal glucose concentration. The ANF and LE cell preparation were positive in the fluid but the C3 complement was normal. The frequency of pericarditis is similar in systemic and drug-induced lupus erythematosus yet low complement levels need not occur. Complement activation may therefore be unnecessary for the development of either type of lupus pericarditis.

Complement System Proteins↗