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A patient with systemic lupus erythematosus (SLE) and spontaneous rupture of the Achilles tendon is reported. Tendon rupture in SLE is extremely uncommon; review of the reported cases suggests that it may be more common in males, and is a late complication of SLE, more likely to occur in older patients. The possible role of corticosteroid therapy is discussed.
In patients with systemic lupus erythematosus (SLE) both a haemorrhagic diathesis and a tendency to thrombosis of the venous and arterial vessels can be observed. In the course of the disease, thrombosis of the leg or pelvic veins developed in 20 per cent of 188 patients. The levels of alpha 2-plasmin inhibitor, plasminogen, fibronectin and of factor VIII complex were increased in patients with SLE compared with a control group. Fifty per cent of the patients showed no increase in fibrinolytic activity after venous occlusion measured with the fibrin plate method. This suggests a reduced fibrinolytic capacity in SLE probably caused by alteration of the endothelial cells through immune complex vasculitis. In addition, the lupus anticoagulant and an acquired antithrombin III deficiency in nephrotic syndrome in SLE are to be considered thrombophilic mechanisms. In the individual case there is an overlapping of hyper- and hypocoagulability.
Antiphospholipid antibodies (APA), including lupus anticoagulants (LAC; as detected by in vitro blood clotting tests) and anti-cardiolipin antibodies (ACA; as assayed by solid-phase immunoassay), are strongly associated with recurrent thrombosis, thrombocytopenia, and recurrent fetal loss in some patients with systemic lupus erythematosus (SLE). The combined presence of APA and these clinical manifestations is termed antiphospholipid syndrome (APS). LAC and ACA comprise heterogeneous and somewhat overlapping autoantibody subsets. To date, it is unclear what degree of heterogeneity is present in an individual patient and between patients. To begin to address these issues, we generated three monoclonal LAC antibodies from a patient with SLE and APS. These antibodies were studied for their binding specificities and variable (V) region nucleotide sequences. All three LAC were unreactive with DNA, cardiolipin or other phospholipids. Sequence analysis of these antibodies revealed extensive overlap in their Ig V genes with anti-DNA antibodies and other autoantibodies characteristic of lupus. These data provide the first V gene sequence information on a group of SLE-derived LAC without ACA activity, representative of a similar subset of LAC found in patients with APS.
Four patients with systemic lupus erythematosus (SLE) and optic neuritis are described. Optic neuritis is uncommon in SLE but may be the presenting feature of the disease. A review of 8 similar cases in the literature indicates that myelopathy is frequently associated, prompting the diagnosis of multiple sclerosis. Visual loss may be permanent despite therapeutic intervention, but rapid improvement occurs in some patients who receive early treatment with corticosteroids.
Systemic lupus erythematosus is a chronic systemic autoimmune collagen vascular disease that can present itself in many forms throughout any system in the body. Classification, etiology, diagnosis, course of the illness with flares and remission, prognosis, treatment and emotional coping are covered. Five tables outline lab tests, classification of symptoms by tissues primarily affected, drugs used, dietary suggestions and symptoms which need the attention of a health care provider.
The association of systemic lupus erythematosus (SLE) and solid tumors is infrequent. Furthermore, there has been no previous description of multiple occurrence of carcinoma in a single patient with SLE. We describe clinical picture of the patient who had dual occurrence of endometrial and gastric adenocarcinomas in addition to clinically active SLE and organ system involvement.
Five patients with systemic lupus erythematosus (SLE) developed septic arthritis. Neisseria gonorrheae, Staphyloccocus aureus, Proteus and Escherichia coli were the offending bacterial organisms. Predisposing factors included systemic and local corticosteroids, aseptic necrosis of bone and synovitis due to SLE. The diagnosis was made by culture of the organisms from the synovial fluid. Three patients recovered without residual joint damage, one required corrective arthroplasty and one died from overwhelming infection.
A patient with systemic lupus erythematosus (SLE) who developed disseminated intravascular coagulation during the beginning of SLE is presented. No other cause responsible for the producing of DIC was found. After treatment with corticoids, and cyclophosphamide the DIC was rapidly settled. This case supports the need for a complete blood test in patients with SLE who show coagulation alterations.
BACKGROUND: Subacute cutaneous lupus erythematosus (SCLE) is a subset of lupus erythematosus characterized mainly by prominent photoaggravated cutaneous manifestations. Standard therapies for SCLE include topical or systemic steroids and antimalarial drugs. Both methods show limited efficacy in clearing cutaneous lesions and occasionally produce serious side effects. AIM: To assess the efficacy of cefuroxime axetil, an oral cephalosporin with antibacterial and immunosuppressive activity, in patients with SCLE. METHODS: Three patients with SCLE were treated with cefuroxime axetil at a daily dose of 500 mg for 30-60 days. RESULTS: In all patients complete clearing of skin lesions was achieved and no side effects were observed. CONCLUSION: We suggest that long-term cefuroxime axetil administration might be an alternative treatment for patients with SCLE skin lesions.
Retinal lesions in systemic lupus erythematosus (SLE) are usually closely related to the patient's general condition and occur frequently in severe states such as renal or central nervous system involvement. However, improved treatment of SLE has reduced retinal involvement, and it is rare today to observe severe retinal lesions in patients with SLE. We report two cases of severe retinal vascular lesions in SLE patients who developed otherwise unremarkable systemic manifestations and laboratory findings.
Three infants with neonatal lupus erythematosus (LE) had characteristic sharply marginated erythematous papules and plaques without congenital heart block. Two of the infants were definitely photosensitive, while the third infant's eruption began on a photoexposed area. All three infants and their mothers were positive for Ro Sjögren's syndrome A antigen (SSA) antibody. These three infants have additional evidence supporting the concept that transplacental passage of Ro (SSA) antibody is a serologic marker for neonatal LE.
Discoid lupus erythematosus (DLE) is a chronic skin disease that may affect the eyelids. Unless suspected, these lid lesions may resemble chronic blepharitis and persist for years. We present the clinicopathologic features of DLE from the lids of seven patients, electron microscopic features of one case, and a review of 31 previously reported cases.
A patient with systemic lupus erythematosus (SLE) and an associated coagulation defect presented with the clinical picture of an inflammatory pelvic mass. The laboratory data led to the diagnosis of SLE. A laparotomy revealed an infected hematoma of the left ovary. The SLE-induced coagulation deficit may have caused an intraovarian hematoma at the time of ovulation that became infected secondarily and led to an inflammatory pelvic mass as the first sign of SLE.
Hematologic complications of systemic lupus erythematosus (SLE) usually involve peripheral destruction of blood cells. We report a case of aplastic anemia associated with SLE observed during the remission phase of SLE 3 months after the beginning of treatment. CD8+ T cells in the patient's bone marrow may have suppressed maturation of hematopoietic progenitor cells, which may have induced the aplastic anemia associated with SLE. Repeated therapy with high-dose methylprednisolone resulted in lasting remission.
Systemic lupus erythematosus (SLE) patients may have psychiatric manifestations during the illness course. Psychotropic agents are indicated in treating these symptoms. Second-generation antipsychotics, such as risperidone, olanzapine and quetiapine, have been thought to be safer than clozapine with regard to the side effect of neutropenia or agranulocytosis. We report a case of SLE who developed agranulocytosis during the treatment with olanzapine for the SLE-related psychiatric symptoms.
A case of systemic lupus erythematosus (SLE) associated with fever, heart failure, and left ventricular (LV) aneurysm is reported. A diagnosis of SLE was suspected owing to the presence of active lymphocytic myocarditis and fibrinous endocarditis at LV endomyocardial biopsy and was confirmed by identification of 4 of the 11 criteria proposed by the American Rheumatism Association for the definition of SLE. A 2-month period of steroid therapy was followed by a remarkable recovery of LV function and progression of endomyocarditis to a healed phase at control LV biopsy. The LV aneurysm disappeared, likely because thrombosis occurred as a result of the hypercoagulable state accompanying the presence of anticardiolipin antibodies. This is the first reported case of LV aneurysm induced by SLE and is a rare clinicohistologic documentation of the effectiveness of steroid treatment on lupus endomyocarditis.
Lupus erythematosus of the breast is a rare disease. It causes very firm nodules that clinically may resemble carcinoma of the breast. Mammography does not show these nodules because of their high content of fatty tissue, whereas sonographically they can be identified as homogeneous, highly echogenic lesions in the subcutaneous fat with no capsule that are connected to the skin. CT shows them as lesions of low attenuation (-50 to -70 HU) in the subcutaneous fat.
20 patients with systemic lupus erythematosus undergoing renal biopsies had their tubular function assessed by maximal concentrating ability, maximal urinary acidification and fractional urinary excretion of beta 2-microglobulin. 80% of patients showed disturbances in one or more of the parameters tested with fractional beta 2-microglobulin excretion being most frequently abnormal. No correlation was found between the histological changes and functional disturbances.