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Query: UMLS:C0024141 (systemic lupus erythematosus)
 44,322 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The spine, pelvic bones and long bones of the lower extremities are common sites for insufficiency fractures. Cases of sternum insufficiency fractures have been rarely reported in an elderly patient. Insufficiency fracture tends to occur in bones with decreased mechanical strength. It tends to occur in elderly patients, especially in postmenopausal women, with underlying diseases. We describe a case of sternum insufficiency fracture in a patient with rheumatoid arthritis and systemic lupus erythematosus on long-term corticosteroid therapy diagnosed in an emergency setting. Sternum insufficiency fracture is a rare cause of chest pain. This case serves to remind the emergency physician to remain vigilant for other noncardiac and nontraumatic causes of chest pain. If diagnosed accurately, these patients can be discharged and treated as outpatients.
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PMID:Sternum insufficiency fracture presenting as acute chest pain: a case report and review of the literature. 1652 48

A 36-year-old woman was admitted for recurring chest pain and hemoptysis. Blood pressure in the right and left arms was equal, and no murmurs or bruits were heard. Body temperature was normal on admission and remained within the normal range during the hospital stay. C-reactive protein was slightly elevated (2.3 mg/dL) and lupus anticoagulant was positive. Angiography showed no abnormality of the aorta or its branches, but the left pulmonary artery showed occlusion at the proximal portion. Computed tomography (CT) revealed segmental wall thickening of the thoracic aorta. Fluorine-18-fluorodeoxyglucose positron emission tomography (18FDG PET) showed high uptake in the proximal portion of the left pulmonary artery and in the thoracic aorta with wall thickening on CT. Based on these findings, a diagnosis of Takayasu's arteritis associated with antiphospholipid syndrome was made and high-dose steroid therapy (prednisolone 30 mg/day) was started. Two months later, the C-reactive protein level had decreased from 2.3 mg/dL to 1.1 mg/dL, and both the focal wall thickening and (18)FDG uptake of the thoracic aorta were decreased. 18FDG PET was useful for evaluating the efficacy of the steroid therapy in addition to making a diagnosis of Takayasu's arteritis associated with antiphospholipid syndrome.
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PMID:Usefulness of fluorine-18-fluorodeoxyglucose positron emission tomography in a patient with Takayasu's arteritis associated with antiphospholipid syndrome. 1660 57

Myocardial infarction in patients with systemic lupus erythematosus (SLE) is most commonly a consequence of atherosclerosis. Coronary vasculitis with aneurysms is a rare cause of myocardial ischemia in SLE. We present a case of a 22-year-old woman with a 4-year history of SLE who was admitted with acute onset of chest pain. Although initially treated for lupus pericarditis, she was subsequently found to have an acute myocardial infarction. Cardiac catheterization revealed multiple areas of aneurysmal coronary dilatation and only moderate stenoses of the secondary branches.In view of the angiographic findings, coronary revascularization was not indicated. Anticoagulant therapy was initiated as a result of the presence of large aneurysmal coronary dilatations, which are predisposed to in situ thrombosis and distal embolization. The coronary vasculitis was treated with immunosuppressive therapy. Measures aimed at secondary prevention of coronary artery disease, including optimization of lipid profile, blood pressure control, and prevention of left ventricular postinfarct remodeling, were initiated and continued indefinitely.
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PMID:Coronary vasculitis with acute myocardial infarction in a young woman with systemic lupus erythematosus. 1704 68

Systemic lupus erythematous (SLE) is a chronic inflammatory autoimmune disorder that primary affects women and may affect any organ system. Pleural inflammation is a common feature of SLE; however, as an initial presentation in SLE is rare. The author report the case of a 23-year-old woman with chest pain, dyspnea and without fever for 1 week. On physical examination, fine crackles were heard and vocal fremitus was decreased at the base of the left-side of lung. Patient had no symptoms/signs that can meet the SLE criteria; however, immunological workup showed positive response of ANA-speckle, anti-dsDNA, and anti-ENA in patient serum and pleural fluid. Lupus pleuritis with effusions was confirmed by the above investigation. A 1-month course of oral prednisolone-combined oral methrotreate was beneficial in relieving the pleuritis and pleural effusions.
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PMID:Pleuritis and pleural effusion as the initial presentation of systemic lupus erythematous in a 23-year-old woman. 1849 95

Diffuse alveolar haemorrhage (DAH) is a rare but life-threatening complication of systemic lupus erythematosus (SLE). We present the case of a 24-year-old Cambodian woman with SLE followed in the Brigham and Women's Hospital Lupus Center in Boston, Massachusetts. She presented with dyspnoea and chest pain and was found to have DAH that required a prolonged hospitalization that was complicated by recurrent DAH episodes and multiple infections. We discuss the diagnostic approach and management of patients with SLE-associated DAH as well as treatment options for refractory disease. Emerging therapies include plasmapheresis, the anti-CD20 monoclonal antibody rituximab and recombinant activated Factor VII therapy. In addition, we review the literature to date and compile what is known about the epidemiology, presenting features, diagnostic findings, management and outcomes in this condition. We found that DAH has been reported in 1.9% of patients with SLE. These patients were mostly female (88%) and young (mean age 30.2 years). Common presenting features included dyspnoea (94%), anaemia (97%) and new radiographic chest infiltrate (99%). Bronchoscopy, when performed, identified DAH in 90% of cases. Corticosteroids were the mainstay of care, and usage of cyclophosphamide varied by report. Despite recent advances in therapy, mortality has not improved substantially (48% overall survival versus 53% survival in reports published since 1993).
Lupus 2009 Aug
PMID:Dyspnoea in a young woman with active systemic lupus erythematosus. 1957 1

We conducted a pilot study to investigate whether tacrolimus was effective for treating patients with systemic lupus erythematosus (SLE) without renal involvement. Ten SLE patients with symptoms such as arthritis and erythema, but no active nephritis, were treated with tacrolimus. They included 8 women and 2 men aged from 24 to 62 years [mean +/- standard deviation (SD): 42.1 +/- 11.3 years]. Tacrolimus was administered at doses of 1-3 mg daily, and efficacy was assessed from the SLE Disease Activity Index (SLEDAI) after 1 year. Two patients ceased treatment due to adverse reactions (after 4 days for chest pain and 7 months for recurrent infections). The other 8 patients completed 1 year of treatment, and significant improvement of disease activity was observed in 6 of them. The mean (+/-SD) SLEDAI showed a significant decrease after 1 year of tacrolimus therapy, from 6.8 +/- 3.1 to 3.4 +/- 0.9; p < 0.05 by Student's paired t test. The mean (+/-SD) dose of prednisolone also decreased significantly, from 16.8 +/- 8.6 to 9.3 +/- 4.6 mg/day; p < 0.05. Although a prospective controlled study will be necessary to confirm, tacrolimus might be a treatment option for active SLE without renal involvement.
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PMID:Tacrolimus therapy for systemic lupus erythematosus without renal involvement: a preliminary retrospective study. 1971 Nov 49

We report a 36-year-old woman with a 1-year history of systemic lupus erythematosus who was admitted with acute onset of dyspnea and chest pain. She presented with a classic medical history of antiphospholipid antibody syndrome, including spontaneous abortion, deep venous thrombosis, and clinical manifestations of lupus activation. The differential diagnosis was made after a detailed history and examinations with transthoracic/transesophageal echocardiography, deep venous ultrasonography, chest computed tomography, and coronary angiography. This case demonstrates a left ventricular apical thrombus in angiographically normal coronary arteries and also deep vein thrombosis causing acute pulmonary thromboembolism. Antiaggregant and anticoagulant therapies were initiated as a result of the presence of a left ventricular apical thrombus and deep venous thrombosis, which is predisposed to recurrent pulmonary or systemic embolization. Control echocardiography demonstrated resolution of apical thrombus and normalized left ventricular systolic function after aspirin, warfarin, and immunosuppressive therapy for 2 months.
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PMID:Antiphospholipid antibody syndrome: coexistence of left ventricular apical thrombus and deep vein thrombosis causing pulmonary thromboembolism in a patient with systemic lupus erythematosus. 2011 28

The prevalence of systemic lupus erythematosus (SLE) is 28 per 100,000. The disease is most common in people of Caribbean or Asian descent. SLE mainly affects adults and is common in women between the ages of 20 and 40 years, with a female to male ratio of 9:1. The pathogenesis is multifactorial and encompasses multiple immunological, vascular and inflammatory processes. Diagnosing SLE can be challenging because of the myriad of clinical features and substantial variability between patients. Cutaneous involvement is present in about 60% of cases and typically manifests as a malar or butterfly rash. Joint involvement is inflammatory in nature with arthralgia, arthritis and/or tendinitis and occurs in about 90% of patients with SLE. Cardiorespiratory symptoms are common with chest pain on inspiration due to lupus-induced pleurisy or pericarditis, which may be associated with effusions. Lupus glomerulonephritis is one of the most important systemic complications, occurring in about 30% of patients with SLE in the UK. Careful screening tests for renal disease need to be undertaken as it is asymptomatic. The diagnosis of SLE is traditionally based on a combination of clinical features and laboratory findings and any patient with suspected clinical features of lupus should be investigated for the presence of autoantibodies. Treatment often includes corticosteroids, by various routes, at different points in disease management. In addition, some experts advocate the use of hydroxychloroquine, an antimalarial, as a principal drug in all SLE patients. It is beneficial in the management of mucocutaneous, musculoskeletal, serosal and constitutional symptoms.
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PMID:GPs have key role in shared care of patients with SLE. 2012 Aug 28

Shrinking lung syndrome (SLS) is a rare manifestation of systemic lupus erythematosus (SLE). We report the case of a 27-year-old woman with SLE presenting with a 2-year history of chest pain and progressive dyspnea. Respiratory function tests demonstrated severe restrictive ventilatory impairment. Chest x-ray demonstrated elevated hemi diaphragms and chest computed tomography showed no evidence of interstitial fibrosis, significant pleural disease or pulmonary emboli. Based on a diagnosis of SLS the patient received 4 months of high dose corticosteroids, mycophenolate and pain management with opiates. Her condition deteriorated and she was given a trial of rituximab. This resulted in marked improvement of the clinical condition and respiratory function tests that was maintained for 18 months. Subsequently, the patient represented with a similar clinical picture and another course of rituximab again produced remission. This is the first case report of reproducible remission of SLS in SLE treated with rituximab.
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PMID:Successful treatment of shrinking lung syndrome with rituximab in a patient with systemic lupus erythematosus. 2021 26

Pulmonary embolism is rare in children aged less than 15 years in whom its estimated annual incidence is 0.2 cases per 100,000, against the approximately 700 cases per 100,000 in patients aged more than 85 years. We describe the case of a 15-year-old girl who had a history of thrombocytopenia with anti-platelet and anti-nuclear antibodies. Misdiagnosed chest pain and dyspnea were treated for 6 weeks as community-acquired pneumonia, but proved to be the onset of pulmonary thromboembolism. Although this life-threatening event is rare in paediatrics, the presence of lupus anticoagulant combined with previously asymptomatic thrombocytopenia allowed a diagnosis of systemic lupus erythematosus (SLE). The combination of a history of thrombocytopenia and the presence of antinuclear antibodies, even in the absence of any other diagnostic criteria, should always suggest considering SLE as a differential diagnosis, particularly when the course of a clinical manifestation is atypical.
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PMID:Systemic lupus erythematosus presenting with pulmonary thromboembolism in a 15-year-old girl. 2037 66


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