A 26-year-old white man with a systemic lupus erythematosus flare and acute multiorgan ischemia: Vasculitis or thrombosis?

A 31-year-old Woman with Painful Black Palms: Thrombosis or Vasculitis?

Both of vaso-occlusive incidence of antiphospholipid syndrome (APS) or vasculitis secondary to systemic lupus erythematosus (SLE) can lead to gangrene, which requiring the urgent and appropriate therapeutic approach. However, it is sometimes difficult to achieve the differential diagnosis, especially when a tissue biopsy is difficult to obtain or is clinically contraindicated. Herein we report and discuss such a female patient who suffered rare progressive gangrene of palm skin and successfully treated with aggressive anticoagulation and immunosuppressive therapy.

Factors associated with thrombosis in pediatric patients with systemic lupus erythematosus

OBJECTIVE

The risk of thrombosis is increased in patients with systemic lupus erythematosus (SLE). Few studies have assessed factors associated with thrombosis within the pediatric SLE (pSLE) population. We sought to better characterize these associated factors in pSLE patients using the Childhood Arthritis & Rheumatology Research Alliance (CARRA) registry.

METHODS

Within the CARRA registry, patients with a history of thrombosis were compared to those without. Univariate logistic regression was used to calculate odds ratios. A multivariable logistic regression model was conducted that included variables from the univariate analysis that had a p value < 0.10 and other variables identified as clinically significant from published literature.

RESULTS

Among the 979 pSLE patients in the CARRA registry, 24 (2.5%) patients had a history of arterial thrombosis and 35 (3.6%) of venous thrombosis. In the univariate analysis, the odds ratio of having a thrombotic event were found to be significantly higher in patients with a history of vasculitis, avascular necrosis (AVN), or antiphospholipid antibody (aPL). Similar results were found for vasculitis, AVN, and aPL in the multivariable analysis.

CONCLUSION

Our study of pSLE patients suggests that vasculitis, positive APL, and AVN are associated with thrombotic events in this population.