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Chen YL, Meng J, Li C. Intestinal perforation with systemic lupus erythematosus: A systematic review. Medicine (Baltimore) 2023; 102:e34415. [PMID: 37543816 PMCID: PMC10402941 DOI: 10.1097/md.0000000000034415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/07/2023] Open
Abstract
Intestinal perforation (IP) is a rare complication of systemic lupus erythematosus (SLE), and the timely diagnosis and treatment of IP are necessary to prevent death. In this study, the clinical features of IP in SLE were described in an attempt to enhance its understanding to reduce mortality. The clinical data of IP in SLE from 1984 to 2022 were retrospectively collected. A total of 18 patients were enrolled, and data on clinical symptoms, preoperative evaluation, surgical procedures, and postoperative outcomes were collected and retrospectively analyzed. The analysis included 15 females and 3 males, with a mean age of 49.2 years. Fifteen patients (83.3%) had a history of the disease for >5 years, and the SLE disease activity index score of 1 (5.6%) patient was <5 points and that of 17 (94.4%) patients was >10 points. A total of 9 (50%), 5 (27.7%), 3 (16.7%), and 1 (5.6%) patient had lesions in the rectum, colon, ileum, and both ileum and appendix, respectively. The cause of perforation in 12 (66.7%) patients was lupus mesenteric vasculitis and in 3 (16.7%) patients was chronic inflammation. Seven (38.9%) patients had other immune system diseases. All patients were treated with steroids and surgical treatment. However, 5 patients died after surgery. A disease duration of >5 years, SLE disease activity index score of >10, nonstandard use of steroids, and concomitant presence of other immune system diseases are the possible risk factors of IP in SLE. The most common site of perforation was the rectum, which was caused by lupus mesenteric vasculitis. The results suggest that the key to successfully manage such cases is early diagnosis, aggressive resuscitation, antibiotics, steroid therapy, and prompt surgical intervention.
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Affiliation(s)
- Ya Lan Chen
- Department of Gastroenterology, The Affiliated Hospital of Hebei University, Baoding, P.R. China
| | - Jie Meng
- Department of Gastroenterology, The Affiliated Hospital of Hebei University, Baoding, P.R. China
| | - Cong Li
- Department of Hepatobiliary Surgery, The Affiliated Hospital of Hebei University, Baoding, P.R. China
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2
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Amouei M, Momtazmanesh S, Kavosi H, Davarpanah AH, Shirkhoda A, Radmard AR. Imaging of intestinal vasculitis focusing on MR and CT enterography: a two-way street between radiologic findings and clinical data. Insights Imaging 2022; 13:143. [PMID: 36057741 PMCID: PMC9440973 DOI: 10.1186/s13244-022-01284-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 08/04/2022] [Indexed: 11/21/2022] Open
Abstract
Diagnosis of intestinal vasculitis is often challenging due to the non-specific clinical and imaging findings. Vasculitides with gastrointestinal (GI) manifestations are rare, but their diagnosis holds immense significance as late or missed recognition can result in high mortality rates. Given the resemblance of radiologic findings with some other entities, GI vasculitis is often overlooked on small bowel studies done using computed tomography/magnetic resonance enterography (CTE/MRE). Hereon, we reviewed radiologic findings of vasculitis with gastrointestinal involvement on CTE and MRE. The variety of findings on MRE/CTE depend upon the size of the involved vessels. Signs of intestinal ischemia, e.g., mural thickening, submucosal edema, mural hyperenhancement, and restricted diffusion on diffusion-weighted imaging, are common in intestinal vasculitis. Involvement of the abdominal aorta and the major visceral arteries is presented as concentric mural thickening, transmural calcification, luminal stenosis, occlusion, aneurysmal changes, and collateral vessels. Such findings can be observed particularly in large- and medium-vessel vasculitis. The presence of extra-intestinal findings, including within the liver, kidneys, or spleen in the form of focal areas of infarction or heterogeneous enhancement due to microvascular involvement, can be another radiologic clue in diagnosis of vasculitis. The link between the clinical/laboratory findings and MRE/CTE abnormalities needs to be corresponded when it comes to the diagnosis of intestinal vasculitis.
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Affiliation(s)
- Mehrnam Amouei
- Department of Radiology, Shariati Hospital, Tehran University of Medical Sciences, North Kargar St., Tehran, 14117, Iran
| | - Sara Momtazmanesh
- Department of Radiology, Shariati Hospital, Tehran University of Medical Sciences, North Kargar St., Tehran, 14117, Iran
| | - Hoda Kavosi
- Department of Rheumatology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Amir H Davarpanah
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, USA
| | - Ali Shirkhoda
- Department of Radiological Science, University of California at Irvine, Irvine, USA
| | - Amir Reza Radmard
- Department of Radiology, Shariati Hospital, Tehran University of Medical Sciences, North Kargar St., Tehran, 14117, Iran.
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3
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Tejera Segura B, Altabás González I, Rúa-Figueroa I, Pérez Veiga N, Del Campo Pérez V, Olivé-Marqués A, Galindo M, Calvo J, Ovalles-Bonilla JG, Fernández-Nebro A, Menor-Almagro R, Tomero E, Del Val Del Amo N, Uriarte IE, Martínez-Taboada VM, Andreu JL, Boteanu A, Narváez J, Movasat A, Montilla C, Senabre Gallego JM, Hernández-Cruz B, Andrés M, Salgado E, Freire M, Machín García S, Moriano C, Expósito L, Pérez Velásquez C, Velloso-Feijoo ML, Cacheda AP, Lozano-Rivas N, Bonilla G, Arévalo M, Jiménez I, Quevedo-Vila V, Manero-Ruiz FJ, de la Peña Lefebvre G, Vázquez-Rodríguez TR, Ibañez-Ruan J, Cobo-Ibañez T, Pego-Reigosa JM. Relevance of gastrointestinal manifestations in a large Spanish cohort of patients with systemic lupus erythematosus: what do we know? Rheumatology (Oxford) 2021; 60:5329-5336. [PMID: 33950249 DOI: 10.1093/rheumatology/keab401] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 04/28/2021] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Systemic lupus erythematosus (SLE) can affect any part of the gastrointestinal (GI) tract. GI symptoms are reported to occur in more than 50% of SLE patients. AIMS To describe the GI manifestations of SLE in the RELESSER (Registry of Systemic Lupus Erythematosus Patients of the Spanish Society of Rheumatology) cohort and to determine if these are associated with a more severe disease, damage accrual and a worse prognosis. METHODS We conducted a nationwide, retrospective, multicenter, cross-sectional cohort study of 3658 SLE patients who fulfill ≥ 4 ACR-97 criteria. Data on demographics, disease characteristics, activity (SLEDAI-2K or BILAG), damage (SLICC/ACR/DI) and therapies were collected. Demographic and clinical characteristics were compared between lupus patients with and without GI damage to establish whether GI damage is associated with a more severe disease. RESULTS From 3654 lupus patients, 3.7% developed GI damage. Patients in this group (group 1) were older, they had longer disease duration, and were more likely to have vasculitis, renal disease and serositis than patients without GI damage (group 2). Hospitalizations and mortality were significantly higher in group 1. Patients in group 1 had higher modified SDI. The presence of oral ulcers reduced risk of developing damage in 33% of patients. CONCLUSIONS Having GI damage is associated with a worse prognosis. Patients on high dose of glucocorticoids are at higher risk of developing GI damage which reinforces the strategy of minimizing glucocorticoids. Oral ulcers appear to decrease the risk of GI damage.
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Affiliation(s)
- Beatriz Tejera Segura
- Rheumatology Department, Hospital Universitario Insular de Gran Canaria, Islas Canarias, Spain
| | - Irene Altabás González
- Rheumatology Department, Complejo Hospitalario Universitario de Vigo, Vigo, Galicia, Spain.,Rheumatology & Immuno-Mediated Diseases Research Group (IRIDIS), Galicia Sur Health Research Institute (IIS Galicia Sur), Spain
| | - Iñigo Rúa-Figueroa
- Rheumatology Department, Hospital Universitario de Gran Canaria Dr Negrin, Las Palmas de Gran Canaria, Islas Canarias, Spain
| | - Natalia Pérez Veiga
- Rheumatology & Immuno-Mediated Diseases Research Group (IRIDIS), Galicia Sur Health Research Institute (IIS Galicia Sur), Spain
| | | | - Alejandro Olivé-Marqués
- Rheumatology Department, Germans Trías i Pujol University Hospital, Badalona, Cataluña, Spain
| | - María Galindo
- Rheumatology Department, 12 de Octubre University Hospital, Madrid, Spain
| | - Jaime Calvo
- Rheumatology Department, Hospital Araba, Araba, Spain
| | | | - Antonio Fernández-Nebro
- Instituto de Investigación Biomédica de Málaga - IBIMA, Málaga. Spain.,Rheumatology Department, Hospital Regional Universitario de Málaga, Málaga.,Departamento de Medicina, Universidad de Málaga, Málaga
| | | | - Eva Tomero
- Rheumatology Department. Hospital Universitario de la Princesa. Madrid, Spain
| | | | | | | | - Jose L Andreu
- Rheumatology Department, Puerta de Hierro-Majadahonda Hospital, Madrid, Spain
| | - Alina Boteanu
- Rheumatology Department, Hospital Gregorio Marañón, Madrid, Spain.,Rheumatology Department, Hospital Ramon y Cajal, Madrid, Spain
| | - Javier Narváez
- Rheumatology Department, Hospital de Bellvitge, Hospitalet Llobregat, Cataluña, Spain
| | - Atusa Movasat
- Rheumatology Department, Hospital Universitario Príncipe de Asturias, Madrid, Spain
| | - Carlos Montilla
- Rheumatology Department, Salamanca Clinic University Hospital, Salamanca, Spain
| | | | | | - Mariano Andrés
- Rheumatology Department, Hospital General Universitario de Alicante, Elche, Alicante, Spain
| | - Eva Salgado
- Rheumatology Department, Hospital Universitario de Orense, Galicia, Spain
| | - Mercedes Freire
- Rheumatology Department, Hospital Juan Canalejo de La Coruña, A Coruna, Galicia, Spain
| | - Sergio Machín García
- Rheumatology Department, Hospital Universitario Insular de Gran Canaria, Islas Canarias, Spain
| | - Clara Moriano
- Rheumatology Department, Hospital Universitario de León, León, Spain
| | - Lorena Expósito
- Rheumatology Department, Hospital Universitario de Canarias, La Laguna, Tenerife, Spain
| | | | - M L Velloso-Feijoo
- Rheumatology Department, Hospital Universitario de Valme, Sevilla, Spain
| | - Ana Paula Cacheda
- Rheumatology Department, Hospital Son Llatzer, Mallorca, Islas Baleares, Spain
| | - Nuria Lozano-Rivas
- Rheumatology Department, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Gema Bonilla
- Rheumatology Department, La Paz University Hospital, Madrid, Spain
| | - Marta Arévalo
- Rheumatology Department, Consorci Sanitari Parc Taulí, Sabadell, Cataluña, Spain
| | | | | | | | | | | | | | - Tatiana Cobo-Ibañez
- Rheumatology Department, Hospital Universitario Infanta Sofía, Madrid, Spain
| | - Jose María Pego-Reigosa
- Rheumatology Department, Complejo Hospitalario Universitario de Vigo, Vigo, Galicia, Spain.,Rheumatology & Immuno-Mediated Diseases Research Group (IRIDIS), Galicia Sur Health Research Institute (IIS Galicia Sur), Spain
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4
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Obreja EI, Salazar C, Torres DG. Polyserositis and Acute Acalculous Cholecystitis: An Uncommon Manifestation of Undiagnosed Systemic Lupus Erythematosus. Cureus 2019; 11:e4899. [PMID: 31423378 PMCID: PMC6689476 DOI: 10.7759/cureus.4899] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Systemic lupus erythematosus (SLE) is a common systemic disease in the rheumatologic field. Serositis and gastrointestinal symptoms are common manifestations of SLE; however, polyserositis concurrently with acute acalculous cholecystitis is a rare and usually underestimated entity that can be associated with SLE. Medical treatment with steroids is efficacious and, in most instances, cholecystectomy can be avoided. We present the case of a young female patient with polyserositis and acute acalculous cholecystitis secondary to undiagnosed SLE, who eventually required surgical laparoscopic intervention and improved with immunosuppressive treatment.
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Affiliation(s)
- Elena I Obreja
- Internal Medicine, Louis A. Weiss Memorial Hospital Affiliate of the University of Illinois at Chicago, Chicago, USA
| | - Carlos Salazar
- Internal Medicine, Louis A. Weiss Memorial Hospital Affiliate of the University of Illinois at Chicago, Chicago, USA
| | - Daniel G Torres
- Rheumatology, Louis A. Weiss Memorial Hospital Affiliate of the University of Illinois at Chicago, Chicago, USA
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5
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Reshetnyak TM, Doroshkevich IA, Seredavkina NV, Nasonov EL, Maev IV, Reshetnyak VI. The Contribution of Drugs and Helicobacter pylori to Gastric Mucosa Changes in Patients with Systemic Lupus Erythematosus and Antiphospholipid Syndrome. Int J Rheumatol 2019; 2019:9698086. [PMID: 31191660 PMCID: PMC6525898 DOI: 10.1155/2019/9698086] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Revised: 02/01/2019] [Accepted: 04/15/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The nature and rate of gastric mucosal (GM) damage in systemic lupus erythematosus (SLE) and antiphospholipid syndrome (APS) remain to be among the unsolved problems. OBJECTIVE To define the role of H. pylori and drugs in the development of GM damages in SLE and APS. METHODS A study was conducted on 85 patients with SLE and APS. All the patients underwent esophagogastroduodenoscopy with targeted biopsy of the mucosa of the gastric body and antrum. The presence of H. pylori in the gastric biopsy specimens was determined using polymerase chain reaction. RESULTS Endoscopic examination revealed that the patients with SLE and APS on admission had the following GM changes: antral gastritis (82.4%), erosions (24.7%), hemorrhages (8.2%), and pangastritis (8.2%). SLE and APS patients showed no direct correlation between the found GM damages and the presence of H. pylori. The use of glucocorticoid, low-dose acetylsalicylic acid, nonsteroidal anti-inflammatory drug, and anticoagulant in SLE and APS patients is accompanied by GM damage. CONCLUSION There was no evidence of the role of H. pylori in GM damage in the SLE and APS patients. More frequent detection of H. pylori was observed in anticoagulants or low-dose acetylsalicylic acid users than in glucocorticoids and nonsteroidal anti-inflammatory drugs ones.
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Affiliation(s)
- Tatiana M. Reshetnyak
- 1Department of Vascular Rheumatology, VA Nasonova Research Institute of Rheumatology, Kashirskoe shosse, 34A, 115522, Moscow, Russia
- 2Department of Rheumatology, Russian Medical Academy of Postgraduate Education, Barrikadnaya str., 2/1, 125993, Moscow, Russia
| | - Irina A. Doroshkevich
- 3Municipal Outpatient Clinic No 36, Moscow Department of Health, Novomar'inskaya str., 2, 109652, Moscow, Russia
| | - Natalia V. Seredavkina
- 1Department of Vascular Rheumatology, VA Nasonova Research Institute of Rheumatology, Kashirskoe shosse, 34A, 115522, Moscow, Russia
| | - Evgeny L. Nasonov
- 4Department of Systemic Connective Tissue Diseases, VA Nasonova Research Institute of Rheumatology, Kashirskoe shosse, 34A, 115522, Moscow, Russia
| | - Igor V. Maev
- 5Department of Propaedeutic of Internal Diseases and Gastroenterology, A.I. Yevdokimov Moscow State University of Medicine and Dentistry, Delegatskaya St., 20, p. 1, 127473, Moscow, Russia
| | - Vasiliy I. Reshetnyak
- 5Department of Propaedeutic of Internal Diseases and Gastroenterology, A.I. Yevdokimov Moscow State University of Medicine and Dentistry, Delegatskaya St., 20, p. 1, 127473, Moscow, Russia
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6
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Gordon C, Amissah-Arthur MB, Gayed M, Brown S, Bruce IN, D’Cruz D, Empson B, Griffiths B, Jayne D, Khamashta M, Lightstone L, Norton P, Norton Y, Schreiber K, Isenberg D. The British Society for Rheumatology guideline for the management of systemic lupus erythematosus in adults. Rheumatology (Oxford) 2017; 57:e1-e45. [DOI: 10.1093/rheumatology/kex286] [Citation(s) in RCA: 172] [Impact Index Per Article: 24.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Indexed: 12/15/2022] Open
Affiliation(s)
- Caroline Gordon
- Rheumatology Research Group, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham,
- Rheumatology Department, City Hospital, Sandwell and West Birmingham Hospitals NHS Trust,
- Rheumatology Department, University Hospitals Birmingham NHS Foundation Trust, Birmingham,
| | - Maame-Boatemaa Amissah-Arthur
- Rheumatology Research Group, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham,
| | - Mary Gayed
- Rheumatology Research Group, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham,
- Rheumatology Department, University Hospitals Birmingham NHS Foundation Trust, Birmingham,
| | - Sue Brown
- Royal National Hospital for Rheumatic Diseases, Bath,
| | - Ian N. Bruce
- Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Institute for Inflammation and Repair, University of Manchester, Manchester Academic Health Sciences Centre,
- The Kellgren Centre for Rheumatology, NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospitals NHS Foundation Trust, Manchester,
| | - David D’Cruz
- Louise Coote Lupus Unit, Guy’s Hospital, London,
| | - Benjamin Empson
- Laurie Pike Health Centre, Modality Partnership, Birmingham,
| | | | - David Jayne
- Department of Medicine, University of Cambridge,
- Lupus and Vasculitis Unit, Addenbrooke’s Hospital, Cambridge,
| | - Munther Khamashta
- Lupus Research Unit, The Rayne Institute, St Thomas’ Hospital,
- Division of Women’s Health, King’s College London,
| | - Liz Lightstone
- Section of Renal Medicine and Vascular Inflammation, Division of Immunology and Inflammation, Department of Medicine, Imperial College London, London,
| | | | | | | | - David Isenberg
- Centre for Rheumatology, University College London, London, UK
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7
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Yang H, Bian S, Xu D, Zhang F, Zhang X. Acute acalculous cholecystitis in patients with systemic lupus erythematosus: A unique form of disease flare. Lupus 2017; 26:1101-1105. [DOI: 10.1177/0961203317699288] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective We aimed to investigate the clinical features of acute acalculous cholecystitis (AAC) in patients with systemic lupus erythematosus (SLE). Methods SLE patients with AAC hospitalized in the Peking Union Medical College Hospital (PUMCH) from January 2001 to September 2015 were retrospectively analyzed. Their medical records were systematically reviewed. The diagnosis of AAC was based on clinical manifestations and confirmed by radiologic findings including a distended gallbladder with thickened wall, pericholecystic fluid and absence of gallstones. Results Among the 8411 hospitalized SLE patients in PUMCH, 13 (0.15%) were identified to have SLE-AAC. Eleven (84.6%) of them were female, with a mean age of 30.1 ± 8.6 years. AAC was the initial manifestation of SLE in four (30.8%) cases. Eleven (84.6%) patients complained of fever and abdominal pain, four (30.8%) had positive Murphy’s sign and six (46.2%) had elevated liver enzymes. The median SLE Disease Activity Index was 8.0 (range 0–20.0) at the time of AAC. Other affected organs in SLE-AAC included kidney (11, 84.6%) and hematologic system (11, 84.6%), followed by mucocutaneous (seven, 53.8%), musculoskeletal (seven, 53.8%) and neuropsychiatric (two, 15.4%) systems. All patients received treatment of glucocorticoids and immunosuppressants but none underwent surgical intervention. During a median follow-up of 28 months (range, 2–320 months), 12 cases (92.4%) responded to treatment with no relapse and one patient (7.6%) died of septic shock. Conclusion Our study suggests that AAC is a relatively uncommon and underestimated gastrointestinal involvement of SLE that is often associated with active disease. For patients with AAC in SLE, treatment with aggressive glucocorticoids could result in a good prognosis.
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Affiliation(s)
- H Yang
- Department of Rheumatology and Clinical Immunology, Clinical Immunology Center, The Ministry of Education Key Laboratory, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - S Bian
- Department of Rheumatology and Clinical Immunology, Clinical Immunology Center, The Ministry of Education Key Laboratory, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - D Xu
- Department of Rheumatology and Clinical Immunology, Clinical Immunology Center, The Ministry of Education Key Laboratory, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - F Zhang
- Department of Rheumatology and Clinical Immunology, Clinical Immunology Center, The Ministry of Education Key Laboratory, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - X Zhang
- Department of Rheumatology and Clinical Immunology, Clinical Immunology Center, The Ministry of Education Key Laboratory, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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8
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Abstract
Systemic vasculitides are caused by inflammation of blood vessels and can affect any organ and any part of the gastrointestinal tract, hepatic and biliary system, as well as the pancreas. These disorders can cause a wide array of gastrointestinal manifestations, from asymptomatic elevated transaminase levels and mild abdominal pain to potentially life-threatening bowel perforations and peritonitis. A diagnosis based solely on gastrointestinal symptoms is challenging as these manifestations are not specific. Conversely, diagnostic and therapeutic delays can be rapidly detrimental. In this article, we review the epidemiology, characteristics and management of the main gastrointestinal manifestations of systemic vasculitides, including polyarteritis nodosa and antineutrophil cytoplasm antibody-associated vasculitides, as well as isolated vasculitides limited to the gastrointestinal tract.
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9
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Gastrointestinal system manifestations in juvenile systemic lupus erythematosus. Clin Rheumatol 2017; 36:1521-1526. [PMID: 28204893 DOI: 10.1007/s10067-017-3571-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Revised: 01/28/2017] [Accepted: 02/03/2017] [Indexed: 12/11/2022]
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10
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Fawzy M, Edrees A, Okasha H, El Ashmaui A, Ragab G. Gastrointestinal manifestations in systemic lupus erythematosus. Lupus 2016; 25:1456-1462. [PMID: 27055518 DOI: 10.1177/0961203316642308] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Systemic lupus erythematosus (SLE) is an autoimmune disorder characterized by multisystem involvement, including the gastrointestinal (GI) tract. There is a significant variation in the clinical presentation and severity of GI disorders. When GI symptoms present as the initial manifestation of SLE, there is likely to be a delay in the diagnosis. The cause of these GI manifestations in SLE may be the disease, or the side effects of medications, or infections. In this study we investigated the GI manifestations in a group of SLE patients. Our study was conducted on 40 SLE patients and 30 healthy controls to assess the prevalence of GI symptoms in SLE patients. The prevalence of gastrointestinal manifestations in our study was 42.5%. GI manifestations in our SLE patients were: acute abdominal pain (due to pleurisy and peritonitis), 6%; diffuse abdominal pain, 23.5%; epigastric pain, 29%; epigastric pain with vomiting, 23.5%; epigastric pain with chronic constipation, 6%; chronic constipation, 6%; and diffuse abdominal pain with bleeding per rectum, 6%. In our study, we found a higher incidence of Giardia infestation in SLE patients than in healthy controls, and 10% of these patients were asymptomatic. There was more Giardia infestation in patients with GI symptoms as compared with patients with no GI symptoms, with a P value of 0.009. In our study SLE patients with GI symptoms had a peak systolic velocity (cm/s) with a mean of 108.4 ± 32.1 standard deviation (SD) in the celiac Doppler study. Patients without GI symptoms had a peak systolic velocity with a mean of 111.9 ± 37.7 SD, meaning that our patients mostly had no evidence of celiac trunk stenosis, but there was significant difference between SLE patients without GI symptoms and controls, as the mean was higher in SLE patients than in the controls. Also, the celiac end diastolic velocity was higher in both groups of SLE patients with GI symptoms and those without GI symptoms, compared to controls.
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Affiliation(s)
- M Fawzy
- 1 Cairo University, Internal Medicine, Kasr Al Ainy Medical School, Cairo, Egypt
| | - A Edrees
- 2 Department of Internal Medicine University of Missouri-Kansas City, Kansas City, USA
| | - H Okasha
- 1 Cairo University, Internal Medicine, Kasr Al Ainy Medical School, Cairo, Egypt
| | - A El Ashmaui
- 1 Cairo University, Internal Medicine, Kasr Al Ainy Medical School, Cairo, Egypt
| | - G Ragab
- 1 Cairo University, Internal Medicine, Kasr Al Ainy Medical School, Cairo, Egypt
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11
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Huggins JL, Holland MJ, Brunner HI. Organ involvement other than lupus nephritis in childhood-onset systemic lupus erythematosus. Lupus 2016; 25:857-63. [DOI: 10.1177/0961203316644339] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
In this review we critically analyze pulmonary, gastrointestinal and cardiac manifestations of childhood-onset systemic lupus erythematosus (cSLE). Clinical manifestations of these organ systems may be the initial manifestation of cSLE; frequently occur with very active cSLE; and are potential life-threatening manifestations often presenting to the emergency department and requiring admission to the intensive care unit. Early recognition and treatment of the pulmonary, gastrointestinal and cardiac manifestations of cSLE will result in improved prognosis and better outcomes.
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Affiliation(s)
- J L Huggins
- Cincinnati Children’s Hospital Medical Center, Cincinnati, USA
| | - M J Holland
- Cincinnati Children’s Hospital Medical Center, Cincinnati, USA
| | - H I Brunner
- Cincinnati Children’s Hospital Medical Center, Cincinnati, USA
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12
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Zhang L, Xu D, Yang H, Tian X, Wang Q, Hou Y, Gao N, Zhang L, Li M, Zeng X. Clinical Features, Morbidity, and Risk Factors of Intestinal Pseudo-obstruction in Systemic Lupus Erythematosus: A Retrospective Case-control Study. J Rheumatol 2016; 43:559-64. [PMID: 26773109 DOI: 10.3899/jrheum.150074] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/03/2015] [Indexed: 11/22/2022]
Abstract
Objective.To analyze the epidemiology, clinical characteristics, and risk factors for systemic lupus erythematosus-related intestinal pseudo-obstruction (SLE-IPO).Methods.We retrospectively examined 85 patients with SLE with IPO as the case group and 255 randomly matched patients with SLE without any gastrointestinal manifestations as the control group, out of 4331 inpatients at the Peking Union Medical College Hospital (PUMCH) from 2003 to 2014.Results.Over the last 11 years at PUMCH, the prevalence of IPO in patients with SLE was 1.96% and the in-hospital fatality rate was 7.1%. Of these patients, 57.6% presented with IPO as the initial affected system of SLE, and the rate of misdiagnosis was about 78%. Pyeloureterectasis was the most common complication (58.9%) in patients with SLE-IPO and the incidence of biliary tract dilation was 7.1%. Patients with SLE with IPO were always diagnosed at an earlier stage of SLE with a higher frequency of hematological disturbance, polyserositis, and hypocomplementemia. Pyeloureterectasis, hypocomplementemia, and elevated C-reactive protein levels in serum were independent risk factors for IPO in SLE disease. Patients with SLE-IPO with long IPO duration and those diagnosed during late stages of SLE or concurrent with pyeloureterectasis and megacholedochus always had an unfavorable outcome.Conclusion.IPO is a rare complication, but commonly presents as the initial affected system of SLE, which can lead to a difficult diagnosis and delayed treatment. SLE-IPO occurrence concomitantly with pyeloureterectasis and megacholedochus showed a severe clinical situation in our cohort. Thus, patients with SLE-IPO with systemic smooth muscular involvement should be diagnosed early and treated aggressively.
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Abdel Galil SM. Hydroxychloroquine-induced toxic hepatitis in a patient with systemic lupus erythematosus: a case report. Lupus 2014; 24:638-40. [PMID: 25424894 DOI: 10.1177/0961203314561667] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Accepted: 11/05/2014] [Indexed: 12/22/2022]
Abstract
Increased serum level of liver enzymes is a common finding in patients with systemic lupus erythematosus (SLE). Hepatotoxic drugs, viral hepatitis and fatty liver are thought to be the main causes of hepatic lesion in these patients. Our aim was to determine the cause of strikingly elevated liver enzymes in a case with systemic lupus presenting with acute abdomen. Liver enzyme abnormality was defined as a 10-fold or greater increase in aspartate aminotransferase and alanine aminotransferase. Acute toxic hepatitis was diagnosed, which rapidly returned to normal after cessation of the suspected causative medication, hydroxychloroquine, and subsequent administration of mycophenolate mofetil. Elevated liver enzymes are a major concern and should be well investigated in SLE patients.
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Affiliation(s)
- S M Abdel Galil
- Rheumatology & Rehabilitation Department, Faculty of Medicine, Zagazig University, Egypt Medicine Department, Faculty of Medicine, Umm Al-Qura University, Saudi Arabia
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14
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L’ascite non liée à la cirrhose : physiopathologie, diagnostic et étiologies. Rev Med Interne 2014; 35:365-71. [DOI: 10.1016/j.revmed.2013.12.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2013] [Revised: 10/03/2013] [Accepted: 12/02/2013] [Indexed: 12/31/2022]
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15
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Yuan S, Lian F, Chen D, Li H, Qiu Q, Zhan Z, Ye Y, Xu H, Liang L, Yang X. Clinical Features and Associated Factors of Abdominal Pain in Systemic Lupus Erythematosus. J Rheumatol 2013; 40:2015-22. [PMID: 24187097 DOI: 10.3899/jrheum.130492] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Objective.To evaluate the clinical characteristics of systemic lupus erythematosus (SLE)-induced abdominal pain in a cohort in South China and identify the risk factors for SLE-induced abdominal pain.Methods.This is a retrospective cohort study of SLE patients with complaint of abdominal pain admitted to the first affiliated university hospital of Sun Yat-sen University between 2002 and 2011. Demographic information, clinical features, laboratory findings, SLE Disease Activity Index, and imaging characteristics were documented.Results.Of the 3823 SLE patients reviewed, 213 patients complained of abdominal pain and 132 cases were considered SLE-induced. The most common causes were lupus mesenteric vasculitis (LMV; 73.5%, 97/132) and lupus pancreatitis (LP; 17.4%, 23/132). Other causes included appendicitis, acute gastroenteritis, and peritonitis. Univariate and multivariate logistic regression analysis indicated the European Consensus Lupus Activity Measurement (ECLAM) score was significantly associated with lupus-induced abdominal pain (OR = 1.858, 95% CI: 1.441–2.394, p < 0.001), LMV (OR = 1.713, 95% CI: 1.308-2.244, p < 0.001), and LP (OR = 2.153, 95% CI: 1.282, 3.617, p = 0.004). The serum D-dimer level (OR = 1.004, 95% CI: 1.002-1.005, p < 0.001) was a strongly associated factor for lupus-induced abdominal pain. Moderate and large amounts of ascetic fluid was significantly associated with lupus-induced abdominal pain and LMV. Elevated liver enzymes was a risk factor for LP (OR = 34.605, 95% CI: 3.591-333.472, p = 0.002).Conclusion.LMV and LP were the leading causes of SLE-induced abdominal pain. The serum D-dimer was a strongly associated factor for lupus-induced abdominal pain. ECLAM score was a reliable index in assessment of SLE-associated abdominal pain. Elevated liver enzymes, and moderate or large amounts of ascites, were positively associated with lupus-induced abdominal pain.
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Hokama A, Kishimoto K, Ihama Y, Kobashigawa C, Nakamoto M, Hirata T, Kinjo N, Higa F, Tateyama M, Kinjo F, Iseki K, Kato S, Fujita J. Endoscopic and radiographic features of gastrointestinal involvement in vasculitis. World J Gastrointest Endosc 2012; 4:50-6. [PMID: 22442741 PMCID: PMC3309893 DOI: 10.4253/wjge.v4.i3.50] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2011] [Revised: 11/04/2011] [Accepted: 03/01/2012] [Indexed: 02/05/2023] Open
Abstract
Vasculitis is an inflammation of vessel walls, followed by alteration of the blood flow and damage to the dependent organ. Vasculitis can cause local or diffuse pathologic changes in the gastrointestinal (GI) tract. The variety of GI lesions includes ulcer, submucosal edema, hemorrhage, paralytic ileus, mesenteric ischemia, bowel obstruction, and life-threatening perforation.The endoscopic and radiographic features of GI involvement in vasculitisare reviewed with the emphasis on small-vessel vasculitis by presenting our typical cases, including Churg-Strauss syndrome, Henoch-Schönlein purpura, systemic lupus erythematosus, and Behçet’s disease. Important endoscopic features are ischemic enterocolitis and ulcer. Characteristic computed tomographic findings include bowel wall thickening with the target sign and engorgement of mesenteric vessels with comb sign. Knowledge of endoscopic and radiographic GI manifestations can help make an early diagnosis and establish treatment strategy.
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Affiliation(s)
- Akira Hokama
- Akira Hokama, Kazuto Kishimoto, Yasushi Ihama, Tetsuo Hirata, Futoshi Higa, Masao Tateyama, Jiro Fujita, Department of Infectious, Respiratory and Digestive Medicine, Faculty of Medicine, University of the Ryukyus, Okinawa 903-0125, Japan
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17
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Huang D, Aghdassi E, Su J, Mosko J, Hirschfield GM, Gladman DD, Urowitz MB, Fortin PR. Prevalence and risk factors for liver biochemical abnormalities in Canadian patients with systemic lupus erythematosus. J Rheumatol 2011; 39:254-61. [PMID: 22174205 DOI: 10.3899/jrheum.110310] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To determine the prevalence of abnormal liver enzymes in patients with systemic lupus erythematosus (SLE) and whether further investigations were done, and the differences in SLE-related and/or metabolic factors in patients with and without liver biochemical abnormalities. METHOD Patients from the University of Toronto Lupus Clinic who met at least 4 of the American College of Rheumatology classification criteria for SLE and had 1.5 times the upper limit for aspartate transaminase or alanine transaminase on 2 consecutive visits within a 2-year period were matched with controls for age, sex, and SLE duration. Demographic, clinical, and laboratory data were extracted at the time of the first appearance of liver enzyme abnormality for the cases and at the reference point for the controls. RESULTS From the 1533 patients reviewed, 134 (8.7%) met the inclusion criteria. Thirty of these patients were evaluated by a hepatologist, 75 had imaging studies (41 were done specifically for liver investigation), and 13 had liver biopsies. Results based on these investigations showed 31 fatty livers, 35 cases of drug-induced hepatotoxicity, 10 autoimmune etiologies, and 3 cases of viral hepatitis. Compared to controls, cases were higher in body mass index, anti-dsDNA antibody, prevalence of hypertension, antiphospholipid syndrome, and use of immunosuppressive medication, especially azathioprine and methotrexate; they were lower in IgM. CONCLUSION Metabolic abnormalities such as obesity and hypertension and hepatotoxic effects of medication used to treat SLE may contribute more than SLE-related factors to liver biochemical abnormalities in patients with SLE.
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Affiliation(s)
- Darryl Huang
- Division of Health Care and Outcome Research, Toronto Western Research Institute, Toronto, Ontario, Canada
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18
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Nicklin A, Byard RW. Lethal manifestations of systemic lupus erythematosus in a forensic context. J Forensic Sci 2011; 56:423-8. [PMID: 21306376 DOI: 10.1111/j.1556-4029.2010.01683.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Systemic lupus erythematosus is an autoimmune connective tissue disorder that affects multiple organs. While the clinical manifestations may vary in intensity over time and be associated with chronic disease, occasional cases occur where sudden and unexpected death has occurred. Cardiovascular disease is common, with accelerated atherosclerosis, intravascular thrombosis associated with antiphospholipid syndrome, and hypertensive cardiomegaly. Vasculitis with superimposed thrombosis may result in critical reduction in blood to vital organs, such as the heart and brain with infarction. Mesenteric ischemia may be caused by vasculitis, thrombosis, and accelerated atherosclerosis and may result in lethal intestinal infarction. Other diverse causes of sudden death include myocarditis, epilepsy, pulmonary hypertension, pulmonary thromboembolism, and sepsis. The autopsy evaluation of such cases requires careful examination of all organs with extensive histological sampling to include blood vessels, and microbiological sampling for bacteria, viruses, and fungi.
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Affiliation(s)
- Angela Nicklin
- Discipline of Pathology & Forensic Science SA, The University of Adelaide, Frome Road, Adelaide 5005, Australia
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Abstract
Rheumatologic diseases such as rheumatoid arthritis, systemic lupus erythematosus, Sjögren syndrome, and scleroderma are immunologically mediated disorders that typically have multisystem involvement. Although clinically significant liver involvement is rare, liver enzyme abnormalities may be observed in up to 43% of patients. The biochemical abnormalities are typically mild and transient and the histologic abnormalities are usually nonprogressive. Such biochemical and histologic findings are typically ascribed to the primary rheumatologic condition and require no specific management. In a subset of patients with rheumatologic conditions and liver test abnormalities, further evaluation identifies a coexisting, primary liver disease or medication-related liver toxicity as the cause of the biochemical abnormality. Liver test abnormalities in patients with a coexisting primary liver disease are more likely to be persistent. In such cases, further workup using serologic tests, appropriate imaging studies and liver biopsy may be needed to accurately identify the cause of liver test abnormalities. This article reviews the spectrum of liver-related abnormalities associated with several rheumatologic diseases. Hepatotoxicity related to medications commonly prescribed in such conditions is also discussed.
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Affiliation(s)
- Christine Schlenker
- Department of Medicine, University of Washington, 1959 NE Pacific Street, UW Box Number 356424, Seattle, WA 98195, USA
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20
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Abstract
Systemic lupus erythematosus (SLE) is a chronic multisystem autoimmune connective tissue disease with protean manifestations. Most often it presents with mucocutaneous, musculoskeletal or renal involvement. In comparison, gastrointestinal (GI) manifestations of SLE are far less common. The case presented here highlights the differential diagnosis of GI manifestations of SLE that range from non-life-threatening to serious life-threatening complications, including some of the complications of on-going drug treatments. While some of them present as 'acute abdomen', others are more subacute or chronic, yet serious enough to be life-threatening. The serious GI manifestations of SLE include mesenteric vasculitis causing perforation or hemorrhage with peritonitis, acute pancreatitis and intestinal pseudo-obstruction. The patient in this paper had clinical features, imaging findings and laboratory parameters that helped the treating physician to narrow down the diagnostic possibilities and finally, in making the diagnosis of lupus-pancreatitis. She was treated with intravenous 'bolus' (i.v.-pulse) methylprednisolone for 3 days, i.v.-pulse cyclophosphamide 750 mg (one dose) along with oral methylprednisolone and other supportive measures including blood transfusions. This led to prompt and complete recovery.
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Affiliation(s)
- Anand N Malaviya
- Department of Rheumatology, ISIC Superspeciality Hospital, Vasant Kunj, New Delhi, India.
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Hérault M, Mazet J, Beurey P, Cuny JF, Barbaud A, Schmutz JL, Bursztejn AC. [Hypocomplementemic vasculitis treated with dapsone]. Ann Dermatol Venereol 2010; 137:541-5. [PMID: 20804899 DOI: 10.1016/j.annder.2010.04.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2009] [Revised: 02/19/2010] [Accepted: 04/01/2010] [Indexed: 12/30/2022]
Abstract
BACKGROUND Hypocomplementemic urticarial vasculitis, described by MacDuffie in 1973, is rare. Some doubt surrounds its classification. We report a case of hypocomplementemic urticarial vasculitis (MacDuffie syndrome) treated with dapsone with a favorable outcome. CASE REPORT Over a number of years, a 43-year-old man presented urticarial vasculitis attacks with palpebral oedema and systemic symptoms such as fever and arthralgia. In 2006, MacDuffie syndrome was diagnosed on the grounds of positive anti-C1q antibodies. Treatment with dapsone was started and resulted in considerable improvement. DISCUSSION Hypocomplementemic urticarial vasculitis is characterized by urticarial vasculitis lesions, leucocytoclastic vasculitis and systemic symptoms. The latter symptoms are similar to those of systemic lupus erythematosus (SLE), and some authors have suggested that MacDuffie syndrome may in fact belong to SLE. Diagnosis is based on clinical appearance, histology and the presence of anti-C1q antibodies. There is no specific treatment for hypocomplementemic urticarial vasculitis. Immunosuppressant therapy can be used for lesions refractory to systemic corticosteroids.
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Affiliation(s)
- M Hérault
- Service de dermatologie, hôpital Fournier, CHU de Nancy, 36, quai de la bataille, 54000 Nancy, France.
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Abstract
Systemic lupus erythematosus (SLE) is a chronic autoimmune connective tissue disorder, with a heterogeneous presentation. Disease severity is wide ranging, with most suffering milder forms; however, it is potentially fatal depending on organ involvement. The disorder was recognized as early as the Middle Ages, with the 12th-century physician Rogerius being the first to apply the term lupus to the classic malar rash, and in 1872, Moric Kaposi first recognized the systemic nature of the disease. Perioperatively, SLE can present major challenges to the anesthesiologist because of accrued organ damage, coagulation defects, and complex management regimes. In this article I highlight adult SLE manifestations and treatments pertinent to the anesthesiologist and discuss perioperative management of these complex patients.
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[Lupus enteritis: an uncommon manifestation of systemic lupus erythematosus with favourable outcome on corticosteroids]. Rev Med Interne 2010; 31:493-7. [PMID: 20471141 DOI: 10.1016/j.revmed.2010.01.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2009] [Revised: 11/27/2009] [Accepted: 01/12/2010] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Lupus enteritis is a rare manifestation of systemic lupus erythematosus. The clinical manifestations are variable including abdominal pain, diarrhea, nausea and vomiting. Lupus enteritis is thought to be related to vasculitis. CASE REPORTS We report here three new cases. All three patients aged of 45, 24 and 43 years (two females and one male) were admitted for abdominal pain, vomiting and diarrhea, and fulfilled the ACR criteria of systemic lupus erythematosus. The diagnosis of lupus enteritis was retained on the CT scan findings and the favorable outcome on corticosteroids after infectious etiologies were excluded. CONCLUSION Lupus enteritis is thought to be one of the most common causes of acute abdominal pain in systemic lupus erythematosus. The diagnosis is based on clinical, radiological and biological findings. A good response to corticosteroids is usually reported.
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Affiliation(s)
- DA Medeiros
- Rheumatology Department, Portuguese Institute of Rheumatology, Lisbon, Portugal
| | - DA Isenberg
- Centre for Rheumatology Research, The Department of Medicine University College Hospital, London, UK
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Mechanical bowel strangulation mimicking mesenteric vasculitis in a systemic lupus erythematosus patient. South Med J 2008; 101:436-8. [PMID: 18360324 DOI: 10.1097/smj.0b013e318167d6a8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
A case of systemic lupus erythematosus with jaundice and vague abdominal pain which did not respond to steroid pulse therapy is presented. Noninvasive examinations and imaging studies showed ileus. Two weeks later, an emergency laparotomy was performed because of severe refractory abdominal pain and hemodynamic decompensation. An ischemic part of the terminal ileum was resected. It was pathologically determined to be ischemic bowel disease because of mechanical strangulation resulting from adhesion band, but without evidence of vasculitis, atherosclerotic change, or thrombosis. After intensive postoperative care, the patient gradually recovered. This unusual case shows that nonlupus-related mechanical strangulation should be considered in the differential diagnosis of acute abdomen in lupus patients, particularly in those who have received steroid therapy or have a history of previous abdominal operation.
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Barnabe C, Fahlman N. Overlapping clinical features of lupus and leptospirosis. Clin Rheumatol 2008; 27 Suppl 1:S23-5. [PMID: 18193381 DOI: 10.1007/s10067-007-0823-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2007] [Accepted: 12/11/2007] [Indexed: 11/25/2022]
Abstract
Systemic manifestations of infectious disease may be confused with systemic lupus erythematosus (SLE), leading to potential patient morbidity and mortality. We report the case of a patient with severe renal failure and liver involvement who was initially diagnosed and treated for leptospirosis infection. It was later determined that his organ involvement was related to active SLE. We review the clinical and laboratory features common to both SLE and leptospirosis infection to highlight not only the importance of maintaining a high index of suspicion for infectious organisms in a patient with a suspect travel history but also the recognition of atypical features of a systemic autoimmune disease.
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Affiliation(s)
- Cheryl Barnabe
- Division of Rheumatology, University of Calgary, Area 5A, 1301 3350 Hospital Dr NW, Calgary T2N 2T9, Canada.
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Chronic intestinal pseudo-obstruction in patients with systemic lupus erythematosus: report of four cases. Clin Rheumatol 2007; 27:399-402. [PMID: 17938989 DOI: 10.1007/s10067-007-0760-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2007] [Revised: 09/11/2007] [Accepted: 09/19/2007] [Indexed: 02/07/2023]
Abstract
Chronic intestinal pseudo-obstruction (CIPO), a recently recognized manifestation of systemic lupus erythematosus (SLE) with only 23 cases reported in the English literature, may appear as a complication or as the initial presentation of SLE and usually occurs during the setting of an active lupus. The pathogenic mechanism in SLE is unknown. We describe four additional cases with clinical, radiological, and manometric features of CIPO. As SLE-related CIPO usually responds to treatment with high doses of corticosteroids and/or immunosuppressive and prokinetic agents, a high level of awareness of this complication is needed to avoid unnecessary surgical intervention.
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