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Nolasco-Amezcua J, González-Chávez HE, Borrero-Colmenares R, Arrazola-Mendoza KS, De la Peña-Camacho F. Unilateral Alveolar Hemorrhage: A Rare Pulmonary Complication in Systemic Lupus Erythematosus. Cureus 2024; 16:e61491. [PMID: 38952604 PMCID: PMC11216114 DOI: 10.7759/cureus.61491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2024] [Indexed: 07/03/2024] Open
Abstract
Systemic lupus erythematosus (SLE) is an autoimmune disease that presents a broad spectrum of clinical manifestations. Alveolar hemorrhage in SLE is rare and has a poor prognosis. We present the case of a patient with a diagnosis of SLE and lupus nephropathy on hemodialysis who presented criteria for alveolar hemorrhage with unilateral involvement, with clinical improvement after the administration of steroid boluses. The uncommon presentation of unilateral pulmonary involvement and the importance of making an adequate protocol for ruling out differential diagnoses are highlighted.
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Affiliation(s)
- Jorge Nolasco-Amezcua
- Department of Internal Medicine, General Hospital of the Institute of Security and Social Services of State Workers of Querétaro, Queretaro, MEX
| | - Hugo E González-Chávez
- Department of Internal Medicine, General Hospital of the Institute of Security and Social Services of State Workers of Querétaro, Queretaro, MEX
| | | | - Karen S Arrazola-Mendoza
- Department of Internal Medicine, General Hospital of the Institute of Security and Social Services of State Workers of Querétaro, Queretaro, MEX
| | - Francisco De la Peña-Camacho
- Department of Internal Medicine, General Hospital of the Institute of Security and Social Services of State Workers of Querétaro, Queretaro, MEX
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2
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Palafox-Flores JG, Valencia-Ledezma OE, Vargas-López G, Jamaica-Balderas L, Acevedo-Silva N, Castro-Fuentes CA. Systemic lupus erythematosus in pediatric patients: Pulmonary manifestations. Respir Med 2023; 220:107456. [PMID: 37926179 DOI: 10.1016/j.rmed.2023.107456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 11/01/2023] [Accepted: 11/02/2023] [Indexed: 11/07/2023]
Abstract
The pulmonary manifestations of Systemic Lupus Erythematosus (SLE) in pediatric patients are poorly understood and the pulmonary manifestations reported from the adult population are generally extrapolated to the pediatric population. In the present work, the review of 228 files was carried out, in which the pulmonary manifestations, symptoms and antibody levels of the patients treated at the Hospital Regional de Alta Especialidad de Ixtapaluca (HRAEI), State of Mexico, Mexico, were identified. Statistical significance between groups was estimated using the Chi-square and Mann-Whitney U test. The main pulmonary manifestations identified were pleurisy (14 %), pulmonary hemorrhage (3.9 %), pulmonary thromboembolism (0.9 %), acute lupus pneumonitis (0.4 %), pulmonary arterial hypertension (0.4 %), and small lung syndrome (0.4 %). While the initial symptomatology was dyspnea with an incidence of 9.6 %, the mean oxygen saturation in the population was 96.87 %. Pleural effusion was identified as the most frequent pulmonary manifestation in radiographic changes. No statistically significant difference was found in antibody levels when comparing the groups. The most common pulmonary manifestation associated with SLE is pleurisy, however, the range of pulmonary manifestations in this type of patient can be very varied, as well as the presentation of each of them.
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Affiliation(s)
| | | | | | | | - Nydia Acevedo-Silva
- Pediatric Rheumatology Unit, Hospital Regional de Alta Especialidad de Ixtapaluca, Mexico
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3
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Yost C, Vercillo D, Abuqare A, Yost MB, Love AN. Pleural and Pericardial Effusion With COVID-19 and Systemic Lupus Erythematosus and Its Recurrence: A Case Study. Cureus 2023; 15:e37988. [PMID: 37223159 PMCID: PMC10202560 DOI: 10.7759/cureus.37988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2023] [Indexed: 05/25/2023] Open
Abstract
As a chronic autoimmune disease, systemic lupus erythematosus (SLE) primarily affects young women and does not discriminate against any particular organs. In December 2019, coronavirus disease 2019 (COVID-19) spread worldwide, with many speculations of cardiac involvement in the pathogenesis of infection. Moreover, in cases where cardiac symptoms were described, they consisted solely of chest pain or a general deterioration in health if the patient presented with pleural effusion or pericardial effusion. Our patient, a 25-year-old Hispanic woman, initially complained of chest pain, cough, and shortness of breath. After being admitted, she noticed growing dyspnea and mild discomfort on the right side of her chest. The patient had both SLE and COVID-19 and had developed pleural and pericardial effusions. After two days in culture, nothing had grown from the fluid samples. In addition, measures of brain natriuretic peptide and total creatine kinase fell within the normal range. Considering the investigational findings, pericardiocentesis was performed. After the procedure, the patient's condition improved, and she was discharged. The patient continued taking CellCept® 1,500 mg and Plaquenil 200 mg and started taking colchicine. Her daily prednisone dose was increased to 40 milligrams. She felt well initially; however, after two weeks of follow-up, the pericardial effusion recurred, and pericardiocentesis was performed again. The patient was discharged in stable condition after a two-day hospital stay. After treatment of both initial and recurrent effusions, the patient's cardiac symptoms were resolved, and blood pressure became stable. We hypothesize that there may be other unreported cases of COVID-19-related viral pericarditis, pericardial effusion, and pericardial tamponade that could be caused by a combination of COVID-19 and a pre-existing condition, mainly autoimmune disorders. Due to the lack of clarity surrounding typical COVID-19 manifestations, it is crucial to record all cases of this unique illness and analyze any increased incidence of pericarditis, pericardial effusion, and pericardial tamponade in the public.
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Affiliation(s)
- Connor Yost
- Internal Medicine, A.T. Still University-School of Osteopathic Medicine in Arizona (ATSU-SOMA), Mesa, USA
| | - Darin Vercillo
- Internal Medicine, Davis Hospital and Medical Center, Layton, USA
| | | | - Mckenna B Yost
- Internal Medicine, A.T. Still University-School of Osteopathic Medicine in Arizona (ATSU-SOMA), Mesa, USA
| | - Avery N Love
- Internal Medicine, A.T. Still University-School of Osteopathic Medicine in Arizona (ATSU-SOMA), Mesa, USA
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4
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Sain B, Chakraborty R, Ghosh N, Saha A. Systemic lupus erythematosus presenting as right-sided massive pleural effusion with autoimmune hypothyroidism and medium vessel vasculopathy. BMJ Case Rep 2022; 15:e251953. [PMID: 36446471 PMCID: PMC9710365 DOI: 10.1136/bcr-2022-251953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Segmental involvement of medium-sized vessels are lesser-known manifestations of systemic lupus erythematosus (SLE) vasculopathy. Medium vessel vasculopathy and peripheral vascular disease (PVD) mimicking manifestations of SLE, although rare, have been reported, particularly in Asian women mostly under the age of 30 years. This is due to metabolic disadvantages in their ethnicity, with high incidence of insulin resistance and resulting metabolic syndrome, leading to lower high-density lipoprotein cholesterol levels, higher triglyceride levels and small dense low-density lipoprotein, increased proinflammatory cytokines, endothelial dysfunction and procoagulant tendency. Owing to the longer duration of the disease with the simultaneous use of steroids, vessels are often affected. SLE may also present with thyroid manifestations against a background of a proinflammatory immune state, where autoimmune thyroid diseases, such as Hashimoto's thyroiditis, may coexist. Here, we describe the case of a young woman who presented with progressive shortness of breath, right leg pain and cough with amenorrhoea and was diagnosed with SLE.
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Affiliation(s)
- Baijaeek Sain
- Department of Trauma & Orthopaedics, Imperial College Healthcare NHS Trust, London, UK
- Department of General and Upper GI Surgery, Aneurin Bevan University Health Board, Newport, Wales, UK
| | - Ritam Chakraborty
- Department of Critical Care, AMRI Hospitals, Kolkata, West Bengal, India
| | - Natalia Ghosh
- Department of Internal Medicine, KPC Medical College and Hospital, Jadavpur, West Bengal, India
| | - Arpit Saha
- Department of Critical Care, AMRI Hospitals, Kolkata, West Bengal, India
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5
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Shin JI, Lee KH, Park S, Yang JW, Kim HJ, Song K, Lee S, Na H, Jang YJ, Nam JY, Kim S, Lee C, Hong C, Kim C, Kim M, Choi U, Seo J, Jin H, Yi B, Jeong SJ, Sheok YO, Kim H, Lee S, Lee S, Jeong YS, Park SJ, Kim JH, Kronbichler A. Systemic Lupus Erythematosus and Lung Involvement: A Comprehensive Review. J Clin Med 2022; 11:jcm11226714. [PMID: 36431192 PMCID: PMC9698564 DOI: 10.3390/jcm11226714] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 10/27/2022] [Accepted: 11/04/2022] [Indexed: 11/16/2022] Open
Abstract
Systemic lupus erythematosus (SLE) is a complex autoimmune disease with multiorgan manifestations, including pleuropulmonary involvement (20-90%). The precise mechanism of pleuropulmonary involvement in SLE is not well-understood; however, systemic type 1 interferons, circulating immune complexes, and neutrophils seem to play essential roles. There are eight types of pleuropulmonary involvement: lupus pleuritis, pleural effusion, acute lupus pneumonitis, shrinking lung syndrome, interstitial lung disease, diffuse alveolar hemorrhage (DAH), pulmonary arterial hypertension, and pulmonary embolism. DAH has a high mortality rate (68-75%). The diagnostic tools for pleuropulmonary involvement in SLE include chest X-ray (CXR), computed tomography (CT), pulmonary function tests (PFT), bronchoalveolar lavage, biopsy, technetium-99m hexamethylprophylene amine oxime perfusion scan, and (18)F-fluorodeoxyglucose positron emission tomography. An approach for detecting pleuropulmonary involvement in SLE includes high-resolution CT, CXR, and PFT. Little is known about specific therapies for pleuropulmonary involvement in SLE. However, immunosuppressive therapies such as corticosteroids and cyclophosphamide are generally used. Rituximab has also been successfully used in three of the eight pleuropulmonary involvement forms: lupus pleuritis, acute lupus pneumonitis, and shrinking lung syndrome. Pleuropulmonary manifestations are part of the clinical criteria for SLE diagnosis. However, no review article has focused on the involvement of pleuropulmonary disease in SLE. Therefore, this article summarizes the literature on the epidemiology, pathogenesis, diagnosis, and management of pleuropulmonary involvement in SLE.
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Affiliation(s)
- Jae Il Shin
- Department of Pediatrics, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Keum Hwa Lee
- Department of Pediatrics, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Seoyeon Park
- Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Jae Won Yang
- Department of Nephrology, Yonsei University Wonju College of Medicine, Wonju 26426, Republic of Korea
| | - Hyung Ju Kim
- Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Kwanhyuk Song
- Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Seungyeon Lee
- Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Hyeyoung Na
- Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Yong Jun Jang
- Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Ju Yun Nam
- Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Soojin Kim
- Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Chaehyun Lee
- Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Chanhee Hong
- Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Chohwan Kim
- Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Minhyuk Kim
- Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Uichang Choi
- Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Jaeho Seo
- Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Hyunsoo Jin
- Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - BoMi Yi
- Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Se Jin Jeong
- Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Yeon Ook Sheok
- Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Haedong Kim
- Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Sangmin Lee
- Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Sangwon Lee
- Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Young Soo Jeong
- Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Se Jin Park
- Department of Pediatrics, Eulji University School of Medicine, Daejeon 34824, Republic of Korea
| | - Ji Hong Kim
- Department of Pediatrics, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
- Department of Pediatrics, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 26426, Republic of Korea
- Correspondence:
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Fukushima K, Uchida HA, Fuchimoto Y, Mifune T, Watanabe M, Tsuji K, Tanabe K, Kinomura M, Kitamura S, Miyamoto Y, Wada S, Koyanagi T, Sugiyama H, Kishimoto T, Wada J. Silica-associated systemic lupus erythematosus with lupus nephritis and lupus pneumonitis: A case report and a systematic review of the literature. Medicine (Baltimore) 2022; 101:e28872. [PMID: 35363197 PMCID: PMC9282083 DOI: 10.1097/md.0000000000028872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 02/01/2022] [Indexed: 01/04/2023] Open
Abstract
INTRODUCTION Several epidemiological studies have shown that silica exposure triggers the onset of systemic lupus erythematosus (SLE); however, the clinical characteristics of silica-associated SLE have not been well studied. PATIENT CONCERNS A 67-year-old man with silicosis visited a primary hospital because of a fever and cough. His respiratory condition worsened, regardless of antibiotic medication, and he was referred to our hospital. DIAGNOSIS The patient showed leukopenia, lymphopenia, serum creatinine elevation with proteinuria and hematuria, decreased serum C3 level, and was positive for anti-double stranded DNA antibody, anti-nuclear antibody, and direct Coombs test. He was diagnosed with SLE. Renal biopsy was performed, and the patient was diagnosed with lupus nephritis (class IV-G(A/C) + V defined by the International Society of Nephrology/Renal Pathology Society classification). Computed tomography revealed acute interstitial pneumonitis, bronchoalveolar lavage fluid showed elevation of the lymphocyte fraction, and he was diagnosed with lupus pneumonitis. INTERVENTIONS Prednisolone (50 mg/day) with intravenous cyclophosphamide (500 mg/body) were initiated. OUTCOMES The patient showed a favorable response to these therapies. He was discharged from our hospital and received outpatient care with prednisolone slowly tapered off. He had cytomegalovirus and herpes zoster virus infections during treatment, which healed with antiviral therapy. REVIEW We searched for the literature on sSLE, and selected 11 case reports and 2 population-based studies. The prevalence of SLE manifestations in sSLE patients were comparative to that of general SLE, particularly that of elderly-onset SLE. Our renal biopsy report and previous reports indicate that lupus nephritis of sSLE patients show as various histological patterns as those of general SLE patients. Among the twenty sSLE patients reported in the case articles, three patients developed lupus pneumonitis and two of them died of it. Moreover, two patients died of bacterial pneumonia, one developed aspergillus abscesses, one got pulmonary tuberculosis, and one developed lung cancer. CONCLUSION Close attention is needed, particularly for respiratory system events and infectious diseases, when treating patients with silica-associated SLE using immunosuppressive therapies.
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Affiliation(s)
- Kazuhiko Fukushima
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Haruhito A. Uchida
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
- Department of Chronic Kidney Disease and Cardiovascular Disease, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Yasuko Fuchimoto
- Department of Respiratory Medicine, Okayama Rosai Hospital, Okayama, Japan
| | - Tomoyo Mifune
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Mayu Watanabe
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Kenji Tsuji
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Katsuyuki Tanabe
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Masaru Kinomura
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Shinji Kitamura
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Yosuke Miyamoto
- Department of Respiratory Medicine, Okayama Rosai Hospital, Okayama, Japan
| | - Sae Wada
- Department of Respiratory Medicine, Okayama Rosai Hospital, Okayama, Japan
| | - Taisaku Koyanagi
- Department of Respiratory Medicine, Okayama Rosai Hospital, Okayama, Japan
| | - Hitoshi Sugiyama
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
- Department of Human Resource Development of Dialysis Therapy for Kidney Disease, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Takumi Kishimoto
- Department of Respiratory Medicine, Okayama Rosai Hospital, Okayama, Japan
| | - Jun Wada
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
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Depascale R, Del Frate G, Gasparotto M, Manfrè V, Gatto M, Iaccarino L, Quartuccio L, De Vita S, Doria A. Diagnosis and management of lung involvement in systemic lupus erythematosus and Sjögren's syndrome: a literature review. Ther Adv Musculoskelet Dis 2021; 13:1759720X211040696. [PMID: 34616495 PMCID: PMC8488521 DOI: 10.1177/1759720x211040696] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 08/03/2021] [Indexed: 12/20/2022] Open
Abstract
Lung involvement in systemic lupus erythematosus (SLE) and primary Sjögren's syndrome (pSS) has extensively been outlined with a multiplicity of different manifestations. In SLE, the most frequent finding is pleural effusion, while in pSS, airway disease and parenchymal disorders prevail. In both cases, there is an increased risk of pre-capillary and post-capillary pulmonary arterial hypertension (PAH) and pulmonary venous thromboembolism (VTE). The risk of VTE is in part due to an increased thrombophilic status secondary to systemic inflammation or to the well-established association with antiphospholipid antibody syndrome (APS). The lung can also be the site of an organ-specific complication due to the aberrant pathologic immune-hyperactivation as occurs in the development of lymphoma or amyloidosis in pSS. Respiratory infections are a major issue to be addressed when approaching the differential diagnosis, and their exclusion is required to safely start an immunosuppressive therapy. Treatment strategy is mainly based on glucocorticoids (GCs) and immunosuppressants, with a variable response according to the primary pathologic process. Anticoagulation is recommended in case of VTE and multi-targeted treatment regimens including different drugs are the mainstay for PAH management. Antibiotics and respiratory physiotherapy can be considered relevant complement therapeutic measures. In this article, we reviewed lung manifestations in SLE and pSS with the aim to provide a comprehensive overview of their diagnosis and management to physicians taking care of patients with connective tissue diseases.
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Affiliation(s)
- Roberto Depascale
- Rheumatology Unit, Department of Medicine, University of Padua, Padua, Italy
| | - Giulia Del Frate
- Rheumatology Unit, Department of Medicine, University of Udine, Udine, Italy
| | - Michela Gasparotto
- Rheumatology Unit, Department of Medicine, University of Padua, Padua, Italy
| | - Valeria Manfrè
- Rheumatology Unit, Department of Medicine, University of Udine, Udine, Italy
| | - Mariele Gatto
- Rheumatology Unit, Department of Medicine, University of Padua, Padua, Italy
| | - Luca Iaccarino
- Rheumatology Unit, Department of Medicine, University of Padua, Padua, Italy
| | - Luca Quartuccio
- Rheumatology Unit, Department of Medicine, University of Udine, Udine, Italy
| | - Salvatore De Vita
- Rheumatology Unit, Department of Medicine, University of Udine, Udine, Italy
| | - Andrea Doria
- Division of Rheumatology, Department of Medicine, University of Padua, Via Giustiniani, 2, 35128 Padua, Italy
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Dorval G, Hadchouel A, Biebuyck-Gougé N, Giniès H, Rabant M, Berteloot L, Berthaud R, Avramescu M, Bader-Meunier B, Boyer O. A diagnostic dilemma in a boy with lupus and dyspnea: Answers. Pediatr Nephrol 2021; 36:853-856. [PMID: 32681275 DOI: 10.1007/s00467-020-04698-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 06/24/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Guillaume Dorval
- AP-HP, Hôpital Universitaire Necker-Enfants Malades, Service de Néphrologie Pédiatrique, Centre de référence MARHEA, Paris, France. .,Université de Paris, Faculté de Médecine, Paris, France.
| | - Alice Hadchouel
- Université de Paris, Faculté de Médecine, Paris, France.,AP-HP, Hôpital Universitaire Necker-Enfants Malades, Service de Pneumologie Pédiatrique, Centre de Référence pour les Maladies Respiratoires Rares de l'Enfant, Paris, France
| | - Nathalie Biebuyck-Gougé
- AP-HP, Hôpital Universitaire Necker-Enfants Malades, Service de Néphrologie Pédiatrique, Centre de référence MARHEA, Paris, France.,Université de Paris, Faculté de Médecine, Paris, France
| | - Henri Giniès
- AP-HP, Hôpital Universitaire Necker-Enfants Malades, Service de Néphrologie Pédiatrique, Centre de référence MARHEA, Paris, France
| | - Marion Rabant
- Université de Paris, Faculté de Médecine, Paris, France.,AP-HP, Hôpital Universitaire Necker-Enfants Malades, Service d'Anatomopathologie, Paris, France
| | - Laureline Berteloot
- Université de Paris, Faculté de Médecine, Paris, France.,AP-HP, Hôpital Universitaire Necker-Enfants Malades, Service d'Imagerie Pédiatrique, Paris, France
| | - Romain Berthaud
- AP-HP, Hôpital Universitaire Necker-Enfants Malades, Service de Néphrologie Pédiatrique, Centre de référence MARHEA, Paris, France.,Université de Paris, Faculté de Médecine, Paris, France
| | - Marina Avramescu
- AP-HP, Hôpital Universitaire Necker-Enfants Malades, Service de Néphrologie Pédiatrique, Centre de référence MARHEA, Paris, France.,Université de Paris, Faculté de Médecine, Paris, France
| | - Brigitte Bader-Meunier
- Université de Paris, Faculté de Médecine, Paris, France.,AP-HP, Hôpital Universitaire Necker-Enfants Malades, Service d'Immunologie et de Rhumatologie Pédiatrique, Paris, France
| | - Olivia Boyer
- AP-HP, Hôpital Universitaire Necker-Enfants Malades, Service de Néphrologie Pédiatrique, Centre de référence MARHEA, Paris, France.,Université de Paris, Faculté de Médecine, Paris, France
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9
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Choi WI, Lee DY, Choi HG, Lee CW. Lung Cancer development and mortality in interstitial lung disease with and without connective tissue diseases: a five-year Nationwide population-based study. Respir Res 2019; 20:117. [PMID: 31182103 PMCID: PMC6558868 DOI: 10.1186/s12931-019-1094-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 06/05/2019] [Indexed: 12/20/2022] Open
Abstract
Background Connective tissue disease associated with interstitial lung disease (CTD-ILD) and interstitial lung disease (ILD) alone have same pathological and imaging backgrounds. However, the differences between lung cancer development and the mortality risk between these two conditions are unclear. Incidence of primary lung cancer and all-cause mortality were studied between interstitial lung disease patients with and without connective tissue disease. Methods Data were extracted from the Korean National Health Insurance Research Database in 2009. A total of 12,787 cases of ILD without idiopathic pulmonary fibrosis and 2491 cases of CTD-ILD were diagnosed in 2009. The cohort was followed up until June 30, 2014. Incident lung cancers and all-cause mortality were ascertained. Results The overall incidence of lung cancer was 165.7 and 161.8 per 10,000 person-years in the CTD-ILD and ILD-only, respectively (rate ratio, 1.08; 95% confidence interval, 0.89–1.30). CTD-ILD patients in the 40–49 and 50–59 years old age groups had lung cancer incidence rates of 92.5 and 139.2, which were 2.0 and 1.7 times higher than those in the ILD-only, respectively. All-cause mortality was significantly higher in the CTD-ILD group compared to ILD-only group in patients aged 50–79 years. All-cause mortality of women in the 50–59, 60–69 and 70–79 age groups was 2.0, 1.8, and 1.4 times higher in the CTD-ILD group than in the ILD-only group, respectively. Conclusions CTD-ILD patients aged < 60 years had a higher lung cancer incidence than ILD-only patients in the same age group. Furthermore, CTD-ILD patients aged 50–79 years had higher all-cause mortality than ILD-only patients in the same age group.
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Affiliation(s)
- Won-Il Choi
- Department of Internal Medicine, Keimyung University Dongsan Hospital, 56 Dalseong-ro, Jung-gu, Daegu, 41931, Republic of Korea. .,Department of Internal Medicine, Keimyung University Dongsan Hospital, 56 Dalseong-ro, Jung-gu, Daegu, 700-712, Republic of Korea.
| | - Dong Yoon Lee
- Department of Internal Medicine, Keimyung University Dongsan Hospital, 56 Dalseong-ro, Jung-gu, Daegu, 41931, Republic of Korea
| | - Hyun-Gi Choi
- Department of Chemistry, Konkuk University, Seoul, 05029, Republic of Korea
| | - Choong Won Lee
- Department of Occupational and Environmental Medicine, Sungso Hospital, Andong, 99 Seodongmun-ro, Andong, Gyeongsangbuk-do, 36690, Republic of Korea
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10
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Pulmonary Systemic Lupus Erythematosus Mimicking a Pneumonia in a Postpartum Female. Case Rep Rheumatol 2018; 2018:5379192. [PMID: 30140480 PMCID: PMC6081512 DOI: 10.1155/2018/5379192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 07/10/2018] [Indexed: 11/18/2022] Open
Abstract
The pulmonary manifestations of systemic lupus erythematosus can range in severity from mild to life threatening and can be particularly marked in women who are recently postpartum. We present below a seventeen-year-old female patient, one month postpartum, who had findings consistent with an acute infectious pneumonia whom upon further query and passage of time was diagnosed with severe pneumonitis due to systemic lupus erythematosus.
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Long DA, Long B, Koyfman A. Clinical mimics: an emergency medicine focused review of pneumonia mimics. Intern Emerg Med 2018; 13:539-547. [PMID: 29582318 DOI: 10.1007/s11739-018-1840-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Accepted: 03/19/2018] [Indexed: 12/13/2022]
Abstract
Pneumonia is a common cause of morbidity and mortality in adults in the United States. While pneumonia classically presents with a fever, cough, and shortness of breath, the presentation can vary widely in adults. This review evaluates history and physical examination findings of pneumonia and several conditions that mimic pneumonia. Pneumonia is a potentially deadly disease. History and examination findings are variable in pneumonia, and many conditions mimic pneumonia. These conditions include pulmonary embolism, diffuse interstitial lung disease, endocarditis, vasculitis, diffuse alveolar hemorrhage, acute decompensated heart failure, tuberculosis, lung cancer, and acute respiratory distress syndrome. Emergency clinicians should assess the patient while resuscitation occurs. Early antibiotics and the diagnosis of pneumonia can improve outcomes. Key historical and physical examination findings may lead the clinician to consider other conditions that require immediate management. Using clinical evaluation and adjunctive imaging, these conditions can be diagnosed and treated. Knowledge of pneumonia mimics is vital for the care of patients with respiratory complaints. Pneumonia is common and may be deadly, and emergency clinicians must differentiate conditions that mimic pneumonia. Rapid evaluation and management may alleviate morbidity and mortality for each of these conditions. The history and physical examination, in addition to utilizing imaging modalities such as ultrasound and computed tomography, are vital in diagnosis of pneumonia mimics.
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Affiliation(s)
- Drew Alan Long
- Department of Emergency Medicine, San Antonio Military Medical Center, 3841 Roger Brooke Dr, Fort Sam Houston, TX, 78234, USA
| | - Brit Long
- Department of Emergency Medicine, San Antonio Military Medical Center, 3841 Roger Brooke Dr, Fort Sam Houston, TX, 78234, USA.
| | - Alex Koyfman
- Department of Emergency Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX, 75390, USA
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Şişmanlar Eyüboğlu T, Aslan AT, Özdemir Y, Gezgin Yıldırım D, Buyan N, Boyunağa Ö. Isolated acute lupus pneumonitis as the initial presentation of systemic lupus erythematosus in an 8-year-old girl. AUTOIMMUNITY HIGHLIGHTS 2018; 9:4. [PMID: 29589182 PMCID: PMC5869323 DOI: 10.1007/s13317-018-0104-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 03/18/2018] [Indexed: 11/29/2022]
Abstract
Systemic lupus erythematosus (SLE) is a systemic autoimmune disease which has broad pleuropulmonary manifestations. One of the rare and mortal complications is acute lupus pneumonitis, which is reported very rarely, especially in childhood. Herein, we report an 8-year-old girl with isolated acute lupus pneumonitis as the initial presentation that required a lung biopsy for diagnosis. Although she had improvement with the administration of steroids, steroid treatment was reduced due to the drug’s side effects resulting in the addition of azathioprine and mycophenolate mofetil to the treatment regimen. After the new regimen failed to result in clinical improvement, hydroxychloroquine treatment was started and a significant improvement was observed. Acute lupus pneumonitis is an uncommon manifestation of SLE and diagnosis may be difficult in patients without other organ involvement.
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Affiliation(s)
- Tuğba Şişmanlar Eyüboğlu
- Department of Pediatric Pulmonology, Dr. Sami Ulus Maternity and Children Research and Training Hospital, Ankara, Turkey
| | - Ayşe Tana Aslan
- Department of Pediatric Pulmonology, Faculty of Medicine, Gazi University, Ankara, Turkey.
| | - Yeşim Özdemir
- Department of Pediatric Nephrology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Deniz Gezgin Yıldırım
- Department of Pediatric Rheumatology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Necla Buyan
- Department of Pediatric Nephrology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Öznur Boyunağa
- Department of Radiology, Faculty of Medicine, Gazi University, Ankara, Turkey
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The Utility of Diaphragmatic Ultrasound in the Radiological Diagnosis of Systemic Lupus Erythymatosus Patients With Shrinking Lung Syndrome. ACTA ACUST UNITED AC 2017. [PMID: 28669416 DOI: 10.1016/j.arbr.2017.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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14
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Lazovic B, Zlatkovic-Svenda M, Jasarovic D, Stevanovic D. Systemic Lupus Erythematosus Presenting as Acute Lupus Pneumonitis. Arch Bronconeumol 2017; 54:222-223. [PMID: 29102335 DOI: 10.1016/j.arbres.2017.08.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Revised: 07/31/2017] [Accepted: 08/02/2017] [Indexed: 11/17/2022]
Affiliation(s)
| | - Mirjana Zlatkovic-Svenda
- Rheumatology Institute, University of Belgrade, Serbia; School of Medicine, University of Belgrade, Serbia
| | - Damir Jasarovic
- University Clinical Center "Zemun", Belgrade, Serbia; School of Medicine, University of Belgrade, Serbia
| | - Dejan Stevanovic
- University Clinical Center "Zemun", Belgrade, Serbia; School of Medicine, University of Belgrade, Serbia
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Ho CH, Chen YC, Chu CC, Wang JJ, Liao KM. Age-adjusted Charlson comorbidity score is associated with the risk of empyema in patients with COPD. Medicine (Baltimore) 2017; 96:e8040. [PMID: 28885373 PMCID: PMC6392682 DOI: 10.1097/md.0000000000008040] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Patients with chronic obstructive pulmonary disease (COPD) have a higher risk of pneumonia than the general population due to their impaired lung defense. They also have a higher risk of empyema and more comorbidities than patients without COPD. This study aimed to evaluate the risk of empyema in patients with COPD after adjusting for age and comorbidities using the age-adjusted Charlson comorbidity index (ACCI).Data were retrieved from the National Health Insurance Research Database. COPD patients were defined as inpatients aged >40 years with an International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis code for COPD. In total, 558,660 COPD patients were enrolled and separated into 3 groups by ACCI score to represent the severity of comorbidity (≤2, 3-5, and >5). Other comorbidities assessed included autoimmune diseases, gastroesophageal reflux disease, dyslipidemia, chest wall injury, and thoracostomy.Of the 558,660 patients, 36,556 (6.54%) had low ACCI scores (≤2), 208,292 (37.28%) had moderate ACCI scores (3-5), and 313,812 (56.17%) had high ACCI scores (>5). The mean ages of the low, moderate, and high groups were 50.66, 70.62, and 78.05 years, respectively. The hazard ratio (HRs) for empyema were 1.26 (95% confidence interval (CI) = 1.13-1.40) in the moderate ACCI group and 1.55 (95% CI = 1.39-1.72) in the high ACCI group compared with the low ACCI group. The overall incidence of empyema in COPD patients was 2.57 per 1000 person-years.This is the first study to use ACCI scores to analyze the risk of empyema in patients with COPD. Patients with high ACCI scores were older and had more complicated comorbidities, resulting in a higher risk of empyema and poor prognosis. The subgroup analysis indicated that COPD patients with comorbid autoimmune disease, gastroesophageal reflux disease, chest wall injury, or history of thoracostomy did not have a higher risk of empyema than patients without these comorbidities.Empyema is an important issue in patients with COPD and is associated with significant morbidity and mortality. Awareness of the risk factors for empyema, close monitoring, and early intervention may improve patient outcomes and decrease mortality.
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Affiliation(s)
- Chung-Han Ho
- Department of Medical Research, Chi Mei Medical Center
- Department of Hospital and Health Care Administration, Chia-Nan University of Pharmacy and Science
| | - Yi-Chen Chen
- Department of Medical Research, Chi Mei Medical Center
| | - Chin-Chen Chu
- Department of Anesthesiology, Chi Mei Medical Center
| | | | - Kuang-Ming Liao
- Department of Internal Medicine, Chi Mei Medical Center, Chiali, Taiwan
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Díaz Rubia L, Callejas Rubio JL, Martín-Rodríguez JL. The Utility Of Diaphragmatic Ultrasound In The Radiological Diagnosis Of Systemic Lupus Erythymatosus Patients With Shrinking Lung Syndrome. Arch Bronconeumol 2017; 53:702-703. [PMID: 28669416 DOI: 10.1016/j.arbres.2017.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 05/11/2017] [Accepted: 05/15/2017] [Indexed: 11/15/2022]
Affiliation(s)
- Laura Díaz Rubia
- Servicio de Radiodiagnóstico, Complejo Hospitalario Universitario de Granada, Granada, España.
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Elewa YHA, Ichii O, Kon Y. Sex-related differences in autoimmune-induced lung lesions in MRL/MpJ-fas lpr mice are mediated by the development of mediastinal fat-associated lymphoid clusters. Autoimmunity 2017; 50:306-316. [PMID: 28665157 DOI: 10.1080/08916934.2017.1344973] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
MRL/MpJ-Faslpr (lpr) mice are a model for autoimmune diseases such as systemic lupus erythematosus (SLE). These diseases mainly affect women, with a 10:1 female-to-male ratio, and cause pleuropulmonary lesions. We previously revealed a correlation between mediastinal fat-associated lymphoid cluster (MFALC) development and cellular infiltration in the lungs of lpr male mice; however, we did not report on MFALCs in females. The purpose of this investigation was to reveal sex-related differences in MFALCs in lpr mice. We compared the morphological features of MFALCs and lung mononuclear cell aggregates (LMCAs) in 5-month-old male and female lpr mice. The females showed significantly elevated anti-dsDNA autoantibody titers and larger MFALCs, with a higher ratio of lymphatic vessel (LV) and high endothelial venule (HEV) areas to MFALC area, and greater numbers of T- and B-cells, macrophages, and proliferating and dendritic cells in MFALCs and LMCAs than males. Our data indicated that MFALCs were more developed and lung lesions were more severe in female than in male lpr mice, thereby suggesting a potential role for LVs and HEVs in the establishment of MFALCs and lung lesions. Further investigation in female lpr mice will be needed for treatment of human respiratory diseases and autoimmune disorders.
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Affiliation(s)
- Yaser Hosny Ali Elewa
- a Department of Histology and Cytology, Faculty of Veterinary Medicine , Zagazig University , Zagazig , Egypt.,b Laboratory of Anatomy, Department of Biomedical Sciences, Graduate School of Veterinary Medicine , Hokkaido University , Sapporo , Japan
| | - Osamu Ichii
- b Laboratory of Anatomy, Department of Biomedical Sciences, Graduate School of Veterinary Medicine , Hokkaido University , Sapporo , Japan
| | - Yasuhiro Kon
- b Laboratory of Anatomy, Department of Biomedical Sciences, Graduate School of Veterinary Medicine , Hokkaido University , Sapporo , Japan
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Kim D, Choi J, Cho SK, Choi CB, Kim TH, Jun JB, Yoo DH, Bae SC, Sung YK. Clinical characteristics and outcomes of diffuse alveolar hemorrhage in patients with systemic lupus erythematosus. Semin Arthritis Rheum 2017; 46:782-787. [DOI: 10.1016/j.semarthrit.2016.09.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Revised: 09/05/2016] [Accepted: 09/08/2016] [Indexed: 02/06/2023]
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Ammar Y, Launois C, Perotin JM, Dury S, Servettaz A, Perdu D, Vallerand H, Nardi J, Boulagnon-Rombi C, Pluot M, Lebargy F, Deslee G. Hypoventilation alvéolaire sévère révélant un shrinking lung syndrome lupique. Rev Mal Respir 2017; 34:571-575. [DOI: 10.1016/j.rmr.2016.10.875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Accepted: 10/17/2016] [Indexed: 12/01/2022]
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20
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El-Garf AK, Gheith RE, Badran SN. Clinical pattern in Egyptian systemic lupus erythematosus patients with pleuropulmonary involvement. THE EGYPTIAN RHEUMATOLOGIST 2017. [DOI: 10.1016/j.ejr.2017.02.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Bertoli AM, Vila LM, Apte M, Fessler BJ, Bastian HM, Reveille JD, Alarcon GS. Systemic lupus erythematosus in a multiethnic US Cohort LUMINA XLVIII: factors predictive of pulmonary damage. Lupus 2016; 16:410-7. [PMID: 17664231 DOI: 10.1177/0961203307079042] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The objective of this study was to determine the factors predictive of time to the occurrence of pulmonary damage in systemic lupus erythematosus (SLE). Six-hundred and twenty-six SLE patients from a multiethnic (Hispanics, African Americans and Caucasians) longitudinal study of outcome were studied. Pulmonary damage was defined as per the Systemic Lupus International Collaborating Clinics Damage Index. Socioeconomic-demographic, clinical, genetic, serological features, pharmacologic treatments, behavioural, psychological and disease activity [as per the Systemic Lupus Activity Measure-Revised (SLAM-R)] were examined. Factors associated with time to the occurrence of pulmonary damage were examined by Cox proportional hazards regressions. A Kaplan—Meier survival curve was also examined. Forty-six (7.3%) patients had pulmonary damage after a mean (SD) total disease duration of 5.3 (3.6) years. Among those patients, 25 had pulmonary fibrosis, 12 pulmonary hypertension, eight pleural fibrosis, four pulmonary infarction and four shrinking lung syndrome. Seven patients had more than one type of lung damage. Cumulative rates of pulmonary damage at five and 10 years were 7.6% and 11.6%, respectively. In the multivariable analyses, age (HR = 1.033, 95% CI 1.006—1.060; P = 0.0170), pneumonitis (HR = 2.307, 95% CI 1.123—4.739; P = 0.0229) and anti-RNP antibodies (HR = 2.344, 95% CI 1.190—4.618; P = 0.0138) were associated with a shorter time to the occurrence of pulmonary damage while photosensitivity (HR = 0.388, 95% CI 0.184—0.818; P = 0.0128) and oral ulcers (HR = 0.466, 95% CI 0.230—0.942; P = 0.0335) with a longer time. Pulmonary damage is relatively common in SLE. Age, pneumonitis and anti-RNP antibodies were associated with a shorter time to the development of permanent lung disease. Lupus (2007) 16, 410—417.
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Affiliation(s)
- A M Bertoli
- Department of Medicine (Division of Rheumatology), The University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
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22
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Oud KTM, Bresser P, ten Berge RJM, Jonkers RE. The shrinking lung syndrome in systemic lupus erythematosus: improvement with corticosteroid therapy. Lupus 2016; 14:959-63. [PMID: 16425576 DOI: 10.1191/0961203305lu2186cr] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Respiratory manifestations of systemic lupus erythematosus (SLE) are frequent. The ‘shrinking lung syndrome’ (SLS) represents a rare complication of SLE. The pathogenesis and therapy of the SLS remains controversial. We report a series of five consecutive cases with the SLS of which we provide a detailed description of the extent and dynamics of the response to corticosteroid therapy.
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Affiliation(s)
- K T M Oud
- Pulmonology Department, Division of Clinical Immunology & Rheumatology, Academic Medical Centre, Amsterdam, The Netherlands
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23
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Nair A, Walsh SLF, Desai SR. Imaging of pulmonary involvement in rheumatic disease. Rheum Dis Clin North Am 2015; 41:167-96. [PMID: 25836636 DOI: 10.1016/j.rdc.2014.12.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Lung disease commonly occurs in connective tissue diseases (CTD) and is an important cause of morbidity and mortality. Imaging is central to the evaluation of CTD-associated pulmonary complications. In this article, a general discussion of radiologic considerations is followed by a description of the pulmonary appearances in individual CTDs, and the imaging appearances of acute and nonacute pulmonary complications. The contribution of imaging to monitoring disease, evaluating treatment response, and prognostication is reviewed. Finally, we address the role of imaging in the challenging multidisciplinary evaluation of interstitial lung disease where there is an underlying suspicion of an undiagnosed CTD.
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Affiliation(s)
- Arjun Nair
- Department of Radiology, Guy's and St Thomas' NHS Foundation Trust, Great Maze Pond, London SE1 9RT, UK
| | - Simon L F Walsh
- Department of Radiology, King's College Hospital, Denmark Hill, London SE5 9RS, UK
| | - Sujal R Desai
- Department of Radiology, King's College Hospital, Denmark Hill, London SE5 9RS, UK.
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Elewa YHA, Ichii O, Kon Y. Comparative analysis of mediastinal fat-associated lymphoid cluster development and lung cellular infiltration in murine autoimmune disease models and the corresponding normal control strains. Immunology 2015; 147:30-40. [PMID: 26439309 DOI: 10.1111/imm.12539] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Revised: 09/13/2015] [Accepted: 09/28/2015] [Indexed: 12/16/2022] Open
Abstract
We previously discovered mediastinal fat-associated lymphoid clusters (MFALCs) as novel lymphoid clusters associated with mediastinal fat tissue in healthy mice. However, no data about their morphology in immune-associated disease conditions, and their relationship with lung infiltration, is available to date. In the present study, we compared the morphological features of MFALCs in 4-month-old male murine autoimmune disease models (MRL/MpJ-lpr mice and BXSB/MpJ-Yaa mice) with those of the corresponding control strains (MRL/MpJ and BXSB/MpJ, respectively). In addition, we analysed their correlation with lung infiltration. Furthermore, immunohistochemistry for CD3, B220, Iba1, Gr1 and BrdU was performed to detect T cells and B cells, macrophages, granulocytes and proliferating cells, respectively. The spleen weight to body weight ratios and anti-double-stranded DNA autoantibody titres were found to be significantly higher in the autoimmune models than in the control strains. Furthermore, the autoimmune model presented prominent MFALCs, with a significantly greater ratio of lymphoid cluster area to total mediastinal fat tissue area, and more apparent diffused cellular infiltration into the lung lobes than the other studied strains. Higher numbers of T and B cells, macrophages and proliferating cells, but fewer granulocytes, were observed in the autoimmune models than in the control strains. Interestingly, a significant positive Pearson's correlation between the size of the MFALCs and the density of CD3-, B220- and Iba1-positive cells in the lung was observed. Therefore, our data suggest a potentially important role for MFALCs in the progression of lung disease. However, further investigation is required to clarify the pathological role of MFALCs in lung disease, especially in inflammatory disorders.
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Affiliation(s)
- Yaser Hosny Ali Elewa
- Department of Histology and Cytology, Faculty of Veterinary Medicine, Zagazig University, Zagazig, Egypt.,Laboratory of Anatomy, Department of Biomedical Sciences, Graduate School of Veterinary Medicine, Hokkaido University, Sapporo, Japan
| | - Osamu Ichii
- Laboratory of Anatomy, Department of Biomedical Sciences, Graduate School of Veterinary Medicine, Hokkaido University, Sapporo, Japan
| | - Yasuhiro Kon
- Laboratory of Anatomy, Department of Biomedical Sciences, Graduate School of Veterinary Medicine, Hokkaido University, Sapporo, Japan
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Mira-Avendano IC, Abril A. Pulmonary manifestations of Sjögren syndrome, systemic lupus erythematosus, and mixed connective tissue disease. Rheum Dis Clin North Am 2015; 41:263-77. [PMID: 25836642 DOI: 10.1016/j.rdc.2015.01.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Interstitial lung disease is a common and often life-threatening manifestation of different connective tissue disorders, often affecting its overall prognosis. Systemic lupus erythematosus, Sjögren syndrome, and mixed connective tissue disease, although all unique diseases, can have lung manifestations as an important part of these conditions. This article reviews the different pulmonary manifestations seen in these 3 systemic rheumatologic conditions.
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Affiliation(s)
- Isabel C Mira-Avendano
- Department of Pulmonary Medicine, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224, USA.
| | - Andy Abril
- Department of Rheumatology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 33224, USA
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Chen YJA, Tseng JJ, Yang MJ, Tsao YP, Lin HY. Acute respiratory distress syndrome in a pregnant woman with systemic lupus erythematosus: a case report. Lupus 2014; 23:1528-32. [DOI: 10.1177/0961203314548713] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
When the disease activity of systemic lupus erythematosus (SLE) is controlled appropriately, a pregnant woman who has lupus is able to carry safely to term and deliver a healthy infant. While the physiology of a healthy pregnancy itself influences ventilatory function, acute pulmonary distress may decrease oxygenation and influence both mother and fetus. Though respiratory failure in pregnancy is relatively rare, it remains one of the leading conditions requiring intensive care unit admission in pregnancy and carries a high risk of maternal and fetal morbidity and mortality, not to mention the complexity caused by lupus flare. We report a case of SLE complicated with lupus pneumonitis and followed by acute respiratory distress during pregnancy. Though there is a high risk of maternal and fetal morbidity and mortality, maternal respiratory function improved after cesarean section and treatment of the underlying causes. The newborn had an extremely low birth weight but was well at discharge.
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Affiliation(s)
- Y-J A Chen
- Department of Obstetrics and Gynecology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - J-J Tseng
- Department of Obstetrics and Gynecology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - M-J Yang
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Y-P Tsao
- Division of Allergy, Immunology and Rheumatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - H-Y Lin
- Division of Allergy, Immunology and Rheumatology, Taipei Veterans General Hospital and National Yang-Ming University School of Medicine, Taipei, Taiwan
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Qin H, Guo Q, Shen N, Huang X, Wu H, Zhang M, Bao C, Chen S. Chest imaging manifestations in lupus nephritis. Clin Rheumatol 2014; 33:817-23. [PMID: 24696368 DOI: 10.1007/s10067-014-2586-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Revised: 02/21/2014] [Accepted: 03/18/2014] [Indexed: 10/25/2022]
Abstract
The purpose of this study was to analyze the association between renal histopathological features and chest computed tomography (CT) findings in lupus nephritis (LN) patients. We retrospectively reviewed the medical records and chest thin-section CT findings of 152 patients with an established diagnosis of LN based on renal biopsy and 93 systemic lupus erythematosus (SLE) patients without LN between April 2009 and March 2012. The 64-detector row CT images were retrospectively evaluated by an experienced thoracic radiologist without knowledge of the patients' clinical information except that all patients had SLE. Lupus nephritis patients have a significantly higher incidence of lung/plural disease than those without LN (61.8 versus 44.0%, p<0.05). The patients in LN group were more prone to ground glass opacity, interlobular septal thickening, reticular opacities, pleural effusions, and consolidation on CT images than in non-LN group (p<0.05). Class I, class III, and class IV lupus nephritis were associated with traction bronchiectasis, ground glass opacity, and pleural effusions, respectively (p<0.05). The presence of cord on chest CT scans was significantly associated with renal interstitial lesion and interstitial inflammation/fibrosis (p<0.05). Ground glass opacity and reticular opacities on chest CT scans were also related to renal hyaline thrombi (p<0.05). There was a significant association between pleural effusions and cellular/fibrous crescents, interstitial lesion, or interstitial inflammation/fibrosis (p<0.05). It was shown that hyaline thrombi in renal biopsy was an independent risk factor of the presence of ground glass opacity on CTs with logistic regression analysis (Wald=4.124, p=0.042). LN patients were more likely to suffer from lung/pleural disease. The patients with hyaline thrombi in renal biopsy were more prone to have ground glass opacity on CTs.
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Affiliation(s)
- Hui Qin
- Department of Rheumatology and Respiratory, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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28
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Khor CG, Kan SL, Tan BE. Pulmonary manifestation as initial presentation for systemic lupus erythematosus. Int J Rheum Dis 2014; 21:1322-1325. [PMID: 24495523 DOI: 10.1111/1756-185x.12302] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
We report a 29-year-old Malay man who had pulmonary manifestations as an initial presentation for systemic lupus erythematosus. He had prolonged hospitalization and was treated with intensive care therapy with immunosuppressants.
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Affiliation(s)
- Chiew Gek Khor
- Rheumatology Unit, Department of Internal Medicine, Penang General Hospital, Georgetown, Malaysia
| | - Sow Lai Kan
- Rheumatology Unit, Department of Internal Medicine, Penang General Hospital, Georgetown, Malaysia
| | - Bee Eng Tan
- Rheumatology Unit, Department of Internal Medicine, Penang General Hospital, Georgetown, Malaysia
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29
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Kang SM, Jin HY, Lee KA, Park JH, Baek HS, Park TS. Type B insulin-resistance syndrome presenting as autoimmune hypoglycemia, associated with systemic lupus erythematosus and interstitial lung disease. Korean J Intern Med 2013; 28:98-102. [PMID: 23346003 PMCID: PMC3543968 DOI: 10.3904/kjim.2013.28.1.98] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2011] [Revised: 05/12/2011] [Accepted: 06/02/2011] [Indexed: 12/30/2022] Open
Abstract
We describe an unusual case of systemic lupus erythematosus with pulmonary manifestations presenting as hypoglycemia due to anti-insulin receptor antibodies. A 38-year-old female suffered an episode of unconsciousness and was admitted to hospital where her blood glucose was found to be 18 mg/dL. During the hypoglycemic episode, her serum insulin level was inappropriately high (2,207.1 pmol/L; normal range, 18 to 173) and C-peptide level was elevated (1.7 nmol/L; normal range, 0.37 to 1.47). Further blood tests revealed the presence of antinuclear antibodies, anti-double-stranded DNA antibodies, and anti-Ro/SSA, anti-La/SSB, anti-ribonucleoprotein, and anti-insulin receptor antibodies. A computed tomography scan of the abdomen, aimed at tumor localization, such as an insulinoma, instead revealed ground-glass opacities in both lower lungs, and no abnormal finding in the abdomen. For a definitive diagnosis of the lung lesion, video-associated thoracoscopic surgery was performed and histopathological findings showed a pattern of fibrotic non-specific interstitial pneumonia.
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MESH Headings
- Adult
- Autoantibodies/blood
- Autoimmunity
- Biomarkers/blood
- Blood Glucose/metabolism
- Female
- Humans
- Hypoglycemia/blood
- Hypoglycemia/complications
- Hypoglycemia/immunology
- Insulin/blood
- Insulin Resistance
- Lung Diseases, Interstitial/diagnosis
- Lung Diseases, Interstitial/etiology
- Lung Diseases, Interstitial/immunology
- Lung Diseases, Interstitial/surgery
- Lupus Erythematosus, Systemic/complications
- Lupus Erythematosus, Systemic/diagnosis
- Lupus Erythematosus, Systemic/immunology
- Receptor, Insulin/immunology
- Thoracic Surgery, Video-Assisted
- Tomography, X-Ray Computed
- Treatment Outcome
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Affiliation(s)
- Seon Mee Kang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Heung Yong Jin
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Research Institute of Clinical Medicine, Chonbuk National University Medical School, Jeonju, Korea
| | - Kyung Ae Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Research Institute of Clinical Medicine, Chonbuk National University Medical School, Jeonju, Korea
| | - Ji Hyun Park
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Research Institute of Clinical Medicine, Chonbuk National University Medical School, Jeonju, Korea
| | - Hong Sun Baek
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Research Institute of Clinical Medicine, Chonbuk National University Medical School, Jeonju, Korea
| | - Tae Sun Park
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Research Institute of Clinical Medicine, Chonbuk National University Medical School, Jeonju, Korea
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30
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Pulmonary hypertension in parenchymal lung disease. Pulm Med 2012; 2012:684781. [PMID: 23094153 PMCID: PMC3474989 DOI: 10.1155/2012/684781] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2012] [Accepted: 09/07/2012] [Indexed: 01/23/2023] Open
Abstract
Idiopathic pulmonary arterial hypertension (IPAH) has been extensively investigated, although it represents a less common form of the pulmonary hypertension (PH) family, as shown by international registries. Interestingly, in types of PH that are encountered in parenchymal lung diseases such as interstitial lung diseases (ILDs), chronic obstructive pulmonary disease (COPD), and many other diffuse parenchymal lung diseases, some of which are very common, the available data is limited. In this paper, we try to browse in the latest available data regarding the occurrence, pathogenesis, and treatment of PH in chronic parenchymal lung diseases.
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Xia YK, Tu SH, Hu YH, Wang Y, Chen Z, Day HT, Ross K. Pulmonary hypertension in systemic lupus erythematosus: a systematic review and analysis of 642 cases in Chinese population. Rheumatol Int 2012; 33:1211-7. [PMID: 22983159 PMCID: PMC3632720 DOI: 10.1007/s00296-012-2525-y] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2012] [Accepted: 08/23/2012] [Indexed: 02/04/2023]
Abstract
Pulmonary hypertension (PH) is an increasingly recognized complication of systemic lupus erythematosus (SLE). To develop a more comprehensive understanding of the clinical and pathological characteristics of pulmonary hypertension associated with systemic lupus erythematosus (PH/SLE) in the Chinese population, a systematic review of the literature up to 2012 was conducted. Six hundred and forty-two Chinese PH/SLE cases from 22 studies were identified as well documented and further analyzed. Transthoracic echocardiography (TTE), X-ray, electrocardiogram and right heart catheterization (RHC) were performed to diagnose PH in SLE patients. The mean age of subjects was 35.5 years, the male to female ratio was 1:14, and the mean duration of SLE when PH was diagnosed was 10.7 years. The prevalence of PH in SLE was 2.8–23.3 %. Symptoms were usually nonspecific, and the observed clinical characteristics include Raynaud’s phenomenon (41.4 %), serous effusion (27.7 %), positive RNP (51.5 %) and positive ACL (46.6 %). Gold standard RHC is strongly recommended, especially for those who had resting pulmonary arterial systolic pressure >30 mmHg on TTE with the aforementioned clinical characteristics. Corticosteroids, immunosuppressants and vasodilators were the most common medications employed in treatment. Early identification and standard PH treatment with intensive SLE treatment can improve the prognosis.
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Affiliation(s)
- Y K Xia
- Department of Integrated Chinese and Western Medicine, Tongji Hospital of Tongji Medical College, Central-China (Huazhong) University of Science and Technology, 1095 Jiefang Avenue, Wuhan 430030, Hubei, People's Republic of China
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32
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Oki H, Aoki T, Saito K, Yamashita Y, Hanamiya M, Hayashida Y, Tanaka Y, Korogi Y. Thin-section chest CT findings in systemic lupus erythematosus with antiphospholipid syndrome: A comparison with systemic lupus erythematosus without antiphospholipid syndrome. Eur J Radiol 2012; 81:1335-9. [DOI: 10.1016/j.ejrad.2011.03.041] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2010] [Revised: 03/03/2011] [Accepted: 03/11/2011] [Indexed: 11/25/2022]
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33
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Pulmonary arterial hypertension in systemic lupus erythematosus: current status and future direction. Clin Dev Immunol 2012; 2012:854941. [PMID: 22489252 PMCID: PMC3318206 DOI: 10.1155/2012/854941] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2011] [Accepted: 01/02/2012] [Indexed: 12/18/2022]
Abstract
Pulmonary arterial hypertension (PAH) is commonly associated with connective tissue diseases (CTDs) including systemic sclerosis and systemic lupus erythematosus (SLE). The prevalence of PAH in SLE is estimated to be 0.5% to 17.5%. The pathophysiology of PAH involves multiple mechanisms from vasculitis and in-situ thrombosis to interstitial pulmonary fibrosis which increases pulmonary vascular resistance, potentially leading to right heart failure. Immune and inflammatory mechanisms may play a significant role in the pathogenesis or progression of PAH in patients with CTDs, establishing a role for anti-inflammatory and immunosuppressive therapies. The leading predictors of PAH in SLE are Raynaud phenomenon, anti-U1RNP antibody, and anticardiolipin antibody positivity. The first-line of diagnostic testing for patients with suspected SLE-associated PAH (SLE-aPAH) involves obtaining a Doppler echocardiogram. Once the diagnosis is confirmed by right heart catheterization, SLE-aPAH patients are generally treated with oxygen, anticoagulants, and vasodilators. Although the prognosis and therapeutic responsiveness of these patients have improved with the addition of intensive immunosuppressive therapies, these treatments are still largely unproven. Recent data put the one-year survival rate for SLE-aPAH patients at 94%. Pregnant women are most at risk of dying due to undiagnosed SLE-aPAH, and screening should be considered essential in this population.
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Hong CM, Cartagena R, Passannante AN, Rock P. Respiratory Diseases. ANESTHESIA AND UNCOMMON DISEASES 2012. [PMCID: PMC7151791 DOI: 10.1016/b978-1-4377-2787-6.00004-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Pulmonary arteriovenous fistulas have congenital and hereditary etiology, and patients are at risk for life-threatening rupture requiring surgery. Wegener's granulomatosis can affect any organ system, although renal and pulmonary involvement is most common; men ages 40 to 50 are at increased risk. Lymphomatoid granulomatosis affects cardiopulmonary, neurologic, and myeloproliferative systems; may result from opportunistic infection, and frequently progresses to lymphoma; men age 50 to 60 are at increased risk. Spontaneous remission occurs in some cases; mortality is 60% to 90% at 5 years. Churg-Strauss syndrome is usually associated with long-standing asthma, with men and women affected equally, and can affect any organ system; major cause of death is cardiac related. Primary pulmonary hypertension is a diagnosis of exclusion; women are affected twice as likely as men; right-to-left shunt may occur in 30%, secondary to patent foramen ovale; hypoxia with resultant heart failure is typical cause of death. Cystic fibrosis is an autosomal recessive disease, eventually fatal, with increased risk for airway obstruction, fluctuating pulmonary function, and chronic hypoxia; risk for spontaneous pneumothorax is 20%. Bronchiolitis obliterans organizing pneumonia is a pulmonary obstructive disease that may be reversible and usually resolves spontaneously. Idiopathic pulmonary hemosiderosis is associated with autoimmune disorders; patients have recurrent hemorrhage, pulmonary fibrosis, restrictive lung disease, and pulmonary hypertension, with some cases of spontaneous remission. Chronic eosinophilic pneumonia may be preceded by adult-onset asthma; women are at increased risk; prognosis is good. Goodpasture's syndrome is a genetic autoimmune disorder involving the pulmonary and renal systems. Pulmonary alveolar proteinosis, a lipoprotein-rich accumulation in alveoli, has three forms: congenital, decreased alveolar macrophage activity, and idiopathic; some cases of spontaneous remission occur. Sarcoidosis may affect any organ system; African American, northern European, and females are at greater risk; many patients are asymptomatic. Systemic lupus erythematosus may affect any organ system; women of childbearing age are at increased risk. Idiopathic pulmonary fibrosis is a rare interstitial lung disease, with smokers at increased risk for pulmonary malignancy; survival is usually 2 to 3 years from diagnosis; no effective treatment exists, with lung transplant the only therapeutic option. Acute respiratory distress syndrome (ARDS) is associated with underlying critical illness or injury, developing acutely in 1 to 2 days; mortality is 25% to 35%. Pulmonary histiocytosis X is an interstitial lung disease associated with cigarette smoking and an unpredictable course; some spontaneous remission occurs. Lymphangioleiomyomatosis involves progressive deterioration of lung function, associated with tuberous sclerosis and exacerbated by pregnancy, with women at increased risk; possible spontaneous pneumothorax and chylothorax; death usually results from respiratory failure. Ankylosing spondylitis is a genetic inflammatory process resulting in fusion of axial skeleton and spinal deformities, with men at increased risk; radiologic bamboo spine, sacral to cervical progression, and restrictive lung disease with high reliance on diaphragm; extraskeletal manifestations may occur. Kyphosis (exaggerated anterior flexion) and scoliosis (lateral rotational deformity) are spinal/rib cage deformities with idiopathic, congenital, or neuromuscular etiology; corrective surgery done if Cobb thoracic angle >50% lumbar angle >40%. Bleomycin is an antineoplastic antibiotic used in combination chemotherapy, with no myelosuppressive effect; toxicity can cause life-threatening pulmonary fibrosis. Influenza A is highly infectious, presenting with flulike symptoms and possible progression to ARDS; human-to-human exposure is through droplets or contaminated surfaces, with high risk for infants, children, pregnancy, chronically ill, or renal replacement therapy patients. No prophylactic treatment exists; treat patients with high index of suspicion without definitive testing; rRT-PCR and viral cultures are sensitive for pandemic H1N1 strain. Severe acute respiratory syndrome (SARS) is highly infectious, transmitted by coronavirus with human-to-human exposure via droplets or surfaces, and may progress to ARDS. Echinococcal disease of lung is from canine tapeworm, transmitted by eggs from feces; rupture of cyst may result in anaphylactic reaction or spread of disease to other organs; children are at increased risk. No transthoracic needle aspiration is done; surgery is only option.
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Bronchoalveolar carcinoma (adenocarcinoma) mimicking recurrent bacterial community-acquired pneumonia (CAP). Heart Lung 2011; 41:83-6. [PMID: 21481469 DOI: 10.1016/j.hrtlng.2010.07.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2010] [Accepted: 07/19/2010] [Indexed: 11/24/2022]
Abstract
Depending on the community-acquired pneumonia (CAP) pathogen, host factors, and immune status, CAPs resolve on chest x-rays at different rates. CAPs that resolve more slowly than expected, or not at all, are termed "slowly or non-resolving CAPs." In contrast, recurrent CAPs may be due to host defense defects (eg, multiple myelomas) or post-obstructive bronchogenic carcinomas. There are a variety of noninfectious disorders that may mimic CAPs on chest x-ray: alveolar hemorrhage, pulmonary drug reactions, radiation pneumonitis, Wegener's granulomatosis, bronchiolitis obliterans organizing pneumonia, bronchogenic carcinomas, and lymphomas. Noninfectious mimics of recurrent CAPs include congestive heart failure, pulmonary emboli, infarctions, sarcoidosis, and systemic lupus erythematosus pneumonitis. We present the case of a middle-aged man who presented with recurrent right middle lobe and right lower lobe CAPs. Diagnostic bronchoscopy showed no bronchial obstruction, but open lung biopsy showed bronchoalveolar carcinoma (well-differentiated adenocarcinoma). Bronchoalveolar carcinomas presenting as post-obstructive or recurrent CAPs are rare because the spread is along tissue planes and not endobronchially. The case described demonstrates a rare cause of bronchogenic carcinoma mimicking recurrent CAP.
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36
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Systemic lupus erythematosus (SLE) pneumonitis mimicking swine influenza pneumonia during the swine influenza (H1N1) pandemic. Heart Lung 2011; 40:462-6. [PMID: 21453970 DOI: 10.1016/j.hrtlng.2010.07.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2010] [Accepted: 07/17/2010] [Indexed: 11/22/2022]
Abstract
BACKGROUND We present a young woman with a negative medical history who presented with acute systemic lupus erythematosus (SLE) pneumonitis mimicking swine influenza (H1N1) pneumonia. Because this case occurred during the H1N1 pandemic, the initial diagnostic impression was of H1N1 pneumonia. METHODS Although her clinical and laboratory findings were consistent with the diagnosis of H1N1 pneumonia, e.g., fever, sore throat, dry cough, arthralgias, myalgias, thrombocytopenia, relative lymphopenia, and elevated serum transaminases, some findings suggested an alternate diagnosis, e.g., leukopenia, a highly elevated erythrocyte sedimentation rate, highly elevated serum ferritin levels, elevated antinuclear antibody (ANA) levels, and double-stranded (DS) DNA titers. Her chest x-ray showed an accentuation of basilar lung markings, with a small pleural effusion similar to the chest x-ray findings of early H1N1 pneumonia. Initially, her headaches were thought to be related to central nervous system manifestations of H1N1. RESULTS After laboratory test results demonstrated elevated ANA and anti-DS DNA titers, she was diagnosed with acute SLE pneumonitis. The take-home lesson for clinicians is that other infectious diseases, e.g., human parainfluenza virus or Legionnaires' disease, can mimic H1N1 pneumonia during an influenza pandemic. Excluding asthma, congestive heart failure, exacerbations of acute bronchitis, chronic obstructive pulmonary disorder, and pulmonary interstitial disease, noninfectious mimics of H1N1 are extremely rare. CONCLUSION To the best of our knowledge, this is the first reported case of de novo SLE pneumonitis mimicking H1N1 pneumonia during the swine influenza pandemic.
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37
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Alveolar hemorrhage in systemic lupus erythematosus: An overview. EGYPTIAN RHEUMATOLOGIST 2011. [DOI: 10.1016/j.ejr.2010.02.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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38
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Waldman SD. The Connective Tissue Diseases. Pain Manag 2011. [DOI: 10.1016/b978-1-4377-0721-2.00044-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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39
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Carmier D, Marchand-Adam S, Diot P, Diot E. Respiratory involvement in systemic lupus erythematosus. Rev Mal Respir 2010; 27:e66-78. [DOI: 10.1016/j.rmr.2010.01.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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40
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Utility of Bronchoalveolar Lavage in Evaluation of Patients with Connective Tissue Diseases. Clin Chest Med 2010; 31:423-31. [DOI: 10.1016/j.ccm.2010.04.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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41
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42
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Shen M, Zeng X, Tian X, Zhang F, Zeng X, Zhang X, Xu W. Diffuse alveolar hemorrhage in systemic lupus erythematosus: a retrospective study in China. Lupus 2010; 19:1326-30. [PMID: 20647253 DOI: 10.1177/0961203310373106] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The objective of this study was to determine the clinical features of systemic lupus erythematosus (SLE) patients with diffuse alveolar hemorrhage (DAH). The medical records of 29 patients with DAH among 2133 SLE patients admitted to Peking Union Medical College Hospital from January 2004 to January 2009 were reviewed in this retrospective study. It was found that hypoxemia (100%), dyspnea (90%), cough (79%) and fever (72%), rather than hemoptysis (66%), were the most common symptoms. The most common extrapulmonary presentation was renal involvement (90%). In about 60% of patients nosocomial infection was also present. The mean drop in hemoglobin was 32 ± 10.9 g/l. Mean Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) was 17 ± 9. All patients received high-dose corticosteroid therapy and most were also given immunosuppressive agents. Rates of concomitant nosocomial infection and mechanical ventilation in non-survivors were higher than those of survivors (p < 0.05). DAH is a rare and catastrophic event in SLE. DAH can occur at any stage of the disease course; it usually occurs in patients with active SLE, and is frequently complicated by lupus nephritis. Some patients may have no hemoptysis. Early aggressive management with high-dose steroids and cyclophosphamide is advocated.
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Affiliation(s)
- M Shen
- Department of Rheumatology and Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
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43
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Torok N, Abu Malouh A, Kasmani R, Abusamieh M. Cavitary lung lesions in systemic lupus: an unusual presentation. Lupus 2010; 19:993-6. [DOI: 10.1177/0961203310365716] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Lupus is a multisystem disease with varied clinical manifestations. Cavitary lung lesions in lupus could be secondary to infections, embolism, or underlying vasculitis. We report a man who presented with lung cavitations and was diagnosed as lupus, secondary antiphospholipid syndrome, and plasma cell dyscrasia. The lesions resolved after the initiation of immunosuppressive therapy. All the previous case reports have been reviewed and the possible mechanisms underlying this association are discussed.
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Affiliation(s)
- N. Torok
- Internal Medicine, University of Toledo, Ohio, USA
| | | | - R. Kasmani
- St Vincent Mercy Medical Center, Toledo, Ohio, USA
| | - M. Abusamieh
- Arthritis Associates of Northwest Ohio, Toledo, Ohio, USA,
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Brillet P, Mama N, Nunes H, Uzunhan Y, Abbad S, Brauner M. Sémiologie tomodensitométrique de l’atteinte pulmonaire des connectivites. ACTA ACUST UNITED AC 2009; 90:1854-68. [DOI: 10.1016/s0221-0363(09)73288-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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45
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Quadrelli SA, Alvarez C, Arce SC, Paz L, Sarano J, Sobrino EM, Manni J. Pulmonary involvement of systemic lupus erythematosus: analysis of 90 necropsies. Lupus 2009; 18:1053-60. [DOI: 10.1177/0961203309106601] [Citation(s) in RCA: 79] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Pleuropulmonary manifestations of systemic lupus erythematosus (SLE) have been reported to be of variable prevalence, depending on the diagnostic methods used. The objective of this study was to determine the anatomopathological prevalence and the nature of lung involvement associated with SLE and to define if there were differences in the grade and type of pulmonary involvement in patients who had died at different time periods, before or after 1996. Complete autopsy studies of 90 patients with SLE diagnosis carried out between 1958 and 2006 and their clinical records were studied. All patients fulfilled the American College of Rheumathology (ACR) diagnostic criteria for SLE. Two groups of patients were analyzed: patients who had died before 1996 and those deceased in 1996–2006. Some pleuropulmonary involvement was detected in 97.8% of the autopsies. The most frequent findings were pleuritis (77.8%), bacterial infections (57.8%), primary and secondary alveolar haemorrhages (25.6%), followed by distal airway alterations (21.1%), opportunistic infections (14.4%) and pulmonary thromboembolism (7.8%), both acute and chronic. No cases of acute or chronic lupus pneumonitis were found. Opportunistic lung infections were invasive aspergillosis, disseminated strongyloidiasis, mucormicosis and Pneumocystis carinii. Only three of 23 patients with alveolar haemorrhage showed capillaritis. The four patients with primary pulmonary hypertension (PHT) had plexiform lesions. Deceased patients’ age at death (46.09 ± 11.01 vs 30.3 ± 11.5 years, P < 0.0001) as well as survival time from diagnosis date (11.8 ± 11.2 vs 4.4 ± 4.9 years, P < 0.0001) in the second time period evaluated were significantly higher. However, there were no statistically significant differences in the prevalence of any of the pulmonary manifestations. Sepsis was considered the major cause of death without significant differences in both groups. Our results show that pulmonary manifestations directly caused by systemic lupus erythematosus are very uncommon and that their prevalence has not changed in the past 10 years. Pulmonary infection is still the most frequent affection, and it is an important cause of death in patients with lupus.
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Affiliation(s)
- SA Quadrelli
- Instituto de Investigaciones Médicas Alfredo Lanari, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - C Alvarez
- Instituto de Investigaciones Médicas Alfredo Lanari, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - SC Arce
- Instituto de Investigaciones Médicas Alfredo Lanari, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - L Paz
- Instituto de Investigaciones Médicas Alfredo Lanari, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - J Sarano
- Instituto de Investigaciones Médicas Alfredo Lanari, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - EM Sobrino
- Instituto de Investigaciones Médicas Alfredo Lanari, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - J Manni
- Instituto de Investigaciones Médicas Alfredo Lanari, Universidad de Buenos Aires, Buenos Aires, Argentina
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46
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Cheng CC, Huang WC, Chiou KR, Hsiao SH, Lin SK, Lu LY, Tseng JC, Hu JC, Mar GY, Chiou CW, Lin SL, Liu CP. Tricuspid Flow Propagation Velocity Predicts Exercise Tolerance and Readmission in Patients With Systemic Lupus Erythematosus. J Am Soc Echocardiogr 2009; 22:411-7. [DOI: 10.1016/j.echo.2008.12.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2008] [Indexed: 01/23/2023]
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47
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Krych EH, Fischer PR, Wylam ME. Pleural fibrosis mediates shrinking lungs syndrome in children. Pediatr Pulmonol 2009; 44:90-2. [PMID: 19061229 DOI: 10.1002/ppul.20946] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The etiology of restrictive lung physiology in SLS is not well-defined, and has been hypothesized to be due to defects in lung recoil, phrenic nerve function and diaphragmatic strength. We present a case of SLS in an adolescent in whom imaging and electrophysiology studies demonstrate pleural fibrosis as the fundamental defect accounting for the restrictive lung physiology.
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Affiliation(s)
- Esther H Krych
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN 55905, USA
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48
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Carmier D, Marchand-Adam S, Diot P, Diot E. Atteinte respiratoire au cours du lupus érythémateux systémique. Rev Mal Respir 2008; 25:1289-303. [DOI: 10.1016/s0761-8425(08)75093-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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49
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Wan KS. Pleuritis and pleural effusion as the initial presentation of systemic lupus erythematous in a 23-year-old woman. Rheumatol Int 2008; 28:1257-60. [DOI: 10.1007/s00296-008-0598-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2008] [Accepted: 04/29/2008] [Indexed: 10/22/2022]
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50
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Kawahata K, Yamaguchi M, Kanda H, Komiya A, Tanaka R, Dohi M, Misaki Y, Yamamoto K. Severe airflow limitation in two patients with systemic lupus erythematosus: effect of inhalation of anticholinergics. Mod Rheumatol 2008. [DOI: 10.3109/s10165-007-0002-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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