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Sah BK, Chaudhary S, Pahari A, Ghimire A, Sah RK, Sah AK, Kumari N, Jaiswal YK, Sah VK. Dysentery and leg ulcer as an atypical presentation of systemic lupus erythematosus: A case report. Medicine (Baltimore) 2022; 101:e32201. [PMID: 36550795 PMCID: PMC9771335 DOI: 10.1097/md.0000000000032201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Due to heterogeneity in the organs involved and a variety of influencing factors, a wide range of clinical manifestations are possible in systemic lupus erythematosus (SLE). In our knowledge, a combination of leg ulcer and dysentery as presenting symptoms of SLE has never been reported previously. PATIENT CONCERNS A 13-year-old female child presented with a chronic wound over right medial malleolus for 6 months, and passing of watery stool, later mixed with blood, for 4 days. On examination, she had a fever of 38.5°C. Lab reports revealed anemia, thrombocytopenia, proteinuria, and features of urinary tract infection. Renal biopsy showed membranous glomerulonephropathy. She was positive for antinuclear antibodies (ANA) and antidouble stranded DNA (anti-dsDNA). Immunofluorescence revealed reduced C4 and C3 levels. Abdominal ultrasound showed symmetrical circumscribed thickening, and edematous cecum and ascending colon. DIAGNOSIS The patient was diagnosed with SLE based on the Systemic Lupus International Collaborating Clinics classification criteria. INTERVENTIONS The patient was treated with prednisolone, hydroxychloroquine, metronidazole, ciprofloxacin, trypsin-chymotrypsin, zinc, calcium, and calcitriol tablets. OUTCOMES Fever subsided within 3 days of treatment. Gastrointestinal symptoms subsided within 1 week of treatment. On 31 day of treatment, the wound had been reduced and showed features of healing. CONCLUSION Dysentery and leg ulcers can be the manifestations of SLE. Therefore, SLE should also be considered when a patient presents with such symptoms. Any suspicion of infection in SLE should be treated aggressively with antibiotics.
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Affiliation(s)
- Biki Kumar Sah
- Department of Pediatrics and Adolescent Medicine, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Shipra Chaudhary
- Department of Pediatrics and Adolescent Medicine, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | | | - Aasha Ghimire
- Department of Pediatrics and Adolescent Medicine, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | | | | | - Neelam Kumari
- Department of Pediatrics and Adolescent Medicine, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | | | - Vivek Kumar Sah
- Universal College of Medical Sciences and Teaching Hospital, Bhairahawa, Nepal
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Shafie M, Hadizadeh A, Khalaji S, Parsa S. Concurrent monoclonal gammopathy and systemic lupus erythematosus in a known case of ulcerative colitis: A case report. Clin Case Rep 2021; 9:e05063. [PMID: 34786200 PMCID: PMC8577241 DOI: 10.1002/ccr3.5063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 10/20/2021] [Accepted: 10/26/2021] [Indexed: 12/03/2022] Open
Abstract
Our patient had previously been diagnosed with Ulcerative colitis. The clinical manifestations of the patient along with laboratory tests such as anti-dsDNA and proteinuria were also positive. Therefore, the clinical manifestation was consistent with SLE. In the following work up, monoclonal gammopathy in serum electrophoresis was also detected.
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Affiliation(s)
- Mahan Shafie
- Tehran University of Medical SciencesTehranIran
- NeuroTRACT AssociationStudents' Scientific Research CenterTehran University of Medical SciencesTehranIran
| | | | | | - Samaneh Parsa
- Department of Internal MedicineImam Khomeini Hospital ComplexTehranIran
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3
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Malagón C, Gomez MDP, Mosquera C, Vargas C, Gonzalez T, Arango C, Martin L, Perez P, Amaya-Uribe L, Molano-Gonzalez N, Anaya JM. Juvenile polyautoimmunity in a rheumatology setting. Autoimmun Rev 2019; 18:369-381. [DOI: 10.1016/j.autrev.2018.11.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 11/10/2018] [Indexed: 02/06/2023]
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Catastrophic antiphospholipid syndrome (CAPS)-induced ischemic pancreatic ducts injury mimicking intraductal papillary mucinous neoplasm (IPMN). Semin Arthritis Rheum 2018; 47:565-568. [DOI: 10.1016/j.semarthrit.2017.07.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Revised: 06/20/2017] [Accepted: 07/07/2017] [Indexed: 11/17/2022]
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Shor DBA, Dahan S, Comaneshter D, Cohen AD, Amital H. Does inflammatory bowel disease coexist with systemic lupus erythematosus? Autoimmun Rev 2016; 15:1034-1037. [PMID: 27481039 DOI: 10.1016/j.autrev.2016.07.027] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Accepted: 07/10/2016] [Indexed: 11/25/2022]
Abstract
BACKGROUND The data regarding the association between inflammatory bowel disease (IBD) and systemic lupus erythematosus (SLE) is mostly composed of case reports and case series indicating an infrequent association. OBJECTIVES To investigate the association between IBD and SLE. METHODS Patients with SLE were compared with age- and sex-matched controls regarding the prevalence of ulcerative colitis (UC) and Crohn's disease (CD) in a case-control study. Chi-square and t-tests were used for univariate analysis and a logistic regression model was used for multivariate analysis. The study was performed utilizing the medical database of Clalit Health Services. RESULTS The study included 5018 patients with SLE and 25,090 age- and sex-matched controls. The prevalence of UC was significantly higher in patients with SLE than in controls in a univariate analysis (0.4% and 0.2%, respectively; p<0.017). However, in a multivariate logistic regression model SLE was not associated with UC (OR 1.67, 95% CI 0.99-2.815, p<0.052). The prevalence of CD was higher in patients with SLE than in controls in a univariate analysis (0.7% and 0.3%, respectively; p<0.001). A multivariate logistic regression model confirmed this finding and corroborated that SLE was associated with comorbid CD (OR 2.23, 95% CI 1.46-3.4, p<0.001). CONCLUSIONS Patients with SLE have a greater prevalence of CD than matched controls. The distinction of IBD from SLE gastrointestinal involvement can be challenging as clinical manifestations, laboratory tests, and radiographic findings may appear similar between the two diseases. Therefore, physicians treating patients with rather IBD or SLE should consider this potential association.
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Affiliation(s)
- Dana Ben-Ami Shor
- Department of Gastroenterology, Sheba Medical Center affiliated with the Sackler Faculty of Medicine, Tel-Aviv University, Israel.
| | - Shani Dahan
- Department of Medicine 'B', Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Israel
| | | | - Arnon D Cohen
- Chief Physician's Office, Clalit Health Services, Tel Aviv, Israel; Siaal Research Center for Family Medicine and Primary Care, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Howard Amital
- Department of Medicine 'B', Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Israel
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Clinical Characteristics of Concomitant Systemic Lupus Erythematosus and Primary Biliary Cirrhosis: A Literature Review. J Immunol Res 2015; 2015:713728. [PMID: 26090497 PMCID: PMC4452083 DOI: 10.1155/2015/713728] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Accepted: 01/17/2015] [Indexed: 12/14/2022] Open
Abstract
Although autoimmune diseases often coexist, concomitant cases of systemic lupus erythematosus (SLE) and primary biliary cirrhosis (PBC) are uncommon. In this review paper, 34 cases of SLE with concomitant PBC found in English and Japanese scientific literature and Japanese proceedings were reviewed and summarized, including cases with liver dysfunction complicated by SLE. Of the 34 reported concomitant cases of SLE and PBC, 97.1% (33/34) were females, and PBC was diagnosed initially in 69.0% (20/29), except for five cases in which both SLE and PBC were simultaneously diagnosed. Sjögren's syndrome was the most common autoimmune disease complicating concomitant SLE and PBC (23.5%, 8/34). Five deaths have been reported: two elderly patients died of liver failure because of the worsening of PBC, and another two patients died from pulmonary infection associated with SLE pharmacotherapy. It is uncertain whether concomitant cases occur by chance or share a common immunological or genetic basis.
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7
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Inflammatory bowel disease and lupus: a systematic review of the literature. J Crohns Colitis 2012; 6:735-42. [PMID: 22504032 DOI: 10.1016/j.crohns.2012.03.005] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2012] [Revised: 03/08/2012] [Accepted: 03/08/2012] [Indexed: 02/08/2023]
Abstract
Coexistence of systemic lupus erythematosus (SLE) should be considered in patients with inflammatory bowel disease (IBD) and complex extraintestinal manifestations and the diagnosis of IBD could be established either before or after the diagnosis of SLE. Differential diagnosis of concomitant SLE and IBD is difficult and should always exclude infectious conditions, lupus-like reactions, visceral vasculitis and drug-induced lupus. The underlying mechanism by which 5-ASA/sulphasalazine induces SLE or lupus-like syndromes is not clear and high awareness for possible predictive factors is demanded for early prevention. In most cases the symptoms from drug-induced lupus have been reversible after the discontinuation of the drug and response to steroids is favorable. Treatment of patients co-diagnosed with SLE and IBD may include corticosteroids, immunosupressants and hydroxychloroquine. In severe lupus and IBD patients cyclophosphamide pulse may be of benefit while infliximab may be beneficiary in patients with lupus nephritis. However, the role TNFalpha plays in humans with SLE and IBD is controversial and data on the likely effects of blocking TNFalpha on anti-DNA autoantibody production is always of interest.
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8
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[Lupus erythematosus. Wide range of symptoms through clinical variation, associated diseases and imitators]. Hautarzt 2010; 61:676-82. [PMID: 20549478 DOI: 10.1007/s00105-010-1939-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The typical clinical forms of cutaneous lupus erythematosus (LE) are the butterfly rash, acute, subacute and chronic cutaneous lupus, intermediate lupus (lupus tumidus), chilblain- and bullous lupus, lupus profundus, and ulcerating lesions on the mucous membrane. Besides the typical lupus forms, nonspecific skin lesions are also observed such as dermal mucinosis, acneiform skin lesions, different variants of livedo, necrotizing vasculitis with ulcers, purpura, urticaria vasculitis, neutrophilic dermatosis, hyperpigmentation, hair and nail changes as well as overlap syndromes with erythema multiforme, scleroderma, Sjögren syndrome, Raynaud phenomenon, lichen planus, bullous pemphigoid und psoriasis. There are lupus imitators which create differential diagnostic challenges, such as infections with atypical mycobacteria or subcutaneous T-cell lymphoma both of which are similar to lupus profundus. All these skin lesions can present as maximal pathological findings seen in lupus or be caused by a variety of pathological laboratory findings such as the anti-phospholipid antibodies or a deficiency of complement factors. In the latter situation severe lupus often with complications can be expected.
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Affiliation(s)
- DA Medeiros
- Rheumatology Department, Portuguese Institute of Rheumatology, Lisbon, Portugal
| | - DA Isenberg
- Centre for Rheumatology Research, The Department of Medicine University College Hospital, London, UK
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Wiederkehr MR, Nicosia RF, Munschauer C, Moe OW. An unusual case of urticaria and nephrotic syndrome. Am J Kidney Dis 2006; 48:506-12. [PMID: 16931227 DOI: 10.1053/j.ajkd.2006.03.087] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2006] [Accepted: 03/24/2006] [Indexed: 11/11/2022]
Affiliation(s)
- Michael R Wiederkehr
- Division of Nephrology, Baylor University Medical Center, Dallas, TX 75246, USA.
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11
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Nitzan O, Elias M, Saliba WR. Systemic lupus erythematosus and inflammatory bowel disease. Eur J Intern Med 2006; 17:313-8. [PMID: 16864003 DOI: 10.1016/j.ejim.2006.02.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2005] [Revised: 01/15/2006] [Accepted: 02/03/2006] [Indexed: 01/18/2023]
Abstract
We hereby summarize a case reported by the authors, as well as all of the previously reported cases, of patients suffering from both systemic lupus erythematosus (SLE) and inflammatory bowel disease (IBD) that have been published in the English literature. In most cases, SLE was diagnosed prior to IBD, and the latter was of the ulcerative colitis subtype. Interestingly, the first disease diagnosed was almost never active at the time the second disease manifested itself. Patients with both diseases tended to have less photosensitivity, less arthritis, and less serositis than patients with SLE alone. There were no cases with neurological disorders or overt nephritis. All of these patients had anti-dsDNA and there was a tendency towards more anemia and thrombocytopenia. These patients had a relatively benign course with no flare-ups of lupus during follow-up and a favorable course of their bowel disease as well.
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Affiliation(s)
- O Nitzan
- Department of Internal Medicine C, Hae'meK Medical Center, Afula 18101, Affiliated with the Technion-Israel Institute of Technology, Faculty of Medicine, Haifa, Israel
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Affiliation(s)
- Martina Mattiuzzo
- Department of Clinical Medicine, Montebelluna General Hospital, Treviso, Italy
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Zachou K, Liaskos C, Rigopoulou E, Gabeta S, Papamichalis P, Gatselis N, Georgiadou S, Dalekos GN. Presence of high avidity anticardiolipin antibodies in patients with autoimmune cholestatic liver diseases. Clin Immunol 2006; 119:203-12. [PMID: 16500150 DOI: 10.1016/j.clim.2006.01.002] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2005] [Revised: 01/11/2006] [Accepted: 01/14/2006] [Indexed: 01/04/2023]
Abstract
We studied the prevalence and clinical significance of anticardiolipin antibodies (aCL) in primary biliary cirrhosis (PBC) and primary sclerosing cholangitis (PSC) as similar data are missing. Ninety-nine PBC patients, 41 PSC, 228 HCV, 50 HBV, 111 with other non-viral and non-autoimmune liver disorders and 267 healthy were investigated. In order to evaluate the avidity of aCL, urea 2 M was used. IgG and/or IgM aCL were detected in 40% of PBC and PSC patients, in 26.2% of disease controls (P < 0.05) and 2.25% of healthy (P < 0.05). In PBC, IgG aCL associated with presence of cirrhosis, increased Mayo risk score and thrombocytopenia, while in PSC with longer disease duration and biochemical activity. Anti-beta2-GPI was detected in only three patients. Both in PBC and PSC, resistance of aCL to urea was high, similar to that observed in antiphospholipid syndrome (APS). We demonstrated a significantly higher prevalence of aCL in PBC and PSC compared to other liver diseases and healthy. aCL were associated with more severe disease in PBC and biochemical activity in PSC, but they rather seem to be "non-pathogenic" (co-factor-independent). However, their avidity was comparable with that of APS, indicating the need for prospective studies in order to address whether aCL in PBC and PSC may contribute to APS development or the progression of hepatic disease.
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Affiliation(s)
- Kalliopi Zachou
- Department of Medicine, Research Laboratory of Internal Medicine, Medical School, University of Thessaly, Larissa, Greece
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Panani AD, Grigoriadou M, Magira E, Roussos C, Raptis SA. Perinuclear antineutrophil cytoplasmic antibody myeloperoxidase-positive vasculitis in association with ulcerative colitis. Clin Rheumatol 2005; 25:35-7. [PMID: 15902516 DOI: 10.1007/s10067-005-1124-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2004] [Revised: 02/22/2005] [Accepted: 02/22/2005] [Indexed: 11/25/2022]
Abstract
We describe a patient with ulcerative colitis (UC) who developed small vessel vasculitis. Perinuclear antineutrophil cytoplasmic antibody myeloperoxidase (p-ANCA-MPO) positivity was detected along with a highly elevated titer of anticardiolipin antibodies. A total proctocolectomy was undertaken and the patient, more than 5 years later, remains in very good condition. The possible causative association between the UC, the p-ANCA-MPO-positive small vessel vasculitis, and the anticardiolipin antibodies is discussed.
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Affiliation(s)
- Anna D Panani
- Critical Care Department, Evangelismos Hospital, Medical School of Athens University, Ipsilantou 45-47, Athens, 10676, Greece.
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Naimeh LG, Muller BA. Chronic urticaria in a 17-year-old patient with a past history of bowel disease. Ann Allergy Asthma Immunol 2001; 86:511-6. [PMID: 11383562 DOI: 10.1016/s1081-1206(10)62898-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- L G Naimeh
- Department of Internal Medicine, University of Iowa Health Care, Iowa City 52242-1009, USA
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Sultan SM, Ioannou Y, Isenberg DA. A review of gastrointestinal manifestations of systemic lupus erythematosus. Rheumatology (Oxford) 1999; 38:917-32. [PMID: 10534541 DOI: 10.1093/rheumatology/38.10.917] [Citation(s) in RCA: 132] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
In this review, we analyse critically the effects of systemic lupus erythematosus (SLE) on the gastrointestinal (GI) tract from mouth to anus, attempting to distinguish the features that are most likely to be due to therapy. GI manifestations of SLE include mouth ulcers, dysphagia, anorexia, nausea, vomiting, haemorrhage and abdominal pain. GI vasculitis is usually accompanied by evidence of active disease in other organs. Early recognition of the significance of these symptoms offers the best opportunity to improve the symptoms and to aid long-term survival.
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Affiliation(s)
- S M Sultan
- Centre for Rheumatology/Bloomsbury Rheumatology Unit, Department of Medicine, University College London, UK
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Abstract
Urticaria and angioedema are common processes that are experienced by 15% to 25% of the population at least once during a lifetime. This article presents an overview of urticaria and angioedema with emphasis on these processes as they relate to rheumatic disease. Discussion includes classification of urticaria and angioedema and recommended evaluation and treatment of patients presenting with such problems.
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Ishikawa O, Miyachi Y, Fujita K, Takenoshita S, Nagamachi Y, Hirato J. Ulcerative colitis associated with preceding systemic lupus erythematosus. J Dermatol 1995; 22:289-91. [PMID: 7608387 DOI: 10.1111/j.1346-8138.1995.tb03389.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
We report a 50-year-old female patient who developed ulcerative colitis 31 after years being diagnosed with systemic lupus erythematosus. The overall clinical evaluation of her SLE activity differentiated ulcerative colitis from lupus colitis. Since the association of idiopathic systemic lupus erythematosus with ulcerative colitis has rarely been reported, the combination of these two diseases may be coincidental.
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Affiliation(s)
- O Ishikawa
- Department of Dermatology, Gunma University School of Medicine, Japan
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