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Mohanasundaram S, Samuel MK, Kurien AA. Abdominal Pain in a Female with Lupus - Opening the Pandora's Box. Indian J Nephrol 2024; 34:181-184. [PMID: 38681004 PMCID: PMC11044692 DOI: 10.4103/ijn.ijn_316_22] [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: 09/21/2022] [Accepted: 12/08/2022] [Indexed: 05/01/2024] Open
Abstract
Systemic lupus erythematosus (SLE) is an autoimmune disease that can involve multiple organ systems. The most common form of vasculitis seen in SLE is small vessel vasculitis. Aortitis in SLE or antiphospholipid syndrome is an extremely rare complication. Here, we present a 32-year-old female who presented with a history of prolonged abdominal pain, who was evaluated and diagnosed to have aortitis as an unusual involvement in SLE with secondary antiphospholipid antibody syndrome.
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Affiliation(s)
- Subashri Mohanasundaram
- Assistant Professor, Department of Nephrology, Government Thoothukudi Medical College and Hospital, Thoothukudi, Tamil Nadu, India
| | - Marchwin Kingston Samuel
- Head of the Department- in-Charge, Associate Professor of General Medicine, Department of Nephrology, Government Thoothukudi Medical College and Hospital, Thoothukudi, Tamil Nadu, India
| | - Anila A. Kurien
- Renopath Center for Renal and Urological Pathology Pvt Ltd., Chennai, Tamil Nadu, India
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Aortitis presenting as acute myeloid leukemia - A case report. Ann Med Surg (Lond) 2022; 80:104255. [PMID: 36045831 PMCID: PMC9422307 DOI: 10.1016/j.amsu.2022.104255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Revised: 07/14/2022] [Accepted: 07/20/2022] [Indexed: 11/21/2022] Open
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Escoda T, George J, Jarrot PA, Jean R, Mazodier K, Sanderson F, Poullin P, Saby L, Jourde-Chiche N, Kaplanski G, Chiche L. Aortitis is an under-recognized manifestation of antiphospholipid syndrome: A case report and literature review. Lupus 2022; 31:744-753. [PMID: 35341372 DOI: 10.1177/09612033221091142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Aortitis is a classic manifestation of large vessel vasculitis. Antiphospholipid syndrome (APS), sometimes known as Hughes syndrome, is an acquired autoimmune disorder that manifests clinically as recurrent venous or arterial thrombosis. Patients with APS may also suffer from various underlying diseases, most frequently systemic lupus erythematosus (SLE). Catastrophic antiphospholipid syndrome (CAPS) is a rare but serious complication of APS characterized by failure of several organs due to diffuse microcirculatory thrombi. Its main manifestations involve the kidneys, lungs, heart and central nervous system, and require early diagnosis and rapid therapeutic management. While APS can affect virtually any blood vessel, aortitis is not a known symptom of APS. We report the case of a 36-year-old patient with APS and SLE who presented with CAPS during pregnancy, with no concomitant SLE flare. The first manifestation of CAPS was aortitis, preceding renal, cardiac and haematological manifestations. The outcome was favourable with combined treatment including corticosteroids, anticoagulants, plasma exchange and rituximab. We then carried out a literature search for papers describing the presence of aortitis in APS and/or SLE. In the cases of aortic involvement identified in the literature, including another case of CAPS, the occurrence of aortitis in SLE, often associated with the presence of antiphospholipid antibodies/APS, suggests that aortitis should be considered as an under-recognized manifestation and potential non-criterion feature of APS.
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Affiliation(s)
- Thomas Escoda
- Service de Médecine Interne, 36900CHU Conception, Marseille, France.,Service de Médecine Interne, 36900Hôpital Européen, Marseille, France
| | - Julia George
- Service de Médecine Interne, 36900CHU Conception, Marseille, France
| | | | - Rodolphe Jean
- Service de Médecine Interne, 36900CHU Conception, Marseille, France
| | - Karin Mazodier
- Service de Médecine Interne, 36900CHU Conception, Marseille, France
| | | | - Pascale Poullin
- Service d'Hémaphérèse, 36900CHU Conception, Marseille France
| | - Ludivine Saby
- Service de Cardiologie, 36900Hôpital Européen, Marseille, France
| | | | - Gilles Kaplanski
- Service de Médecine Interne, 36900CHU Conception, Marseille, France
| | - Laurent Chiche
- Service de Médecine Interne, 36900Hôpital Européen, Marseille, France
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Hegde A, Dorji T, Asturkar V, Yangzom S, Bhanu KU. Cases of catastrophic anti-phospholipid syndrome in systemic lupus erythematosus: An experience. SAGE Open Med Case Rep 2022; 10:2050313X221085099. [PMID: 35308057 PMCID: PMC8928371 DOI: 10.1177/2050313x221085099] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Accepted: 02/15/2022] [Indexed: 11/25/2022] Open
Abstract
Anti-phospholipid syndrome is an autoimmune disorder characterized by episodes of arterial and/or venous thrombosis and/or pregnancy morbidity in the presence of anti-phospholipid antibodies. Catastrophic anti-phospholipid syndrome is an accelerated form of the disease with rapid involvement of multiple organ systems often posing a diagnostic challenge. There is a paucity of literature on the myriad presentations of catastrophic anti-phospholipid syndrome owing to the orphan nature of the disease. We present three cases of catastrophic anti-phospholipid syndrome in patients with systemic lupus erythematosus that presented with episodes of thrombosis involving both arterial and venous systems and multisystem organ failure. Timely diagnoses were made based on a high index of suspicion and were managed with a combination of systemic glucocorticoids, cyclophosphamide, plasmapheresis, intravenous immunoglobulin and other supportive measures. However, despite providing the standard of care, we encountered a poor outcome in two of these patients, highlighting the high mortality associated with catastrophic anti-phospholipid syndrome.
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Affiliation(s)
- Arun Hegde
- Department of Rheumatology, Command Hospital (Southern Command), Pune, India
| | - Thinley Dorji
- Department of Internal Medicine, Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan
- Department of Internal Medicine, Armed Forces Medical College, Pune, India
| | - Vikram Asturkar
- Department of Neurology, Command Hospital (Southern Command), Pune, India
| | - Sonam Yangzom
- Department of Radiodiagnosis and Imaging, Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan
- Department of Radiodiagnosis and Imaging, Armed Forces Medical College, Pune, India
| | - Kovilapu Uday Bhanu
- Department of Radiodiagnosis and Imaging, Armed Forces Medical College, Pune, India
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Santacruz JC, Londoño JD, Panqueva U, Cuervo F. Aortitis: An Unusual Inflammatory Complication of Systemic Lupus Erythematosus. Cureus 2021; 13:e18028. [PMID: 34671519 PMCID: PMC8520493 DOI: 10.7759/cureus.18028] [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] [Accepted: 09/16/2021] [Indexed: 11/30/2022] Open
Abstract
Systemic lupus erythematosus (SLE) is a chronic autoimmune disease that can involve any organ system. Vasculitides are classified according to the predominant vessel involved such as large vessel, medium vessel, or small vessel vasculitis. Of these, Takayasu arteritis, Behcet's disease, relapsing polychondritis, and immunoglobulin G4 (IgG4)-related disease predominantly involve large vessels. The most common form of vasculitis seen in SLE is small vessel vasculitis. Aortitis in SLE is an extremely rare complication. This is a case report of a 21-year-old female patient with a history of SLE with overlap syndrome of primary biliary cirrhosis and autoimmune hepatitis associated with antiphospholipid syndrome (APS), who presented with a one-week history of left-back burning lumbar pain, radiating to the flank, which increased with changes in position associated with intermittent claudication. In the angiography images and the positron emission tomography (PET) scan, a hypometabolic left para-aortic oval image was noted, corresponding to the presence of a contained hematoma in an abdominal aorta rupture. Later, she underwent vascular surgery and hemodynamics, performing thoracoabdominal aortic reconstruction together with aortorenal bypass and left nephrectomy. Pathology fundings of the left kidney correspond with class IV lupus nephritis, and the resection sample of the thoracoabdominal aneurysm showed a marked thinning and fragmentation of elastic fibers, areas of fibrosis of the wall with severe IgG4 negative lymphoplasmacytic infiltrate in the immunohistochemical study, establishing the diagnosis of aortitis.
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Affiliation(s)
| | - John Dario Londoño
- Spondyloarthropathies Research Group, Universidad de la Sabana, Chía, COL
| | - Uriel Panqueva
- Rheumatology Department, Fundación Cardioinfantil, Bogotá, COL
| | - Francy Cuervo
- Spondyloarthropathies Research Group, Universidad de la Sabana, Chía, COL
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