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Tsuji N, Inoguchi N, Sakai T, Furumuro T, Takaya K. Unilateral Pleural Effusion as an Initial Manifestation of Systemic Lupus Erythematosus in a Patient of Advanced Age. Cureus 2024; 16:e63327. [PMID: 38947142 PMCID: PMC11214658 DOI: 10.7759/cureus.63327] [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: 06/27/2024] [Indexed: 07/02/2024] Open
Abstract
Systemic lupus erythematosus (SLE) is a chronic, multisystem autoimmune disease that can manifest in older individuals, presenting unique diagnostic challenges because of its atypical presentations and comorbidities. Pleural effusion is a relatively uncommon manifestation of SLE, with studies suggesting a higher prevalence in older than younger patients. We herein report an atypical case of delayed-onset SLE in a 75-year-old man with left-sided pleural effusion as the initial presentation. This case underscores the difficulty of diagnosing SLE in patients of advanced age and the importance of considering a broad range of differential diagnoses, even in cases that may suggest a more common disease. This case also highlights the fact that unilateral pleural effusion can be an initial manifestation of SLE, and when the cause of the pleural effusion is unclear, SLE should be considered as a potential diagnosis.
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Affiliation(s)
| | | | | | | | - Kiho Takaya
- Internal Medicine, Otsu City Hospital, Otsu, JPN
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Goyal A, El-Wiher N, Joseph B. Not Your Ordinary Teenage Girl With Chest Pain. Clin Pediatr (Phila) 2023; 62:1445-1448. [PMID: 36927173 DOI: 10.1177/00099228231161580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Affiliation(s)
- Ashima Goyal
- Division of Pediatric Emergency Medicine, Beaumont Hospital, Royal Oak, MI, USA
| | - Nidal El-Wiher
- Division of Pediatric Intensive Care, Beaumont Hospital, Royal Oak, MI, USA
| | - Benjamin Joseph
- Division of Pediatric Emergency Medicine, Beaumont Hospital, Royal Oak, MI, USA
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Pérez-Campos A, Gallego-Gutiérrez I, Ortiz-Muñoz M, Muñoz-Hernández P, Jiménez-Heffernan JA. Lupus erythematosus eosinophil cells in a pleural effusion. Diagn Cytopathol 2021; 49:454-456. [PMID: 33400388 DOI: 10.1002/dc.24692] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 12/15/2020] [Accepted: 12/28/2020] [Indexed: 01/21/2023]
Affiliation(s)
- Ana Pérez-Campos
- Departments of Pathology, University Hospital 12 de Octubre, Madrid, Spain
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Ningombam A, Sarkar A, Acharya S, Chopra A. Lupus erythematosus cell in body fluids: A case report and review of literature. Diagn Cytopathol 2020; 48:773-777. [PMID: 32640116 DOI: 10.1002/dc.24450] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 04/11/2020] [Accepted: 04/17/2020] [Indexed: 11/08/2022]
Abstract
The diagnosis of systemic lupus erythematosus (SLE) has undergone radical change after the development of serological techniques. The in vitro demonstration of lupus erythematosus (LE) cell has less significance for the diagnosis of SLE in the present scenario. Although over the years, the spontaneous in vivo occurrence of LE cell in numerous body fluids as an initial presentation of SLE has been documented. The report of the presence of the LE cell can not only aid in the further workup of the patient but also suggest the involvement of a particular organ or body cavities by SLE. The morphology and mimickers of the LE cell should be cogitated and meticulous search of such cells should play an important role in the evaluation of body fluids. In our case, the patient presented at emergency with pericardial tamponade and cytological evaluation of the pericardial fluid demonstrated in vivo presence of LE cells. The serological work-up then confirmed the case to be SLE. This report and review of literature wish to highlight the fact that this cell still plays a significant role even in the era of immunoassays.
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Affiliation(s)
- Aparna Ningombam
- Department of Laboratory Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Abhirup Sarkar
- Department of Laboratory Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Shreyam Acharya
- Department of Laboratory Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Anita Chopra
- Department of Laboratory Oncology, Dr. BRAIRCH, All India Institute of Medical Sciences, New Delhi, India
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Xiong J, Ren Y, Li H, Fu B, Wu R. First case of pleural amyloidosis in systemic erythematosus: report and literature review. Z Rheumatol 2018; 77:841-843. [PMID: 30191392 DOI: 10.1007/s00393-018-0532-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- J Xiong
- Department of Rheumatology, the First Affiliated Hospital of Nanchang University, 330006, Nanchang, China
| | - Y Ren
- Department of Rheumatology, the First Affiliated Hospital of Nanchang University, 330006, Nanchang, China
| | - H Li
- Department of Rheumatology, the First Affiliated Hospital of Nanchang University, 330006, Nanchang, China
| | - B Fu
- Department of Rheumatology, the First Affiliated Hospital of Nanchang University, 330006, Nanchang, China
| | - R Wu
- Department of Rheumatology, the First Affiliated Hospital of Nanchang University, 330006, Nanchang, China.
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Xu M, Chisholm KM, Fan G, Stevens AM, Rutledge JC. Hematoxylin Bodies in Pediatric Bone Marrow Aspirates and their Utility in the Diagnosis of Systemic Lupus Erythematosus. Pediatr Dev Pathol 2018; 21:300-307. [PMID: 28990859 DOI: 10.1177/1093526617734948] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In our recent case report, the finding of lupus erythematosus (LE) cells in a bone marrow aspirate led to the diagnosis of systemic lupus erythematosus (SLE) and appropriate treatment, although the patient was not clinically suspected to have SLE. To determine whether LE cells are present in the bone marrow aspirates of SLE patients, but overlooked in routine bone marrow morphology review, bone marrow aspirates from 30 pediatric patients (15 with SLE and 15 with other diagnoses) evaluated by rheumatologists were reviewed. LE cells were found in the bone marrow aspirates of only 1 SLE patient and none in non-SLE patients. However, hematoxylin bodies were identified in 53% (8/15) of SLE patients. Neither hematoxylin bodies nor LE cells were found in the aspirates from patients with other disorders. Three additional pediatric patients identified prospectively were found to have hematoxylin bodies in the bone marrow aspirates. Although the diagnosis was not initially suspected, 2 of the 3 patients were subsequently diagnosed with SLE. All patients with hematoxylin bodies and SLE had antinuclear antibody titers ≥1:640 with a homogeneous staining pattern. In addition, bone marrow aspirates of 9 adult patients were reviewed, and neither LE cells nor hematoxylin bodies were identified. In summary, hematoxylin bodies were present in the bone marrow aspirates of many pediatric SLE patients, while LE cells were rare. The finding of hematoxylin bodies in pediatric bone marrow aspirates is a helpful and specific diagnostic clue that may lead to the diagnosis of SLE when other clinical features are nonspecific.
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Affiliation(s)
- Min Xu
- 1 Department of Laboratories, Seattle Children's Hospital, Seattle, Washington.,2 Department of Laboratory Medicine, University of Washington, Seattle, Washington
| | - Karen M Chisholm
- 1 Department of Laboratories, Seattle Children's Hospital, Seattle, Washington.,2 Department of Laboratory Medicine, University of Washington, Seattle, Washington
| | - Guang Fan
- 3 Department of Pathology, Oregon Health Science University, Portland, Oregon
| | - Anne M Stevens
- 4 Division of Pediatric Rheumatology, Seattle Children's Hospital, Seattle, Washington.,5 Department of Pediatrics, University of Washington, Seattle, Washington.,6 Center for Immunity and Immunotherapies, Seattle Children's Research Institute, Seattle, Washington
| | - Joe C Rutledge
- 1 Department of Laboratories, Seattle Children's Hospital, Seattle, Washington.,2 Department of Laboratory Medicine, University of Washington, Seattle, Washington
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Xu M, MacNeal LA, Wittman BJ, Rutledge JC. Is Identification of Lupus Erythematosus Cells Still Useful? A Case Report. Pediatr Dev Pathol 2017; 19:424-427. [PMID: 26580095 DOI: 10.2350/15-08-1695-cr.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
A 13-year-old girl presented with significant weight loss, depression, anemia, and neutropenia. The preliminary diagnosis was anorexia nervosa combined with depression. Due to peripheral cytopenia, a bone marrow biopsy was performed to rule out leukemia. Lupus erythematosus (LE) cells were found in the bone marrow aspirate, which prompted autoantibody testing, although clinically it was not suspected the patient had systemic lupus erythematosus (SLE). Further testing demonstrated very high levels of antinuclear antibodies (ANA) (>12 U) and anti-double strand DNA (dsNDA) (>1000 IU/mL), which confirmed the diagnosis of SLE. The patient was treated with steroids for SLE, and symptoms improved quickly. In conclusion, although the identification of LE cells as one of the diagnostic criteria for SLE has been obsolete, careful examination of bone marrow to identify LE cells is still very important in the diagnosis of unsuspected SLE.
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Affiliation(s)
- Min Xu
- 1 Department of Laboratories, Seattle Children's Hospital, Seattle, WA, USA.,2 Department of Laboratory Medicine, University of Washington, Seattle, WA, USA
| | - Lucinda A MacNeal
- 3 Department of Family Medicine3 Providence Alaska Medical Center, Anchorage, AK, USA
| | - Brenda J Wittman
- 4 Pediatric Hematology and Oncology, Providence Alaska Medical Center, Anchorage, AK, USA
| | - Joe C Rutledge
- 1 Department of Laboratories, Seattle Children's Hospital, Seattle, WA, USA.,2 Department of Laboratory Medicine, University of Washington, Seattle, WA, USA
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Naor AW, Wilkerson MJ, Meindel M, Morton M, Pohlman LM. Pathology in Practice. Systemic lupus erythematosus (SLE) in a dog. J Am Vet Med Assoc 2017; 250:627-629. [PMID: 28263107 DOI: 10.2460/javma.250.6.627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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New-onset systemic lupus erythematosus in a long-term hemodialysis patient with acute pleuritis and pneumonitis. CEN Case Rep 2015; 4:139-144. [PMID: 28509090 DOI: 10.1007/s13730-014-0155-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Accepted: 10/20/2014] [Indexed: 10/24/2022] Open
Abstract
A 61-year-old woman, with a 25-year history of maintenance hemodialysis due to end-stage renal disease of unknown causes, was admitted because of systemic joint pain and inflammatory response of unknown etiology that persisted for 1 month. Laboratory data on admission revealed leukocytopenia, lymphocytopenia, high serum C-reactive protein, and positivity for antinuclear antibody (ANA) and anti-double strand DNA. After admission, she progressively developed cough and dyspnea. A chest radiograph revealed bilateral ground glass opacity and pleural effusion. A thoracentesis revealed lupus erythematosus cells, suggesting lupus pleuritis. A chest computed tomography showed a pattern of diffuse alveolar damage compatible with acute lupus pneumonitis. She fulfilled the American Rheumatism Association diagnostic criteria for systemic lupus erythematosus (SLE). Methylprednisolone pulse therapy followed by oral prednisone treatment improved the clinical symptoms and laboratory abnormalities. ANA was negative 25 years earlier when she first started hemodialysis and she had neither clinical nor serological abnormalities related to SLE during the last 25 years. Further, she had neither received drugs that can cause drug-induced SLE, nor had a history of ultraviolet ray exposure, pregnancy, blood transfusion, trauma and smoking. This report suggests that new-onset SLE can develop in patients undergoing long-term dialysis. Hence, when we encounter dialysis patients with arthralgia and/or respiratory disorders, we should consider the possibility of new-onset SLE.
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Study of anti-apolipoprotein A-I antibodies and paraoxonase 1 activity in systemic lupus erythematosus patients; correlation with disease activity and damage indices. EGYPTIAN RHEUMATOLOGIST 2013. [DOI: 10.1016/j.ejr.2013.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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