Cerebral systemic lupus erythematosus presenting with catatonia.

A 13 year old girl with catatonia resulting from cerebral lupus is described. She had concurrent minor epileptic status, but abolition of her seizure activity failed to influence her catatonic state. She recovered after treatment with corticosteroids and immunosuppressive agents. Cerebral lupus should be considered in the differential diagnosis in patients presenting with catatonia.     

Extracorporeal membrane oxygenation in fulminant myocarditis complicating systemic lupus erythematosus

A 24-year-old woman with systemic lupus erythematosus developed cardiac failure and cardiogenic shock that failed to respond to both high-dose inotrope therapy and the insertion of an intra-aortic balloon pump. Circulatory support with extracorporeal membrane oxygenation facilitated cardiac recovery, either spontaneously or assisted by steroid therapy.     

Hypoparathyroidism associated with systemic lupus erythematosus

A case of hypoparathyroidism and systemic lupus erythematosus is reported. It is believed that an association between the 2 diseases has not been described previously.     

Ibuprofen-induced meningitis in systemic lupus erythematosus.

A patient with systemic lupus erythematosus had chills, fever, and headache on four separate occasions after ibuprofen ingestion. One such episode was accompanied by cerebrospinal fluid findings compatible with meningitis. Drug rechallenge under controlled conditions established the relationship between ibuprofen ingestion and meningitis.     

Pregnancy in patients with systemic lupus erythematosus

Ten pregnancies in patients with systemic lupus erythematosus were reviewed. Preterm delivery occurred in 4 cases (40%), fetal growth retardation in 2 (20%) and intrauterine death in 2 (20%). Preeclampsia developed in one case, which was the only found maternal complication. The most important factor associated with poor outcome was lack of antenatal care. Most of the SLE-complicated pregnancies can anticipate a favorable outcome if, and only if, there is a well-planned management with close cooperation among the patient, obstetrician, rheumatologist and neonatologist.     

Systemic lupus erythematosus presenting as morbid jealousy.

A patient fulfilling the diagnostic criteria for systemic lupus erythematosus and presenting with morbid jealousy is described. There was evidence of cerebral lupus. Her physical and mental symptoms responded to a combination of chlorpromazine and steroids. The morbid mental process was probably caused by her physical condition while the content of her disordered thought and behaviour was determined by her introverted premorbid personality, religiosity, unhappy childhood experiences and frustrated desire for children.     

Systemic lupus erythematosus presenting as effuso-constrictive pericarditis.

We describe a 62-year-old woman in whom systemic lupus erythematosus presented as life-threatening effuso-constrictive pericarditis. Surgical drainage of the pericardium was required and the patient made a satisfactory recovery. At six-months follow-up, while taking hydroxychloroquine and a non-steroidal anti-inflammatory agent, she remains well.     

Mortality in Malaysians with systemic lupus erythematosus

One hundred and two patients attending the systemic lupus erythematosus (SLE) clinic of the Department of Medicine, Universiti Kebangsaan Malaysia, were studied retrospectively to determine their survival rates and causes of death. There were 21 deaths. The 1, 5, and 10 year survival rates were 93%, 86% and 70% respectively. There was a bimodal pattern of mortality with more patients dying in the first 2 years or after 5 years of disease. Infection was the direct cause of death in 52% and contributed to a further 19% of deaths. Patients with lupus nephritis had a higher relative risk (RR) of death (RR = 4.34, p < 0.02) although there was no significant increase in risk with any particular histological type on biopsy. Cerebral lupus (RR = 3.08, p < 0.001) and methylprednisolone treatment (RR = 6.24, p < 0.001) were also associated with increased risk of death. Increased awareness of infection and earlier use of antibiotic therapy may improve survival of patients suffering from SLE.     

Gastrointestinal manifestations associated with systemic lupus erythematosus

Gastrointestinal symptoms are often difficult to interpret in patients with systemic lupus erythematosus. Symptoms can develop either from symptomatic autoimmune tissue injury, complications of lupus-related organ dysfunction, infections, thrombembolic manifestations of anti-phospholipid antibody syndrome, medication or unrelated disorders. We describe the gastrointestinal manifestations of lupus and discuss the diagnostic approach and therapy.     

Pregnancy in systemic lupus erythematosus

Systemic lupus erythematosus (SLE) is an autoimmune disease that predominantly affects women of reproductive age. Pregnancy and its outcome is a major concern to most SLE patients. Queries regarding the risk of disease flares during pregnancy, chance of fetal loss, and the safety of various drugs are often raised. With the improvement in the understanding of the pathogenesis of SLE and the judicious use of immunosuppressive drugs, better disease control can now be achieved and SLE patients should not be deprived of the opportunity for bearing children. Prepregnancy counselling and close collaboration with other specialists such as the obstetricians and the perinatologists is essential in optimising the maternal and fetal outcome in lupus pregnancies. In this review, important issues regarding the fertility rate, optimal timing of conception, risk of disease flares during lupus pregnancy, pregnancy course, fetal outcome, safety of various drugs used for disease control during pregnancy and lactation, and contraceptive advice are discussed.     

Methylprednisolone in systemic lupus erythematosus

39 patients who received pulse methylprednisolone for disease manifestations of systemic lupus erythematosus were studied for zero to twenty-four weeks following therapy. Pulse methylprednisolone was given as intravenous infusions of methylprednisolone (10 mg/kg body weight) over one hour each day for three consecutive days. 27 (69.2%) patients were treated for lupus nephritis, 12 (30.8%) patients for non-renal manifestations of lupus. 17 (63.0%) of the renal lupus patients and 7 (58.3%) of the non-renal lupus patients showed clinical response. 11 (28.2%) patients had infections from which 7 (63.6%) died. Overall, 15 (38.5%) patients died. Early deaths (occurring within the first two weeks) were mainly due to disease activity while later deaths were mainly due to infection. In conclusion, the majority of lupus patients appeared to have had a beneficial response to pulse methylprednisolone therapy.     

干扰素γ与系统性红斑狼疮

系统性红斑狼疮(systemic lupus erythematosus,SLE)的病因及发病机制至今尚未完全清楚,作为Th1型细胞因子之一的干扰素γ(IFN-γ)可能参与了SLE的发病及炎症过程。本文就近年来国内外对狼疮患者及狼疮鼠模型的血清、体外细胞培养分泌的IFN-γ水平、IFN-γ诱导蛋白和IFN-γ相关基因表达以及中医药治疗等方面的研究作一综述。     

系统性红斑狼疮17例分析

系统性红斑狼疮(SLE)多发于青中年女性,临床表现多样化。本文按美国风湿病学会(ARA)1982年修订的SLE诊断标准,选择17例住院SLE进行了分析,指出应注意对早期、不典型的病例的诊断,治疗方案和药物剂量必须根据病情活动情况而定,救冶狼疮性肾炎(LN)及减少激素用量是治疗中的重要问题。     

Clinicolaboratory profile of 33 Arabs with systemic lupus erythematosus.

A clinical and laboratory survey of systemic lupus erythematosus was conducted in 33 Arab patients in the UAE. Arthropathy (91%) followed by renal involvement (54%) and haematological disorders (45.5%) were the major clinical manifestations. Discoid rash (3%) was the least common. Apart from headaches, other neuropsychiatric symptoms were uncommon or not encountered. A number of distinctive clinical subsets of lupus was also observed. An unusually high prevalence of dsDNA antibodies was detected in the study (97%), compared with a prevalence of 89.5% of ANF. There was a relative paucity of anti-Ro (18.5%), La (7.5%) and RNP (11%) antibodies, but a high rate of anti-Sm(33%). The occurrence of the latter in patients with central nervous system and renal disease was insignificant. C3-Hypocomplementaemia occurred in 38.5% of the patients and a positive VDRL and Coomb''s test in 9% and 24%, respectively. This study provides additional information on the characterization of systemic lupus erythematosus in various populations.     

系统性红斑狼疮伴发急腹症35例临床分析

目的提高对系统性红斑狼疮(SLE)伴发急腹症的认识,总结治疗经验。方法对35例SLE伴发急腹症的病例做回顾性分析。结果SLE并发急腹症表现多样,包括急性胃肠炎,消化道出血,缺血性肠炎,肠梗阻,肠穿孔,急性胰腺炎,急性腹膜炎,假性肠梗阻等,以急性胃肠炎常见。治疗后33例病情得到控制,2例死亡。结论狼疮活动是急腹症的重要病因,加大激素治疗和/或免疫抑制剂治疗有良好的疗效。