Silica-associated systemic lupus erythematosus with lupus nephritis and lupus pneumonitis: A case report and a systematic review of the literature

IntroductionSeveral 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 concernsA 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.DiagnosisThe 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.InterventionsPrednisolone (50 mg/day) with intravenous cyclophosphamide (500 mg/body) were initiated.OutcomesThe 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.ConclusionClose attention is needed, particularly for respiratory system events and infectious diseases, when treating patients with silica-associated SLE using immunosuppressive therapies.     

Primary anaplastic large cell lymphoma of the psoas muscle: a case report and literature review

Primary anaplastic large cell lymphoma (ALCL) of skeletal muscle is very rare. We report a case of ALCL arising from the left psoas muscle. A 14-year-old girl presented with a large left inguinal tumor. She complained of a 2-month history of left leg pain, which had been exacerbated upon leg extension, and she had become aware of a rapidly growing left inguinal tumor 3 weeks before admission. CT scan and MRI revealed a large tumor arising from the left major psoas muscle and protruding into the inguinal region. In view of the tumor's location and the patient's age, soft tissue tumors such as rhabdomyosarcoma and primitive neuroectodermal tumor were initially considered. However, histopathological examination yielded a diagnosis of anaplastic lymphoma kinase-positive ALCL. The serum level of soluble interleukin-2 receptor was markedly elevated at 50,414 U/ml, and this also strongly suggested ALCL. Although rarely reported, ALCL is an important entity to consider in the differential diagnosis of skeletal muscle tumors in children and young adults.     

Acquired hemophilia in a patient with systemic lupus erythematosus: a case report and literature review

We report the case of a 38-year-old female patient with systemic lupus erythematosus (SLE) who developed acquired hemophilia caused by factor VIII (FVIII) inhibitors. She manifested spontaneous bleeding symptoms such as ecchymoses and hematuria. Laboratory findings showed an isolated prolongation of the activated partial thromboplastin time, reduced FVIII activity, and a high titer of FVIII inhibitors. She was successfully treated with oral predonisolone and cyclosporine in combination with steroid and cyclophosphamide pulse therapy.     

Acquired hemophilia in a patient with systemic lupus erythematosus: a case report and literature review

Abstract

We report the case of a 38-year-old female patient with systemic lupus erythematosus (SLE) who developed acquired hemophilia caused by factor VIII (FVIII) inhibitors. She manifested spontaneous bleeding symptoms such as ecchymoses and hematuria. Laboratory findings showed an isolated prolongation of the activated partial thromboplastin time, reduced FVIII activity, and a high titer of FVIII inhibitors. She was successfully treated with oral predonisolone and cyclosporine in combination with steroid and cyclophosphamide pulse therapy.     

Disseminated nocardiosis with psoas abscess in a patient with AIDS: first reported case

Psoas muscle abscess is an uncommon infection that have been diagnosed increasingly in the last years. We present a case of a patient with advanced human immunodeficiency virus infection who developed a disseminated infection due to Nocardia asteroides sensu stricto type VI with psoas abscess. To our knowledge no other cases of Nocardia psoas abscess in the setting of HIV infection have been reported in the literature.     

Disseminated nocardiosis caused by Nocardia farcinica in a patient with colon cancer: A case report and literature review

Rationale:Nocardiosis is an uncommon and potentially life-threatening infection that usually affects immunocompromised hosts. No clinical guidelines have been established for managing this rare disease, and the optimal treatment modality remains unclear. Nocardia farcinica, a relatively infrequent pathogen of nocardiosis, causes a clinically aggressive infection. In addition to our patient data, our search of the literature for patients who presented with empyema caused by N. farcinica will provide fundamental information for optimal treatment modalities.Patient concerns:A 64-year-old man was diagnosed with empyema, 4 days following surgery for sigmoid colon cancer. Brain lesions were evaluated only after N. farcinica was isolated and identified as the causative pathogen through repeated culture tests.Diagnoses:N. farcinica was isolated from the pleural effusion and confirmed as the pathogen through 16S rRNA sequencing.Interventions:The patient was successfully treated with tube thoracotomy, neurosurgical evacuation, and a combination of trimethoprim/sulfamethoxazole plus imipenem. Long-term antibiotic therapy was required to prevent recurrence.Outcomes:Pyothorax showed a good clinical response to antimicrobial therapy and drainage of pleural effusion, whereas brain abscess did not respond to medical therapy and required surgery. The patient eventually recovered and continued chemotherapy as treatment for sigmoid colon cancer.Lessons:Although extremely rare, this report demonstrates the importance of considering Nocardia infection as the differential diagnosis in immunocompromised patients who present with empyema. In particular, because of the N. farcinica infection''s tendency to spread and the resistance of the organism to antibiotics, aggressive evaluation of metastatic lesions and standardized support from microbiological laboratories are important. Surgery may be required in some patients with brain abscesses to improve the chance of survival.     

Celiac disease in a patient with systemic lupus erythematosus: a case report and review of literature

Celiac disease (CD) is an inflammatory condition of the gut with a known autoimmune pathogenesis. Many similarities exist between the pathogenesis of CD and systemic lupus erythematosus (SLE); it is still unknown whether there is an association. There are 13 case reports in the literature of both diseases occurring simultaneously. We report another patient who was diagnosed with SLE and 8 years later, developed CD. A review of the literature is also presented.     

Development of systemic lupus erythematosus in a patient with hypoparathyroidism: a case report and review of the literature

Systemic lupus erythematosus (SLE) is an autoimmune disease in which organs undergo damage. Hypoparathyroidism is a rare disease, which presents in two forms: hereditary and acquired. Cases of hypoparathyroidism and SLE rarely co‐exist. Only six cases have been reported; five of them first presented with lupus and then hypoparathyroidism or simultaneously. We present here developing lupus disease in a woman who had idiopathic hypoparathyroidism. According to increasing data about the autoimmune origin of idiopathic hypoparathyroidism, these case reports suggest that there may be an autoimmune process linking these diseases.     

Pulmonary toxocariasis: a case report and literature review

Toxocariasis is a parasitic disease caused by Toxocara canis or T. cati. We report a patient with toxocariasis who presented with dyspnea, high-grade eosinophilia, and bilateral pulmonary nodules. To further characterize the pulmonary manifestations of toxocariasis, we have reviewed 11 previously published pulmonary toxocariasis cases. The most common pulmonary symptoms in our review were cough and dyspnea, and the most common finding on chest imaging was bilateral pulmonary nodules. Risk factors for Toxocara infection primarily included exposure to dogs. Most patients received albendazole and responded well. A high index of suspicion is needed to diagnose this otherwise preventable parasitic disease.     

肺母细胞瘤1例并文献复习

目的提高对肺母细胞瘤的认识。方法结合1例肺母细胞瘤患者的临床资料和文献复习,详细分析该病的组织起源、临床病理特点、分类、诊断、鉴别诊断、治疗及预后等。结果该病临床症状少且轻微,影像学提示“良性肿瘤”;病理学检查主要特征是镜下瘤组织由胎儿型腺管样的上皮成分和原始的肉瘤样间质成分混杂存在。免疫组化示瘤组织由上皮和间叶两种成分构成。目前尚无有效治疗措施,预后差。结论肺母细胞瘤罕见,极易误诊,应予重视。     

A case of eosinophilic fasciitis without skin manifestations: a case report in a patient with lupus and literature review

Clinical Rheumatology - Eosinophilic fasciitis (EF) is a rare connective tissue disease that causes inflammation and fibrosis of the fascia, inducing pain and motor dysfunction. Characteristic skin...     

免疫抑制宿主肺奴卡菌病二例并文献复习

结果联合用药;免疫功能抑制患者预后差.     

Early onset multiple myeloma in a patient with systemic lupus erythematosus: a case report and literature review

Patients with systemic lupus erythematosus (SLE) are at increased risk for various plasma cell dyscrasias, but the coexistence of SLE and multiple myeloma (MM) are rarely reported to date. Due to the rarity, the clinical features of MM associated with SLE have not been elucidated, and the pathogenesis under this association remains unclear. In this report, we investigate a 31-year-old woman with 5-year history of SLE, who is diagnosed as IgA λ-type MM with multiple lymph node involvement. We discuss the clinical features of MM in SLE by reviewing previous cases and possible mechanisms connecting the two conditions.     

肺诺卡菌病4例报告并文献复习

目的 提高临床医生对肺诺卡菌病的的认识.方法 分析4例肺诺卡菌病的临床特点,并复习相关文献.结果 4例肺诺卡菌病患者2例有免疫性疾病并服用免疫抑制剂,4例均有咳嗽咳痰和发热,3例为午后发热.肺部影像学表现4例肺实变影,3例大小不等的结节影/肿块影并可见空洞.病原学检查标本多种.磺胺治疗效果较好.结论 肺诺卡菌病缺乏特异性临床表现,肺部多发结节影/肿块影并空洞形成是其影像学特点,磺胺是主要治疗药物.     

An aged patient with Henoch-Sch?nlein purpura nephritis: a case report and review of the literature.

A 63-year-old patient with Henoch-Sch?nlein purpura (HSP) nephritis showed progressive proteinuria. Purpura was observed in the extremities as well as in the trunk without any preceding upper respiratory tract infections or drugs, and it disappeared after corticosteroid therapy although mild proteinuria continued throughout the therapy. Renal biopsy specimens showed mesangial IgA deposits in the glomeruli, but no IgA deposits were observed in the dermal vessels or in the intrarenal extraglomerular capillaries. Progressive proteinuria was improved with 37.5 mg/day of captopril. Severity of HSP nephritis in middle-aged to aged patients in the literature was reviewed. It was suggested that careful observation is required in aged patients with HSP nephritis.     

肺球孢子菌感染一例并文献复习

目的 提高对肺球孢子菌病的认识.方法 结合1例肺球孢子菌病患者的临床资料及诊治经过并复习相关文献,对球孢子菌病的临床表现、病理结果及治疗进行分析.结果 患者男,74岁,因"体检发现双肺占位性病变9个月,咳嗽2周"于2009年2月10日收入南京医科大学第一附属医院呼吸内科.患者9个月前体格检查发现双肺多发占位性病变,于2008年6月17日在外院行肺穿刺活检,病理结果提示隐球菌感染,给予氟康唑治疗6个月后,复查胸部CT病灶无明显改变.入院后13 d行胸腔镜下双肺楔形切除术,术后病理结果提示球孢子菌病、孢子菌瘤形成.术后先后给予伏立康唑和氟康唑治疗共6个月,复查胸部CT未见复发.结论 原发性肺球孢子菌病少见,临床表现不典型,其病理所见易与隐球菌混淆.随着免疫抑制剂的广泛使用,本病可能会逐渐增多,临床医生应提高对该病的认识.     

免疫功能正常宿主播散性奴卡菌病1例报道并文献复习

<正>奴卡菌病(nocardiosis)是由奴卡菌感染引起的一种少见病,以肺部感染最多见,可引起全身播散,多发生在免疫抑制及免疫功能低下的患者,现将我院收治的1例免疫功能正常患者全身播散的奴卡菌病病例进行分析,报告如下。临床资料患者男性,45岁,职员,以间断发热、发现全身多发肿块5月余为主诉就诊,5月余前无明显诱因出现发热、咳嗽、咯血,体温波动在37～38℃之间,无畏寒、寒战,咯血为痰中带血丝,量不大,偶咳白痰,无脓痰、胸痛、呼吸困难,并发现左侧胸壁一皮下肿块(初未在意),渐增大,至就诊2月前直径约4 cm,伴红肿、疼痛,     

Pulmonary embolism with acute pancreatitis: a case report and literature review

Acute pancreatitis is an inflammatory disease characterized by local tissue injury which can trigger a systemic inflammatory response. So vascular complications of pancreatitis are a major cause of morbidity and mortality. Pulmonary embolism in acute pancreatitis has been reported to be very rare. We reported a case of pulmonary embolism with acute pancreatitis. A 38-year-old woman broke out upper abdomen pain without definite inducement. She had no nausea and vomiting, fever, dyspnea, cough and expectoration, chest pain. The patient had been diagnosed with acute pancreatitis in local hospital. The patient was treated with antibiotics and proton pump inhibitors, and the abdomen pain was alleviated slightly. But the patient came forth cough and expectoration with a little blood, progressive dyspnea. A computed tomographic scan of the abdomen revealed pancreatitis. Subsequent computer tomography angiography of chest revealed pulmonary embolism (both down pulmonary arteries, left pulmonary artery and branch of right pulmonary artery). Dyspnea of the patient got well with thrombolytic treatment and anticoagulation therapy. Pulmonary embolism is a rare but potentially lethal complication of pancreatitis. Familiarity with this complication will aid in its early diagnosis, therapy and prevent pulmonary embolism, a rare but catastrophic phenomenon.