Arthrite à Salmonella enteritidis compliquant un lupus érythémateux systémique

Septic arthritis due to Salmonella in systemic lupus erythematosus is rare. We report a case of septic arthritis by Salmonella enteritidis which occurred during the evolution of systemic lupus erythematosus. A 23-year-old man was diagnosed as suffering from systemic lupus erythematosus. This diagnosis was taken on the basis of general symptoms, skin lesions, hemolytic anemia, thrombocytopenia and glomerulonephritis (class III). He was treated with three methylprednisolone boli related by high-dose regimen of prednisolone. A month and a half later, he presented fever with monoarthritis of the left elbow without any other new sign of underlying systemic disease. Bacteriological examinations isolated S. enteritidis. The patient improved with antibiotics and joint lavage. Feverish monoarthritis in systemic lupus erythematosus should be suspect to be septic arthritis. Appropriate treatment should be promptly instituted to improve the prognosis.     

Lupus érythémateux systémique

The systemic lupus is an autoimmune disease characterized by cutaneous-articular, visceral (kidney, nervous system, serous membranes), and haematological lesions. Due to the various groups of symptoms that have been observed, classification criteria have been proposed; these are useful for cohort comparisons, but are not adequate for individual diagnosis. Grouping main clinical manifestations allows to distinguish benign forms – mainly the cutaneous-articular, and the serous (pleuropericarditis) types – from the severe visceral, renal, central neurological, haematological (thrombopenia, haemolytic anaemia), and thrombotic forms. The immunological diagnosis is based on the evidence of high levels of antinuclear antibodies and, less frequently, of native anti-DNA antibodies, or antinucleosome. Other antibodies are useful for the diagnosis, despite their rareness: anti-Sm, and anti-ribosome antibodies. In one case out of three, antiphospholipid antibodies are associated with arterial or venous thrombotic complications, or with obstetrical accidents. The disease evolves spontaneously, by successive attacks, more or less regressive. Prognosis depends on the severity of the visceral sequelae after adequate treatment, with the mortality reduced to 1% per year of disease duration. Therapy is based on symptomatic treatments (aspirin, antihypertensive agents, hypolipidemic agents, anticoagulant drugs), long-acting medications (synthetic antimalarial drugs, methotrexate,…), corticoids dosed according to the severity of clinical manifestations, and immunosuppressive drugs (cyclophosphamide, azathioprin, mycophenolate).     

Association entre lupus érythémateux systémique et maladie coeliaque : cinq cas

Systemic lupus erythematosus and celiac disease are rarely reported in combination. We report five cases seen over a 4–year period. The two conditions occurred concomitantly in one patient, whereas the celiac disease antedated the lupus in one patient and postdated the lupus in the remaining three patients. Villous atrophy on duodenal biopsy specimens with a favorable response to a gluten-free diet was noted in all the five patients. Only four patients had positive serological tests for celiac disease and only three had abdominal symptoms.     

Cardiomyopathies spécifiques au cours du lupus érythémateux systémique : à propos de 3 cas

Clinically important myocarditis is an unusual feature in patients with systemic lupus erythematosus (SLE). We report 3 consecutive lupus patients over a 1 year period that developed severe left ventricular dysfunction in the absence of coronary artery disease or hypertensive cardiomyopathy. Two of them had clinical and biological flare of the disease whereas the lupus was quiescent in the latter. Two of them had positive IgG anticardiolipin antibodies. High dose steroids were given in 2 patients, one of them also required cyclophosphamide on account of diffuse proliferative glomerulonephritis. Left ventricular function improved quickly and markedly in these 2 patients; one of them had recurrence of severe myocarditis at intervalls of 6 years and was each time responsive to steroïds. Lupus cardiomyopathy, a rare event in the course of SLE, can be related to the disease even in the absence of coronary artery disease or hypertensive cardiomyopathy. It may be improved by steroids and immunosuppressive therapy. Literature concerning this cardiac manifestation in lupus is reviewed.     

Hypercalcémie sévère et lupus érythémateux disséminé

A rare case of severe hypercalcemia strongly associated with systemic lupus erythematosus (SLE) is reported. On admission, a young woman showed severe hypercalcemia and photosensitivity. Criteria for diagnosis of SLE were not sufficient. All causes of hypercalcemia were excluded. Radiographs of the skeleton were normal. One year later diagnosis of SLE was evident. In addition, diffuse and severe osteopenia and chest deformities had occurred. The treatment of SLE normalized persistently calcemia. Mild elevation of calcium levels occurred during flares of SLE. It has been hypothesized that hypercalcemia in patients with SLE could be caused by the presence of stimulatory anti-PTH receptor antibodies. This case report suggests that in patients with severe hypercalcemia associated with SLE early diagnosis and treatment of SLE may prevent bone loss. In these patients the prevention of severe bone damage is very important. Indeed severe osteopenia may favour skeletal deformities and fractures; in addition it may represent a serious obstacle in using adequate doses of glucocorticoids for treatment of SLE.