Systemic lupus erythematous after Pfizer COVID-19 vaccine: a case report

Clinical Rheumatology - The Pfizer-BioNTech COVID-19 vaccine has been authorized by the U.S. Food and Drug Administration as it demonstrated 95% effectiveness against the SARS-CoV-2 virus. Although...     

Systemic lupus erythematosus presenting initially with acute pancreatitis and a review of the literature

A patient with systemic lupus erythematosus is reported whose initial clinical presentation was that of acute pancreatitis, confirmed by pancreatic isoamylase elevation and pancreatic enlargement on computerized tomography. A lack of a correlation with steroid therapy and a need to document pancreatitis in a multisystem disease like lupus with radiographic evidence as well as pancreatic isoamylase elevations is emphasized.     

Systemic lupus erythematosus and acute pancreatitis: a case series

The aim of this study was to evaluate whether corticosteroid use is the etiological agent in acute pancreatitis in patients with systemic lupus erythematosus, or whether it is related to the underlying connective tissue disorder. Hospital admissions at Thomas Jefferson University Hospital between 1982 and 2002 that carried the dual diagnosis of systemic lupus erythematosus and pancreatitis were identified, and demographic data, clinical interventions and parameters of clinical progression of their disease were identified. From 2947 admissions with systemic lupus erythematosus 25 (0.85%) were diagnosed as having acute pancreatitis; 76% of cases had active systemic lupus erythematosus on presentation, with an average of 4.4 organ involvement, and a clustering of renal disease (56%), pleural effusion (48%) and arthritis (44%) in these patients. Fifteen patients with active disease and three whose disease was inactive received increased doses of corticosteroids, and four active cases and one inactive one stayed on the same doses. Two inactive patients received no corticosteroids before or after the diagnosis of pancreatitis. Eighty-two percent of patients had clinical and laboratory improvement on the higher or maintenance dose of corticosteroids. We therefore concluded that acute pancreatitis is a rare manifestation of systemic lupus erythematosus, and corticosteroids do not appear to be the etiological agent.Abbreviations ARDS Acute respiratory distress syndrome - ALT Alanine aminotransferase - ANA Antinuclear antibodies - BUN Blood urea nitrogen - GGTP -glutamyltransferase - LDH Lactate dehydrogenase - MCP Metacarpophalangeal - PIP Proximal interphalangeal - PT Prothrombin - PTT Partial thromboplastin - SLE Systemic lupus erythematosusPresented as a poster at the 2002 American College of Rheumatology Annual Scientific Meeting, poster no. 1163)     

系统性红斑狼疮并发肺动脉高压1例并文献复习

目的提高对系统性红斑狼疮（SLE）并发肺动脉高压（PHT）的发病机制、临床表现、治疗及预后的认识。方法对1例并发PHT的SLE病例进行分析和讨论,并结合相关文献复习。结果SLE并发PHT的机制尚不明确。其临床表现无特异性,早期症状多为呼吸困难。SLE患者出现雷诺征时,应高度怀疑PHT的存在。大剂量糖皮质激素联合免疫抑制剂可显著降低PHT。结论SLE并发PHT常提示预后不良,应尽早诊断及治疗。针对原发病的强化治疗可有效降低PHT。     

Systemic lupus erythematosus and thrombotic thrombocytopenic purpura: a case report and literature review

We describe a patient with systemic lupus erythematosus (SLE) who developed severe and acute thrombotic thrombocytopenic purpura (TTP). Detection of the fragmentation of peripheral red blood cells (RBC) helped the early diagnosis of TTP and the patient was rescued by extensive plasma exchange started promptly after the diagnosis. Because manifestations of TTP are similar to those in SLE, it is sometimes difficult to make an accurate diagnosis of TTP in SLE patients. We emphasise here the significance of the early diagnosis of TTP by the observation of fragmented RBC and the intensive therapy, including plasma exchange, for this very severe condition.     

系统性红斑狼疮伴发急腹症20例分析及文献复习

目的 提高对系统性红斑狼疮（SLE）伴发急腹症（AA）临床多样性的认识。总结治疗此类病例的经验。方法 对20例SLE伴发AA的病例做回顾性分析。并复习35年相关文献。结果 AA多数是SLE病情活动的表现（70%），也可能由独立于SLE的其他疾病引直民（30%），病变广泛多变，容易误诊，早期确定采用保守或手术治疗是提高生存率的关键。结论 SLE伴发AA预示病情危重，应尽早明确AA的原因，恰当选择治疗措施。     

系统性红斑狼疮合并腹主动脉瘤继发获得性血友病1例并文献复习

[摘要] 方法：报告1例系统性红斑狼疮合并腹主动脉瘤继发获得性血友病的临床特征、诊治经过,并进行相关文献复习和讨论。 目的：探讨系统性红斑狼疮(SLE)合并腹主动脉瘤(AAA)同时继发获得性血友病(AHA)罕见病情的诊治方法,提高临床医师对此类罕见疾病的认识水平及诊治水平。 结果：短期常规剂量使用甲强龙,联合环磷酰胺,同时行血浆置换治疗,并补充人凝血酶原复合物及凝血因子Ⅷ制剂替代治疗,控制病情后迅速减量激素至小剂量,较短时间内控制了SLE继发的获得性血友病,同时腹主动脉瘤病情持续稳定。 结论：在本例SLE继发AHA同时合并AAA患者的治疗中,我们使用短时间常规剂量糖皮质激素同时联合免疫抑制剂,辅以血浆置换治疗,较早控制了病情,未发生激素相关并发症,同时腹主动脉瘤病情稳定。     

Systemic lupus erythematosus in a boy with chronic granulomatous disease: case report and review of the literature

We describe a patient with X-linked chronic granulomatous disease (CGD) who developed systemic lupus erythematosus, which was characterized by photosensitivity, malar rash, glomerulonephritis, leukopenia, hypocomplementemia, antinuclear antibodies, and anti-double-stranded DNA antibodies, at age 3. The patient's mother is an asymptomatic carrier of CGD, and her other son (the patient's half-brother) also has CGD. Neither the mother nor the brother has clinical or serologic evidence of systemic lupus erythematosus. Previous cases of discoid lupus-like skin lesions have been reported both in carriers and in patients with CGD. Our patient represents the first reported case of an individual with convincing clinical, serologic, and pathologic evidence of systemic lupus erythematosus. The association between defective host defense mechanisms and autoimmune phenomena has been described previously in patients with Job's syndrome and in patients with B cell and T cell deficiency disorders, including the acquired immunodeficiency syndrome. The relationship between the known leukocyte defects in CGD and the pathogenesis of a lupus-like illness is unclear.     

Systemic lupus erythematosus nephritis and COVID-19 disease

Clinical Rheumatology - Of the more than 20 studies published on SLE patients with COVID-19, none of the studies focused on lupus nephritis. We report the outcomes of renal biopsy-proven systemic...     

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.     

Systemic lupus erythematosus myocarditis after COVID-19 vaccination

IntroductionCases of acute myocarditis have been after administration of the BNT162b2 and Ad26.COV2.S vaccine.ObjectiveDescribe another possible mechanism of myocarditis after COVID-19 vaccination.Case presentationWe describe the clinical case of a 72-year-old female with pleuritic chest pain one week after the third of the BNT162b2 mRNA vaccine. Serological tests for cardiotropic pathogens were negative, and autoimmunity screening was positive with anti-nuclear antibody (ANA) in 1:160 dilution, Anti-double-stranded DNA (anti-dsDNA), and anti-histone antibodies. ¹⁸F-fluoro-deoxy-glucose (FDG) positron emission tomography/computed tomography (PET/CT) showed a focal myocardial and pericardial inflammatory process in the cardiac apex.Results and discussionSystemic lupus erythematosus (SLE) diagnosis was made with myocardial affection. As far as we know, this is the first report of a case of lupus myocarditis after the COVID-19 vaccine.ConclusionGiven the pathogenic rationales, the association between SLE and myocarditis should be considered.     

Systemic lupus erythematosus and Crohn's disease: a case report

A 24-year-old woman with systemic lupus erythematosus (SLE) presented abdominal pain and diarrhea. No evidence for an SLE flare was obtained. Colonoscopy and microscopic biopsy examination revealed findings typical of Crohn's disease. Despite the rarity of the combination, patients with SLE showing gastrointestinal manifestations might merit evaluation for Crohn disease.     

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.     

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.