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Systemic lupus erythematosus in a filly.

Systemic lupus erythematosus (SLE) was diagnosed in a 2-year-old Standardbred filly. Clinical signs of SLE included weight loss, bilateral symmetric alopecia, seborrhea, oral ulceration, and lymphadenopathy. Abnormal laboratory findings included a Coombs test-positive hemolytic anemia and positive antinuclear antibody test result. Histologic evaluation of multiple skin biopsy specimens revealed interface dermatitis with linear deposition of IgG at the basement membrane zones of the epidermis and hair follicles. The filly did not respond to glucocorticoid treatment and was euthanatized. Necropsy findings included membranous glomerulonephritis and fibrous synovitis. On the basis of these findings, SLE should be considered in the differential diagnosis of immune-mediated skin disease in horses. Definitive diagnosis of SLE relies on recognition of multisystemic disease and confirmatory histopathologic and immunopathologic findings.

Animals↗

Auto-antibody profile in systemic lupus erythematosus.

Thirty cases of systemic lupus erythematosus (SLE) were selected on the basis of revised ARA criteria (American Rheumatology Association) and their sera examined for the presence of various auto-antibodies. The male to female ratio was 1:5 and joint manifestations were the commonest mode of presentation. The frequency of various manifestations was found to differ between the two sexes. Renal lesions were observed in 9 (nine) cases. ANF was detected in 28 of the 30 cases and the diffuse pattern was the commonest (11 cases) (37.7%). Six cases had very high titres (a titre of more than 1:1280) of antinuclear factor. Antibodies to DNA were detected in 9 cases (30%). These patients tended to have more severe disease, with high titres of ANF and low complement levels. Presence of antibodies to DNA, however, could not be correlated with the severity of renal lesions. Anti Sm antibody was found in 8 cases (26.7%), anti nRNP antibody in 19 cases (63.3%) and antihistone antibodies in 22 cases (73.3%). Patients harbouring any of these three antibodies tended to have a milder clinical disease.

Antibodies, Antinuclear↗

[Status of fibrinolysis in systemic lupus erythematosus].

In patients with systemic lupus erythematosus (SLE) both a haemorrhagic diathesis and a tendency to thrombosis of the venous and arterial vessels can be observed. In the course of the disease, thrombosis of the leg or pelvic veins developed in 20 per cent of 188 patients. The levels of alpha 2-plasmin inhibitor, plasminogen, fibronectin and of factor VIII complex were increased in patients with SLE compared with a control group. Fifty per cent of the patients showed no increase in fibrinolytic activity after venous occlusion measured with the fibrin plate method. This suggests a reduced fibrinolytic capacity in SLE probably caused by alteration of the endothelial cells through immune complex vasculitis. In addition, the lupus anticoagulant and an acquired antithrombin III deficiency in nephrotic syndrome in SLE are to be considered thrombophilic mechanisms. In the individual case there is an overlapping of hyper- and hypocoagulability.

Adult↗

[Disseminated intravascular coagulation in systemic lupus erythematosus].

A patient with systemic lupus erythematosus (SLE) who developed disseminated intravascular coagulation during the beginning of SLE is presented. No other cause responsible for the producing of DIC was found. After treatment with corticoids, and cyclophosphamide the DIC was rapidly settled. This case supports the need for a complete blood test in patients with SLE who show coagulation alterations.

Child↗

OKT4+ T cell deficiency and an association of immunoglobulin deficiency in systemic lupus erythematosus.

A patient with systemic lupus erythematosus and selective serum IgA and IgM deficiency also had a deficiency of OKT4+, OKT4A+, OKT4B+, and OKT4E+ T cells in circulating blood. This deficiency of helper/inducer T cell subsets in blood was associated with impaired T cell responses to phytohaemagglutinin in vitro, and an impaired ability to produce IgA and IgM by the patient's B cells. The patient's OKT4+ (CD4+) T cell deficient population suppressed IgM synthesis by normal B and T cells.

Adult↗

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.

Adult↗

Association of lupus anticoagulant with severe valvular heart disease in systemic lupus erythematosus.

Two cases of systemic lupus erythematosus with hemodynamically significant mitral valve dysfunction and associated lupus anticoagulant are reported. Both patients underwent valve replacement and both had thrombus formation on the mitral valve, one pre- and the other postoperatively. Both patients suffered a number of extracardiac thromboses at different times in the course of their illness. The contribution of the lupus anticoagulant to the thrombotic problems, and its possible relationship to the pathogenesis of Libman-Sacks endocarditis are discussed.

Adolescent↗

Levamisole in systemic lupus erythematosus.

Two patients with systemic lupus erythematosus complicated with lupus nephritis were treated with levamisole, an immunomodulator. Clinical features, including urinary protein excretion and creatine clearance, were restored in one patient, also immunoparameters such as ANA, Ig-bearing cell number and PHA-skin test. The other patient did not respond to levamisole but did respond to cyclophosphamide.

Adolescent↗

Multiple osteonecrotic lesions in systemic lupus erythematosus.

A patient with systemic lupus erythematosus who developed osteonecrosis in 13 sites is presented. Most lesions occurred while corticosteroid dose was increased during disease exacerbations. Pathogenetic mechanisms are reviewed and possible simulation of polysynovitis is discussed.

Adult↗

Validity and yield of a two-stage screening procedure for systemic lupus erythematosus.

Sixty-six systemic lupus erythematosus (SLE) patients, 375 healthy female controls and 537 young Caucasian females were examined according to a recently suggested two-stage model for population screening for SLE. This model consisted in: a) administration of a 10-item questionnaire based on the ARA preliminary criteria for SLE; b) search of antinuclear antibodies (ANA) in the persons positive during the first stage. Among the SLE patients, the overall sensitivity of the two-stage screening was 90%, while its specificity in the healthy 375 normals reached 96%. 13% of 537 young Caucasian females answered affirmatively to 3 or more questions of the questionnaire. Out of these, 59 were tested for ANA. Two out of these 59 had a positive ANA test, but no one had SLE at a subsequent clinical survey. These data confirm the validity of this two-stage screening procedure for SLE. While the low prevalence of this disorder in the general population hardly justifies its massive application, the screening might be recommended for survey groups at high risk for SLE.

Adult↗

Plasmapheresis-immunoadsorption for treatment of systemic lupus erythematosus in a dog.

Systemic lupus erythematosus was diagnosed in a 3-year-old, male German Shepherd Dog. Clinical signs included lethargy, partial anorexia, fever, joint swelling, and skin and oral ulceration. The diagnosis was confirmed on the basis of an antinuclear antibody titer of 1:640 and immunofluorescence for immunoglobulin G at the dermal-epidermal junction in skin biopsy specimens. Treatment with prednisone and cyclophosphamide failed to induce remission. Intensive plasmapheresis-immunoadsorption, using purified Staphylococcus protein A in combination with low-dose prednisone therapy, resulted in sustained remission.

Animals↗

Novel liposome composition for a rapid colorimetric test for systemic lupus erythematosus.

This test for systemic lupus erythematosus utilizes a novel liposome composition entrapping the cation-responsive red dye Arsenazo III. In dilutions of normal sera the liposome membranes undergo a rearrangement when divalent cations are added, resulting in the release of the encapsulated dye and the rapid formation of a stable blue cation-dye complex. Microliter amounts of sera from patients with active lupus stabilize the liposome preparation such that the vesicles remain intact in the presence of the added divalent cations and thus maintain their red color for extended periods. The assay requires 1-min incubations in sera at room temperature and can be performed with standard microtiter plates, allowing the screening of large numbers of serum samples in a short time. Moreover, the unique absorption spectra of the complexed and uncomplexed dye allow for quantification of results.

Arsenazo III↗

Renal transplantation in patients with systemic lupus erythematosus.

The activity of systemic lupus erythematosus (SLE) was investigated in 18 recipients of 20 renal transplants by retrospective analysis of their medical records and by screening the ten patients with more than one year follow-up. Eight grafts were lost, all because of rejection occurring within the first year. From the 12 patients with functioning transplants, one was lost to follow-up at seven years and another had not completed one year. The remaining ten patients were studied, and no evidence of lupus nephritis was found despite serologically active SLE in four cases. Their follow-up was 4.5 +/- 1.3 years. Our study provides the relatively scarce literature on renal transplantation in patients with SLE with a series of 18 recipients of 20 allografts, confirms that the recurrence of lupus nephritis in the allografts is very rare, as previously suggested, and discloses that graft and patient survivals are comparable with those of the general nondiabetic transplant population.

Female↗

Laryngeal complications in a patient with inactive systemic lupus erythematosus.

Laryngeal complications in systemic lupus erythematosus (SLE) are rarely described. They range from hoarseness to life-threatening respiratory distress. To our knowledge, previous reports describe laryngeal involvement with SLE occurring only during periods of active disease. We saw a patient with inactive SLE in whom hoarseness and exertional dyspnea developed as a result of arytenoiditis and vocal cord paresis during steroid tapering. The condition responded dramatically to readjustment of her steroid dosage. Involvement of the larynx with SLE is a potentially life-threatening complication and may occur in patients with either active or inactive disease. It is an indication for close observation and steroid therapy in patients with SLE.

Airway Obstruction↗

Tophaceous gout in patients with systemic lupus erythematosus.

Coexistent gout and systemic lupus erythematosus (SLE) has been reported rarely, below the expected incidence even when adjusted for the discordance of age and sex of the affected populations. It is possible that SLE prevents expression of gout, or vice-versa. Review of the reported cases suggests that SLE is likely to be inactive and serum complement normal when gout is active. Lack of awareness of the possibility of gout and concurrent treatment with corticosteroids and nonsteroidal anti-inflammatory drugs may prevent recognition of gout in many patients with SLE.

Adult↗

Immune complexes in the pericardial fluid in systemic lupus erythematosus.

Two patients with systemic lupus erythematosus (SLE) had pericardial tamponade. The pericardial fluid from both patients contained "mixed" type cryoglobulins consisting of IgG, IgM, and C1q. There was a selective concentration of antinuclear antibodies in the pericardial fluid cryoglobulin of one patient. Pericardial fluid from the same patient contained immune complexes. Anti-DNA antibodies were found in the serum, pericardial fluid, and pericardial fluid cryoprotein. Immune complexes isolated from the pericardial fluid by polyethylene complexes isolated from the pericardial fluid by polyethylene glycol precipitation contained antinuclear antibodies including anti-DNA antibodies. Immune complexes may be important in the pathogenesis of pericarditis in SLE.

Adult↗

Tendon rupture in systemic lupus erythematosus.

A patient with systemic lupus erythematosus (SLE) and spontaneous rupture of the Achilles tendon is reported. Tendon rupture in SLE is extremely uncommon; review of the reported cases suggests that it may be more common in males, and is a late complication of SLE, more likely to occur in older patients. The possible role of corticosteroid therapy is discussed.

Achilles Tendon↗