, Risshi Kudoh, Masahide Seki, Motohiro Endo, Mirei Shiki A 60-year-old man who had been diagnosed with protein-losing enteropathy (PLE) and vitiligo at age 51 years was admitted with dyspnea, hemoptysis, and lower-limb edema. On the basis of computed tomography findings, the cause of respiratory symptoms was thought to be diffuse alveolar hemorrhage (DAH). The final diagnosis of late-onset systemic lupus erythematosus (SLE) was established on the basis of renal biopsy examinations that revealed evidence of active SLE with lupus nephritis (World Health Organization, class V) and positive results for antinuclear antibody. DAH, as well as PLE and vitiligo were attributed to SLE. The patient was successfully treated with methylprednisolone and then prednisolone in combination with cyclosporin A. Because late-onset SLE is rare and patients tend to show atypical symptoms, close attention should be paid to the preceding symptoms.
Citations
, San Ha Kang, Ji Hyun Song, Kyu Hyun Han, Sun Young Shin, Tae Young Yang, Jin Jung Choi, Sung Pyo Hong Systemic lupus erythematosus (SLE) is a chronic inflammatory disease of unknown etiology and is characterized by presence of variable pathogenic auto-antibodies and multiple organ involvement. Serositis is common in SLE, but peritoneal involvement is relatively rare. This is a case report of 28-year-old female who initially presented with abdominal pain and ascites. After ruling out many other possibilities such as liver cirrhosis, neoplasm, and infectious etiologies, we confirmed SLE with clinical features, serologic tests and radiological findings. To conclude, her abdominal pain and ascites were caused by lupus peritonitis. After administration of corticosteroid therapy, her symptoms fairly improved.
, Yoon Jin Cha, Young Eun Kwon, Yung Ly Kim, Kyoung Sook Park, Seong Yeong An, Beom Jin Lim, Hyeon Joo Jeong, Hyung Jung Oh, Tae-Hyun Yoo, Shin-Wook Kang, Kyu Hun Choi, Seung Hyeok Han Nephrotic syndrome is most commonly observed in membranous lupus nephritis in patients with systemic lupus erythematosus (SLE). However, other forms of idiopathic nephrotic syndrome rarely occur in these patients. Here, we report a case of SLE complicated by minimal change disease (MCD). A 24-year-old woman with SLE visited our hospital for generalized edema and heavy proteinuria. Laboratory tests did not support immunological exacerbation of lupus, while renal biopsy revealed diffusely effaced foot processes without electron-dense deposits that were consistent with MCD. Administration of high-dose corticosteroids and 6 subsequent cycles of monthly intravenous cyclophosphamide resulted in complete remission. Although nephrotic-range proteinuria recurred 1 month after switching to maintenance therapy with mycophenolate mofetil, complete remission was reestablished after a 6-month treatment with corticosteroids and cyclosporine. Physicians should be cautious in assessment and management of such a rare renal manifestation.
Citations
, In Sook Kang, Kihwan Kwon, Wook Bum Pyun, Gil Ja Shin This study designed to find the differences of left ventricular (LV) geometry in acute myocardial infarction (AMI) between ST elevation myocardial infarction (STEMI) and non ST elevation myocardial infarction (NSTEMI) and the occurrences of adverse outcome according to the LV geometry.
Comprehensive echocardiographic analyses were performed in 256 patients with AMI. The left ventricular mass index (LVMI) and relative wall thickness (RWT) were calculated. LV geometry were classified into 4 groups based on RWT and LVMI: normal geometry (normal LVMI and normal RWT), concentric remodeling (normal LVMI and increased RWT), eccentric hypertrophy (increased LVMI and normal RWT), and concentric hypertrophy (increased LVMI and increased RWT). Cox proportional hazards models were used to evaluate the relationships among LV geometry and clinical outcomes.
Patients with NSTEMI were more likely to have diabetes mellitus, hypertension, heart failure, stroke and previous myocardial infarction. By the geometric type, patients with NSTEMI were more likely to have eccentric hypertrophy (n=51, 34.7% vs. n=24, 22.0%, P=0.028). There was no significantly different adverse outcome between STEMI and NSTEMI patients. Fifteen patients (5.9%, 7 female [46.7%]) died and the median duration of survival was 10 days (range, 1 to 386 days). Concentric hypertrophy carried the greatest risk of all cause mortality (hazard ratios, 5.83; 95% confidence interval, 1.04 to 32.7).
NSTEMI patients had more likely to have eccentric hypertrophy but adverse outcome after AMI was not different between STEMI and NSTEMI patients. Concentric hypertrophy had the greatest risk of short term mortality.
, Jisoo Lee, You-Hyun Lee To define the abnormalities in homeostasis of B-1 B lymphocytes compartments in human SLE.
Perpheral blood was obtained from 7 patients with untreated active SLE patients and same patients at the time of incative disease after immunosuppressive therapy. The frequencies of CD5+CD45RAint B-1a B lymphocyte, and CD5+CD45RAlow B-1b B lymphocyte, CD5-CD45RAhigh conventional B-2 lymphocyte subsets were analyzed. For the control group, peripheral blood from 7 healthy adults and 7 patients with infectious fever were utilized.
B-1a B lymphocyte subset was found at high frequency in active SLE patients compared to the fever control(33.5±15.0% vs 20.1±5.3%,
These results indicate that there are abnormalities in B cell conpartments with expansion of B-1a B lymphocyte subset and contraction of B-2 B lymphocyte subset associated with the disease activity in patients wite SLE.
, Wha Soon Cjung Systemic lupus erythematosus(SLE) and rheumatoid arthritis(RA) are the widely recognized rheumatic diseases of unknown etiology in which extensive immune dysfunction has been reported. Cytokines are considered to be the most important secretions of the immune system that participate in a variety of cellular, inflammatory and pathogenic processes in human disease. Since imbalance of the cytokine network in autoimmune disease may be detrimental for the severity or clinical manifestation of the disease, I determined serum level of IL-6 in patients with SLE, RA, and normal controls.
The results were as follows:
1) The serum levels of IL-6 in patients with SLE(p=0.0032) and RA(p=0.0001) were significantly higher than those of normal controls.
2) The serum levels of ESR, CRP, and complements did not correlated with serum IL-6 levels. Only the levels of anti-dsDNA in patients with SLE showed correlation with that of serum IL-6. And the serial follow-up of serum IL-6 levels in 6 systemic lupus erythematosus patients show no significant correlation.
3) There were no significant correlation between serum IL-6 of RA patients and disease activity markers such as CRP and rheumatoid factors.
This results indicate that serum IL-6 levels of SLE and RA patients were significantly higher than that of normal controls, and needs further study to be used as a marker for disease activity.
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