MyMedR

Fulltext Penicilliosis in lupus patients presenting with unresolved fever: a report of 2 cases and literature review

Chong YB, Tan LP, Robinson S, Lim SK, Ng KP, Keng TC, et al.

Trop Biomed, 2012 Jun;29(2):270-6.

Penicilliosis is a rare occurrence among non human immunodeficiency virus (HIV) infected patients. We report here two cases of Penicillium marneffei infection in patients with systemic lupus erythematosus (SLE). Both patients had a recent flare of lupus and were on immunosuppressive drugs when they presented with prolonged fever without an obvious foci of infection, unresponsive to broad-spectrum antibiotics. They were leucopaenic upon admission, with rapid deterioration during the course of the illness. Diagnosis of penicilliosis via fungal isolation from blood culture was delayed resulting in the late initiation of antifungal agents. While both patients ultimately recovered, the delay in diagnosis led to a prolonged hospital stay with increased morbidity. Clinicians should be aware of this uncommon but emerging fungal pathogen in SLE patients and maintain a high index of suspicion in diagnosing this potentially fatal but treatable disease.

Matched MeSH terms: Lupus Erythematosus, Systemic/complications

Fulltext Cerebral infarction and cerebral salt wasting syndrome in a patient with tuberculous meningoencephalitis

Loo KL, Ramachandran R, Abdullah BJ, Chow SK, Goh EM, Yeap SS

Southeast Asian J. Trop. Med. Public Health, 2003 Sep;34(3):636-40.

PMID: 15115143

A 38-year old female with underlying systemic lupus erythematosus was admitted with tuberculous meningoencephalitis. After an initial good response to anti-tuberculous treatment, she developed cerebral infarction and profound hyponatremia. This was due to cerebral salt wasting syndrome, which has only previously been described in 2 cases. The difficulties in diagnosis and management of this case are discussed.

Matched MeSH terms: Lupus Erythematosus, Systemic/complications

Systemic lupus erythematosus with membranous lupus nephropathy in Malaysian patients

Wang F, Looi LM

Q. J. Med., 1984;53(210):209-26.

PMID: 6463196 DOI: 10.1093/oxfordjournals.qjmed.a067794

Thirty-one patients with systemic lupus erythematosus had membranous lupus nephropathy (MLN). They were divided into two groups. Group I consisted of 13 patients who had pure MLN but the patients in Group 2 had segmental proliferation in up to 35 per cent of their glomeruli. The rest of the glomeruli had purely membranous change. The patients of Group 2 were no different from the other MLN patients in terms of age, sex and race. The extrarenal disease in both groups was extensive and severe. The renal disease was usually associated with the nephrotic syndrome or oedema but was asymptomatic throughout in one patient. Both renal and extrarenal features responded to treatment initially but relapses were frequent and often severe. Relapses often occurred as treatment was discontinued or medication reduced. Survival at six years in Group I was 62 per cent and in Group 2 was 50 per cent. Only one patient died with renal failure although five patients had impaired renal function at death. The chief causes of death were disease of the central nervous system and infection.

Matched MeSH terms: Lupus Erythematosus, Systemic/complications*

Fulltext Antiphospholipid syndrome with pulmonary artery embolism and multiple venous thromboses

Lee CE, Zain AA, Pang YK

Med J Malaysia, 2010 Sep;65(3):221-3.

PMID: 21939173

We report a case of a 21-year-old university student with underlying lupus nephritis who presented with recurrent symptoms of fever, haemoptysis, and pleuritic chest pain. CT pulmonary angiogram confirmed pulmonary embolism in the right subsegmental pulmonary arteries. One week later, she developed left renal vein and left common iliac vein thromboses, with new emboli in the left subsegmental pulmonary arteries. We hereforth discuss the diagnostic issues of a patient with systemic lupus erythematosus (SLE) on corticosteroids therapy, and also treatment of the antiphospholipid syndrome.

Matched MeSH terms: Lupus Erythematosus, Systemic/complications*

Fulltext Tako Tsubo cardiomyopathy in a patient with antiphosholipid syndrome secondary to systemic lupus erythemathosus (SLE)

Lim BA

Med J Malaysia, 2008 Jun;63(2):146-7.

PMID: 18942303 MyJurnal

Tako Tsubo cardiomyopathy is rare, stress related and indistinguishable from acute myocardial infarction clinically. Proper diagnosis is essential to avoid unnecessary thrombolysis and life long management of coronary artery disease.

Matched MeSH terms: Lupus Erythematosus, Systemic/complications*

Fulltext Mortality patterns in Malaysian systemic lupus erythematosus patients

Yeap SS, Chow SK, Manivasagar M, Veerapen K, Wang F

Med J Malaysia, 2001 Sep;56(3):308-12.

PMID: 11732075

A retrospective analysis of the case records of 494 systemic lupus erythematosus (SLE) patients under follow-up at University Hospital, Kuala Lumpur during 1976-1990 was performed. Overall mortality was 20.2% (100 patients). The causes of death were infection (30%), renal (15%), respiratory (14%), neurological (5%), cardiovascular (7%), other causes (2%) and unknown (27%). Active SLE was a contributing factor in 19% of the deaths. The patients who died had significantly more renal disease, neurological disease, serositis or thrombocytopenia by the end of the first year of disease compared to the survivors. As in other series, infection and active SLE remain important causes of death.

Matched MeSH terms: Lupus Erythematosus, Systemic/complications

Fulltext Kikuchi disease in a connective tissue disorder

Bachi R

Med J Malaysia, 2002 Sep;57(3):357-60.

PMID: 12440277

A 27-year old woman presented with fever, weight loss, arthralgia, macular skin rash and bilateral axillary lymphadenopathy. The histology of an excised lymph node showed evidence suggestive of Kikuchi disease. Subsequent laboratory tests showed evidence of Systemic Lupus Erythematosus, underscoring the importance of considering other diagnoses in a nodal histological diagnosis of Kikuchi disease, a benign condition of unknown aetiology.

Matched MeSH terms: Lupus Erythematosus, Systemic/complications*

Fulltext Optic neuritis and retinal vasculitis as primary manifestations of systemic lupus erythematosus

Barkeh HJ, Muhaya M

Med J Malaysia, 2002 Dec;57(4):490-2.

PMID: 12733176

Systemic lupus erythematosus (SLE) is a common multisystem disorder. However, retinal vasculitis as a primary manifestation of SLE is uncommon, accounting for only 4% of causes of retinal vasculitis. The postulated mechanism appeared to be vaso-occlusion of the retinal arterioles by thrombosis, with resultant ischaemia. Optic neuropathy in SLE is also rare, with a prevalence of 1%. This is a case report of a young lady who presented to us with retinal vasculitis as her initial presentation of SLE. Interestingly, the pathologic mechanism appeared to be inflammatory and not vaso-occlusive.

Matched MeSH terms: Lupus Erythematosus, Systemic/complications*

Fulltext Transverse myelopathy and hyperphagia in systemic lupus erythematosus: a case report

Chong YH, Cheong I

Med J Malaysia, 1985 Dec;40(4):333-4.

PMID: 3870350

We report a case of systemic lupus erythematosus complicated by transverse myelopathy and hyperphagia. To our knowledge the latter has not been reported before.

Matched MeSH terms: Lupus Erythematosus, Systemic/complications*

Fulltext Severe chemosis in systemic lupus erythematosus--a new sign?

Zaini Anuar, Asrar M, Ngan A

Med J Malaysia, 1982 Mar;37(1):78-9.

PMID: 7121353

A young Chinese female presented with severe bilateral chemosis without any other systemic evidence ofoedema or systemic lupus erythematosus (SLE). Investigations confirmed the diagnosis of SLE with early diffuse proliferative glomerulonephritis. The condition improved with steroid therapy.

Matched MeSH terms: Lupus Erythematosus, Systemic/complications*

Fulltext Systemic lupus erythematosus and miliary tuberculosis in a prepubertal girl--a case report

Raj SM, Hunt J

Med J Malaysia, 1990 Dec;45(4):347-8.

PMID: 2152059

A 13 year old girl presented with miliary tuberculosis and active systemic lupus erythematosus (S.L.E.). She responded to a combination of antituberculous drugs and systemic steroids. This case illustrates the fact that S.L.E. presenting in childhood may be rare but not unknown and exemplifies the need for vigilance in detecting life threatening infections in this group of patients.

Matched MeSH terms: Lupus Erythematosus, Systemic/complications*

Fulltext Bilateral optic neuritis in pregnancy

Suraiya MS, Norazlina B, Carmen C, Muhaya M

Med J Malaysia, 2003 Dec;58(5):771-3.

PMID: 15190668

A 25-year old primigravida at 11-weeks period of amenorrhoea presented with bilateral optic neuritis following Varicella Zoster viral (VZV) infection. She was serologically positive for systemic lupus erythematosus but negative for virus. The exact pathogenesis of the patient's severe optic neuritis, adduction and neurological deficit was unknown. The initiation of high dose steroids for optic neuritis was a big clinical dilemma in a pregnant patient with viral infection. The patient was treated with high dose steroids after three days of commencement of antiviral treatment. At 6 months after presentation, her visual acuity in the right eye was 6/36 with perception to light in the left.

Matched MeSH terms: Lupus Erythematosus, Systemic/complications

Acute myocardial infarction in systemic lupus erythematosus

Khoo KL, Pillay RP

Med J Malaysia, 1975 Mar;30(3):206-8.

PMID: 1160680

Matched MeSH terms: Lupus Erythematosus, Systemic/complications*

Vitamin D status in a monocentric cohort of systemic lupus erythematosus (SLE) patients and correlations with clinical and immunological profile

Ong SG, Ding HJ

Med J Malaysia, 2019 12;74(6):492-498.

PMID: 31929474

INTRODUCTION: Numerous studies have found that a majority of systemic lupus erythematosus (SLE) patients have suboptimal vitamin D levels. The major contributory factor is most likely attributed to sun protection measures in order to avoid SLE flares. The objectives of this research included the assessment of vitamin D status and its association with clinical manifestations of SLE, cardiovascular risk factors, autoantibodies, SLE disease activity and damage accrual.

METHOD: This retrospective study involved SLE patients who attended the Rheumatology Clinic at the Hospital Kuala Lumpur from January 2014 to December 2016. Vitamin D was categorised as normal, insufficient or deficient, and the clinical variables were compared across vitamin D categories with chi-squared tests and Pearson correlation coefficient.

RESULTS: We included 216 patients. The mean 25(OH)D concentration was 51.3(Standard Deviation; SD 14.8) nmol/L. Fifty (23.1%) patients had vitamin D deficiency, 120 (55.6%) had vitamin D insufficiency, while 46 (21.3%) had adequate vitamin D levels. There were statistically significant associations between vitamin D status and ethnic group, lupus nephritis and hypertension. No correlations were observed between vitamin D status with SLEDAI score (Pearson correlation coefficient -0.015, p=0.829) as well as SDI score (Pearson correlation coefficient -0.017, p=0.801).

CONCLUSION: SLE patients should be screened for vitamin D concentrations and their levels optimised.

Matched MeSH terms: Lupus Erythematosus, Systemic/complications*

Coronary artery bypass graft surgery in a young female with systemic lupus erythematosus and its operative challenges: A case report

Gurpreet S, Vendargon SJ, Syed Rasul SH

Med J Malaysia, 2019 12;74(6):549-550.

PMID: 31929487

We understand that autoimmune disorders such as Systemic Lupus Erythematosus increases the likelihood of developing coronary heart disease. However, its implications on patients undergoing cardiac surgery is not well understood. Here we present a female patient with SLE who developed coronary artery disease at a young age and underwent coronary artery bypass graft surgery. As SLE is associated with vasculitis, we wanted to understand regarding the choice of conduit as well as its long term patency. Also whether percutaneous angioplasty has a role to play in patients with SLE.

Matched MeSH terms: Lupus Erythematosus, Systemic/complications*

A frequently missed entity in systemic lupus erythematosus (SLE): Intestinal pseudo-obstruction (IpsO)

Shirley L, Thundyil RJ

Med J Malaysia, 2017 12;72(6):374-375.

PMID: 29308779 MyJurnal

Intestinal pseudo-obstruction (IpsO) is defined as presence of clinical features of intestinal obstruction without identifiable mechanical obstructive lesion. IpsO is an uncommon gastrointestinal manifestation of systemic lupus erythematosus (SLE) and is largely under-recognised. There are only over 30 published cases in English literature on SLE-related IpsO. Herein, we report two cases of SLE-related IpsO to illustrate the importance of early recognition to avoid unnecessary surgical intervention, as SLE-related IpsO responds well to systemic high dose corticosteroids. These two cases also demonstrate the apparent association of IpsO with uretero-hydronephrosis, suggesting that the possible mechanism could be smooth muscle dysmotility.

Matched MeSH terms: Lupus Erythematosus, Systemic/complications*

Hyperthyroidism in systemic lupus erythematosus

Cheah JS, Chia BL, Tay HH, Tan BY

Med J Aust, 1970 Nov 28;2(22):1029-30.

PMID: 5494951

Matched MeSH terms: Lupus Erythematosus, Systemic/complications*

Fulltext Kikuchi's lymphadenitis (necrotizing lymphadenitis) and systemic lupus erythematosus: a case report

Fernandez SH

Malays J Pathol, 2000 Jun;22(1):25-9.

PMID: 16329534

A 26-year-old Indian lady was admitted for lower abdominal pain, diarrhoea, vomiting, fever and cough. The initial diagnosis was that of peritonitis secondary to ruptured or perforated viscus with lobar pneumonia. On laparotomy, she was found to have necrotizing or Kikuchi's lymphadenitis of the abdominal lymph nodes. The initial two antinuclear antibody (ANA) results came back negative. She was diagnosed to have systemic lupus erythematosus (SLE) when the third sample for ANA came back positive and the double-stranded DNA (dsDNA) antibody test was homogenously positive. This case illustrates a need to be aware that necrotizing lymphadenitis can precede the onset of systemic lupus erythematosus.

Matched MeSH terms: Lupus Erythematosus, Systemic/complications

The effects of ethnicity on disease patterns in 472 Orientals with systemic lupus erythematosus

Thumboo J, Fong KY, Chng HH, Koh ET, Chia HP, Leong KH, et al.

J Rheumatol, 1998 Jul;25(7):1299-304.

PMID: 9676760

OBJECTIVE: To determine the effects of ethnicity on disease manifestations in Oriental patients with systemic lupus erythematosus (SLE) and to describe the risk of developing renal or central nervous system (CNS) involvement with time.
METHODS: A retrospective study of 472 patients with SLE seen at the only Rheumatology Unit in Singapore. The effect of ethnicity on selected disease manifestations at diagnosis was assessed after adjusting for demographic variables using multiple logistic regression. The probability of developing selected disease manifestations with time was determined using the Kaplan-Meier product limit method.
RESULTS: At diagnosis, Malays had a higher risk of renal or CNS involvement than Chinese (OR 2.26, 95% CI 1.21 to 4.21, and OR 3.07, 95% CI 1.01 to 9.34, respectively), and Indians a lower risk of malar rash and a higher risk of oral ulcers than Chinese (OR 0.30, 95% CI 0.13 to 0.68, and OR 2.90, 95% CI 1.45 to 7.34, respectively). The prevalence of renal or CNS involvement in the entire cohort increased with time, reaching 75.6% (95% CI 66.1% to 85.0%) and 16.7% (95% CI 11.7% to 21.6%), respectively, after 18 years of disease.
CONCLUSION: Ethnicity influenced disease manifestations at diagnosis in this cohort of Oriental patients with SLE. Renal or CNS involvement developed in previously unaffected patients up to 18 years after diagnosis, highlighting the need for continued vigilance in patients with lupus.

Matched MeSH terms: Lupus Erythematosus, Systemic/complications

Tophaceous gout in young patients with systemic lupus erythematosus

Veerapen K, Schumacher HR, van Linthoudt D, Neilson EG, Wang F

J Rheumatol, 1993 Apr;20(4):721-4.

PMID: 8496872

Systemic lupus erythematosus (SLE) and gout have been associated infrequently. We describe 3 young adults with SLE who developed tophaceous gout relatively early in the course of their disease. All were underexcretors of uric acid but were studied after the development of renal disease; 2 were treated with diuretics. In 2 cases, gout became obvious while lupus was quiescent.

Matched MeSH terms: Lupus Erythematosus, Systemic/complications*

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