MyMedR

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*

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 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*

Solitary paraventricular calcification in cerebral lupus erythematosus: a report of two cases

Daud AB, Nuruddin RN

Neuroradiology, 1988;30(1):84-5.

PMID: 3357575

Paraventricular calcification not previously reported in systemic lupus erythematosus was seen in cranial computed tomograms of two patients with this disorder.

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

Fulltext Cutaneous tuberculosis mimicking cellulitis in an immunosuppressed patient

Chin PW, Koh CK, Wong KT

Singapore Med J, 1999 Jan;40(1):44-5.

PMID: 10361486

A 28-year-old lady suffering from systemic lupus erythomatosus (SLE) with diffuse proliferative glomerulonephritis (DPGN) and who was on oral cyclophosphamide and prednisolone presented with left lower limb 'cellulitis'. The 'cellulitis' of the left lower limb failed to respond to usual antibiotics which prompted evaluation of the clinical diagnosis. The diagnosis is made based on the presence of granulomas, multinucleated giant cells and acid fast bacilli on the skin biopsy.

Matched MeSH terms: Lupus Erythematosus, Systemic/complications

Fulltext The clinical significance of vitamin D in systemic lupus erythematosus: a systematic review

Sakthiswary R, Raymond AA

PLoS One, 2013;8(1):e55275.

PMID: 23383135 DOI: 10.1371/journal.pone.0055275

BACKGROUND: Vitamin D deficiency is more prevalent among SLE patients than the general population. Over the past decade, many studies across the globe have been carried out to investigate the role of vitamin D in SLE from various clinical angles. Therefore, the aim of this systematic review is to summarise and evaluate the evidence from the published literature; focusing on the clinical significance of vitamin D in SLE.

METHODS: THE FOLLOWING DATABASES WERE SEARCHED: MEDLINE, Scopus, Web of Knowledge and CINAHL, using the terms "lupus", "systemic lupus erythematosus", "SLE and "vitamin D". We included only adult human studies published in the English language between 2000 and 2012.The reference lists of included studies were thoroughly reviewed in search for other relevant studies.

RESULTS: A total of 22 studies met the selection criteria. The majority of the studies were observational (95.5%) and cross sectional (90.9%). Out of the 15 studies which looked into the association between vitamin D and SLE disease activity, 10 studies (including the 3 largest studies in this series) revealed a statistically significant inverse relationship. For disease damage, on the other hand, 5 out of 6 studies failed to demonstrate any association with vitamin D levels. Cardiovascular risk factors such as insulin resistance, hypertension and hypercholesterolaemia were related to vitamin D deficiency, according to 3 of the studies.

CONCLUSION: There is convincing evidence to support the association between vitamin D levels and SLE disease activity. There is paucity of data in other clinical aspects to make firm conclusions.

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*

Clinical and electrophysiological characteristics of symmetric polyneuropathy in a cohort of systemic lupus erythematosus patients

Jasmin R, Sockalingam S, Ramanaidu LP, Goh KJ

Lupus, 2015 Mar;24(3):248-55.

PMID: 25253567 DOI: 10.1177/0961203314552115

OBJECTIVE: Peripheral neuropathy in systemic lupus erythematosus (SLE) is heterogeneous and its commonest pattern is symmetrical polyneuropathy. The aim of this study was to describe the prevalence, clinical and electrophysiological features, disease associations and effects on function and quality of life of polyneuropathy in SLE patients, defined using combined clinical and electrophysiological diagnostic criteria.
METHODS: Consecutive SLE patients seen at the University of Malaya Medical Centre were included. Patients with medication and other disorders known to cause neuropathy were excluded. Demographic, clinical and laboratory data were obtained using a pre-defined questionnaire. Function and health-related quality of life was assessed using the modified Rankin scale and the SF-36 scores. Nerve conduction studies (NCS) were carried out in both upper and lower limbs. Polyneuropathy was defined as the presence of bilateral clinical symptoms and/or signs and bilateral abnormal NCS parameters.
RESULTS: Of 150 patients, 23 (15.3%) had polyneuropathy. SLE-related polyneuropathy was mainly characterized by sensory symptoms of numbness/tingling and pain with mild signs of absent ankle reflexes and reduced pain sensation. Function was minimally affected and there were no differences in quality of life scores. NCS abnormalities suggested mild length-dependent axonal neuropathy, primarily in the distal lower limbs. Compared to those without polyneuropathy, SLE-related polyneuropathy patients were significantly older but had no other significant demographic or disease associations.
CONCLUSIONS: SLE-related polyneuropathy is a chronic, axonal and predominantly sensory neuropathy, associated with older age. Its underlying pathogenetic mechanisms are unknown, although a possibility could be an increased susceptibility of peripheral nerves in SLE patients to effects of aging.

Matched MeSH terms: Lupus Erythematosus, Systemic/complications*

Lupus organ damage: what is damaged in Asian patients?

Kuan WP, Li EK, Tam LS

Lupus, 2010 Oct;19(12):1436-41.

PMID: 20947554 DOI: 10.1177/0961203310370050

Assessment of organ damage has become the standard outcome measure for morbidity and mortality in patients with lupus. Ethnicity is thought to be a marker for genetic, environmental, behavioral, and other variables that may affect disease outcomes. Previous studies suggest that Asians residing in western countries had significantly higher prevalence of damage compared with Whites. In contrast, studies performed in Chinese, Korean and Arab patients showed that the overall prevalence of damage and the most commonly involved organs (neuropsychiatric and musculoskeletal) were similar to Whites. Compared with their Asian counterparts, Pakistani and Jewish patients appeared to have a higher prevalence of damage, most likely secondary to longer disease duration. Chinese patients had an increased prevalence of premature gonadal failure, whereas patients residing in western and southern Asia had more skin damage. When compared with Whites, Asian patients had more renal damage but less ocular and cardiovascular damage. Risk factors associated with organ damage in Asian lupus patients included older age, higher disease activity, and the use of cyclophosphamide and steroids. Further investigations into other determinants such as genetic predisposition, socioeconomic factors, prevalence and severity of disease manifestations, and treatment, is needed in order to understand the variation in damage accrual in lupus patients from different ethnicities.

Matched MeSH terms: Lupus Erythematosus, Systemic/complications*

Posterior reversible encephalopathy syndrome in systemic lupus erythematosus: pooled analysis of the literature reviews and report of six new cases

Shaharir SS, Remli R, Marwan AA, Said MS, Kong NCT

Lupus, 2013 Apr;22(5):492-6.

PMID: 23435619 DOI: 10.1177/0961203313478303

INTRODUCTION:Posterior reversible encephalopathy syndrome (PRES) is a rare neurological disorder which is increasingly recognized to occur in systemic lupus erythematosus (SLE).
OBJECTIVE: The purpose of this study was to identify the characteristics of SLE patients with PRES and the associated factors of the poor outcome among them.
METHODS: We investigated SLE patients who developed PRES between 2005-2011 at the Universiti Kebangsaan Malaysia Medical Centre. A comprehensive literature search was done to find all published cases of PRES in SLE. Pooled analysis was conducted to identify the factors associated with poor outcome.
RESULTS: There were 103 cases of PRES in SLE published in the literature but only 87 cases were included in the analysis in view of incomplete individual data in the remaining cases. The majority of the cases were Asians (74.2%), female (95.4%) with mean age of 26.3 ± 8.8 years. PRES was highly associated with active disease (97.5%), hypertension (91.7%) and renal involvement (85.1%). We found that 79 patients had a full recovery (90.8%) with a mean onset of full clinical recovery in 5.6 ± 4.1 days. On univariate analysis and logistic regression analysis the predictors of poor outcome, defined as incomplete clinical recovery or death, were intracranial hemorrhage, odds ratio (OR) 14 (1.1-187.2), p=0.04 and brainstem involvement in PRES, OR 10.9 (1.3-90.6), p=0.003.
CONCLUSION: Intracranial hemorrhage and brainstem involvement were the two important predictors of poor outcome of PRES. Larger prospective studies are needed to further delineate the risk of poor outcome among them.

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

Childhood cerebral lupus in an Oriental population

Haji Muhammad Ismail Hussain I, Loh WF, Sofiah A

Brain Dev, 1999 Jun;21(4):229-35.

PMID: 10392744

In a cross-sectional study of 24 Oriental children with systemic lupus erythematosus (SLE) with a mean age of 11.25 years, 75% were found to have clinical and neurophysiological evidence of cerebral lupus. Seizures were the most common manifestation affecting 11 (61%) of the cases, followed by psychosis in five (27.7%), encephalopathy in five (27.7%), headaches in five (27.7%), personality changes in four (22.2%), stroke in three (16.6%), movement disorders in three (16.6%) and myelitis in one child (5.5%). Four children had cerebral lupus as the presenting manifestation of SLE. Twenty-one children had an electroencephalogram (EEG) of which 11 were normal. Abnormalities detected in the rest included focal sharps, slowing of background and electrodecremental changes. There was a poor correlation of EEG with the clinical presentation. Sixteen children with cerebral lupus had a computed tomogram (CT) of which three were normal. The commonest abnormality was cerebral atrophy with or without infarcts. Only four of the cases had lupus anticoagulant but compliment was reduced in 13. Sixteen of the cases also had renal involvement. Treatment was generally with steroids with only two patients receiving cyclophosphamide for cerebral relapse. Eight children (44%) made a full recovery. Learning disability was the most frequent sequelae affecting one-third of children seen at a 1-year follow up. Four (22%) had epilepsy, two (11%) had motor deficits and one child had optic atrophy. One child died of cerebral haemorrhage during a hypertensive crisis.

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*

Pneumocystis carinii pneumonia in patients with systemic lupus erythematosus

Liam CK, Wang F

Lupus, 1992 Dec;1(6):379-85.

PMID: 1304406 DOI: 10.1177/096120339200100607

At the University Hospital, Kuala Lumpur, Malaysia, nine patients with systemic lupus erythematosus (SLE) were treated for Pneumocystis carinii pneumonia (PCP) between January 1987 and December 1988. When they developed PCP all the patients' SLE disease course was active and eight of them were on prednisolone. Four of these eight patients were also receiving cyclophosphamide. Patients who were on more intensive immunosuppressive therapy were found to develop more severe PCP. All the patients except one were treated with high-dose cotrimoxazole. Four patients responded to antipneumocystis treatment and survived, while PCP was responsible for the death of the five non-survivors.

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 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*

Spectrum of nocardiosis in renal patients

Kong NC, Morad Z, Suleiman AB, Cheong IK, Lajin I

Ann Acad Med Singap, 1990 May;19(3):375-9.

PMID: 2393240

Nocardiosis is an increasingly recognised opportunistic infection in immunologically incompetent hosts but diagnosis is often delayed. Between December 1975 to October 1988, our two Nephrology Units have encountered five cases of nocardiosis occurring in two post-renal transplant patients, two patients with systemic lupus erythematous (SLE) and one patient with mesangiocapillary glomerulo--nephritis. All were on immunosuppressants at the time. The first three patients presented with predominant pulmonary disease and were cured by combined trimethoprim-sulphamethoxazole (cotrimoxazole) and doxycycline therapy. The patient with limited skin involvement responded to cotrimoxazole alone. However, the last patient with lymphocutaneous disease initially responded to cotrimoxazole (+ chloramphenicol) but developed acute-on-chronic renal failure and relapsed with dose reduction of cotrimoxazole. Alternative treatment with amikacin and doxycycline was instituted with good response. We shall review potential clues that may suggest the diagnosis of nocardiosis and discuss other effective antimicrobial agents.

Matched MeSH terms: Lupus Erythematosus, Systemic/complications

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