Características clínicas e inmunológicas de los pacientes diagnosticados de Lupus eritematoso sistémico, atendidos en los servicios de medicina interna y reumatología de los hospitales Vicente Corral Moscoso y José Carrasco Arteaga de la ciudad de Cuenca, durante el período comprendido entre octubre de 1993 a octubre de 2003

Investigación clínica descrptiva para determinar cuáles son las principales características clínicas e inmunológicas que se presentan en pacientes diagnosticados de Lupus Eritematoso Sistémico (LES)en los hospitales: Vicente Corral Moscoso y José Carrasco Arteaga, áreas de medicina interna y reumatología, en el período comprendido entre octubre de 1993 a octubre de 2003, a quiénes se les aplica un formulario (Anexo Nª 1), el que contiene información acerca de datos de filiación epidemiológicos antecedentes patológicos y los Criterios para el diagnóstico de LES según la Asociación Americana de Reumatoloría (ARA) 1982. Resultados: 96 pacientes con diagnóstico de LES; el 34.4sexo femenino, y el 15.6sexo masculino, manteniendo una relación mujer-hombre de 5.4 a 1, la edad de presentación más frecuente estuvo entre los 20 a 29 años, la ocupación principal de este grupo fueron los quehaceres domésticos y el mayor porcentaje de pacientes procedían de la provincia del Azuay. Según los criterios diagnosticados de LES, (ARA 1982) del total de pacientes, el 78.1presentaron artritis, el 97-9anticuerpos (ANA) y complemento (C4) disminuido en el 82.3anemia hemolítica en el 12.5; proteinuria en 81.3; VSG acelerada en un 85depresión 50, y pleuritis en 31.3de los pacientes. La prevalencia hospitalaria del LES fue de 3.87X 1000 pacientes. Esta investigación reune el mayor número de pacientes diagnosticados de LES en el medio tomando como centros de referencia y concentración las dos principales casas de salud de la Provincia del Azuay, para pacientes de otras provincias principalmente a la provincia de El Oro y la provincia de Loja, constituyendo una base de datos sólida para investigaciones futuras, puesto que hasta el día de hoy no se disponían de estadísticas reales de esta enfermedad, y únicamente se regla a literaturas extranjeras. El estudio dice demostrar que cada día se detectan más casos de LES, porque se han mejorado las técnicas diagnosticadas y se conoce mejor la enfermedad, de esta investigación se logró establecer un algoritmo para el diagnóstico de LES, que traerá como consecuencia, la instauración rápida del tratamiento y obviamente un pronóstico aceptable

Simultaneous Occurrence of Systemic Lupus Erythematosus, Rheumatoid Arthritis, Hashimoto’s Thyroiditis and Membranous Glomerulonephritis

Introduction: Membranous glomerulonephritis is commonly described in systemic lupus erythematosus (SLE) and hypothyroidism. Clinical presentation: We report a case of a 40-year-old woman who presented with a membranous glomerulonephritis associated with SLE, rheumatoid arthritis and hypothyroidism due to Hashimoto’s thyroiditis. Conclusions: The simultaneous occurrence of these three diseases as possible causes of membranous glomerulonephritis is extremely exceptional.

Chronic Active Hepatitis B with HBV-Associated Nephropathy: Close Resemblance to Lupus Nephritis

We present a rare case of a 23-year-old male incidentally detected with hepatitis B virus (HBV) infection presenting with features suggestive of HBV-associated nephropathy. A renal biopsy specimen suggested a mesangioproliferative glomerulonephritis with a full-house pattern on immunoflourescence consistent with a diagnosis of diffuse lupus nephritis. Glomerular HbeAg and HbsAg antigens were not detectable by immunofluorescence. Antiviral therapy was instituted to suppress viral replication, thereby leading to clinical and virological remission, including that of the glomerulonephritis, without the need for additional immunosuppressant therapy. This case depicts the uniqueness of the presentation of the two conditions mimicking each other, the strategy adopted to prevent the activation of viral replication and the achievement of clinical remission.

Development of Myasthenia Gravis in Systemic Lupus Erythematosus

Objectives: To perform a literature review and estimate MG incidence in an SLE cohort. Materials and methods: We searched MEDLINE and PubMed for case reports of SLE and MG. We also calculated MG incidence within our clinical SLE cohort (females only). Results: Eleven articles met our criteria, providing 13 SLE patients who developed MG. The majority were female (84.6%), with the average ages of 25.6 and 33.5 years at diagnoses of SLE and MG, respectively. In 380 SLE female patients followed for 2,850 person-years, one MG case occurred. Conclusion: MG in SLE is a rare event.

Immunologic Storm Simulating Systemic Lupus Erythematosus Following Parvovirus B19 Infection

Background: The appearance of symptoms compatible with systemic autoimmune diseases has been described in relation to several viral infections like HIV, cytomegalovirus and especially PVB19, depending on the evolution of the immunological condition of the host and their age. We present a young immunocompetent male patient, with clinical manifestations simulating systemic lupus erythematosus (SLE) with important activation of cytokines. Methods: For quantification of the different cytokines in plasma, a commercially available multiplex bead immunoassay, based on the Luminex platform (Cat # HSCYTO-60SK-08, Milliplex® MAP High Sensitivity, Millipore), was used according to the manufacturer’s instructions. All samples were run in duplicate and the data (mean fluorescence intensity) were analyzed using a Luminex reader. The mean concentration was calculated using a standard curve. Results: The clinical evolution was favourable without the need for any specific treatment, showing complete recovery after two months. Whilst the symptoms and viral charge were disappearing, the anti-DNA continued to increase and we demonstrate important activation of IL-10, IL-6 and TNFα cytokines as a result of a hyperstimulating response by an immunocompetent hyperfunctional system, which persists after clinical improvement. We should emphasize the behaviour of two cytokines: IL-12p70 and IL-2, which showed opposite tendencies. Conclusions: Viral infections, especially PVB19, can produce or simulate several autoimmune diseases as a hyperstimulation response from an immunocompetent hyperfunctional system. Consequently, a persistent increase of autoantobodies and important activation of cytokines, even after clinical improvement and seroconversion, can be demonstrated.

Hydroxychloroquine Myocardial Toxicity in a Patient with Systemic Lupus Erythematosus

Hydroxychloroquine is an antimalarial drug used in many rheumatologic and systemic diseases. Although considered by clinicians to be relatively safe, serious side effects have been documented (retinotoxicity, neuromyotoxicity and cardiotoxicity). We present the case of a 41-year-old woman with systemic lupus erythematosus (SLE) who presented at our institution with acute heart failure after taking hydroxychloroquine for a period of 3 months. An endomyocardial biopsy ruled out myocarditis related to systemic lupus erythematosus but demonstrated pathological changes related to hydroxychloroquine toxicity. It is exceptional to observe such cardiac toxicity after such a low cumulative dose (16 grams). The potential severity and reversibility of this complication underscores the importance of a high level of suspicion and timely diagnosis.

Chylous Ascites in Systemic Lupus Erythematosus (SLE) Patients

The gastrointestinal system is commonly implicated in Systemic Lupus Erythematosus (SLE). Ascites, produced by several mechanisms has been reported as a systemic manifestation of lupus, but only rarely as an initial presentation of the disease. Its appearance is often insidious and without abdominal pain. Chylous ascites (such as chyle in the peritoneal cavity) has seldom been reported in SLE. We describe a case of chylous ascites in an SLE patient, reviewing the other published cases, its pathophysiology and its management.

Acute Acalculous Cholecystitis as a Presenting Manifestation in Systemic Lupus Erythematosus

Systemic lupus erythematosus (SLE) is known to involve the gastrointestinal tract, but gallbladder involvement is rare. The authors report the case of a 26-year-old postpartum female who presented with acute right upper quadrant abdominal pain and was diagnosed with acute acalculous cholecystitis (AAC). In the presence of concomitant features of nephritis, pericardial effusion, anaemia and positive ANA titre, the diagnosis of SLE was confirmed during hospitalisation. Histopathological analysis of the gall bladder revealed evidence of vasculitis. Although rare, AAC can be the first presentation of patients diagnosed with SLE. Prompt diagnosis and management results in a better patient outcome.

O Psicodrama como abordagem psicoterapêutica à alexitimia: Espontaneidade e alexitimia em pacientes com lupus

Dissertação de Mestrado apresentada ao Instituto Superior de Psicologia Aplicada para obtenção de grau de Mestre na especialidade de Psicologia Clínica.

Estadios de la nefropatía lúpica mediante biopsia renal realizada en niños/as con diagnóstico de lupus eritematoso sistémico en el Hospital Nacional de Niños Benjamín Bloom en el periodo del 1 de enero de 2010 al 31 de diciembre de 2012.

Es un estudio de tipo descriptivo ya que se pretende evaluar el nivel de actividad del Lupus eritematoso sistémico, el grado de afectación renal por medio de los resultados de los reportes de biopsia renal en pacientes con nefropatía lúpica; transversal ya que se analizará en el período de enero del 2010 a diciembre del 2012. Observacional, no se realizará ninguna acción ni interacción con el paciente; retrospectivo donde se analizarán expedientes de pacientes con diagnóstico de nefropatía lúpica en un período de tres años. El método utilizado fue la revisión de expedientes clínicos, completando la hoja de recolección de datos instrumento creado para la obtención de la información útil para este trabajo de investigación. La investigación está conformada por un total de 45 pacientes con diagnóstico de lupus eritematoso sistémico la mayoría pertenecen al género femenino en una relación de 1: 2.75 masculino: femenino; más de la mitad provienen del área rural; la manifestación clínica más frecuente de enfermedad renal es la hipertensión arterial seguida por el edema, la alteración renal más frecuente por lo que se les realizo biopsia renal fue la proteinuria que representa el 50%, seguido de la elevación de la creatinina; la clasificación según la histopatología de la biopsia renal según la clasificación de la OMS fue la Clase IV que representa más del 40 %.

Avaliação demográfica, clinico-laboratorial e genética de indivíduos com lupus eritematoso sistêmico e artrite reumatóide residentes em região tropical

The aetiology of autoimmunes disease is multifactorial and involves interactions among environmental, hormonal and genetic factors. Many different genes may contribute to autoimmunes disease susceptibility. The major histocompatibility complex (MHC) genes have been extensively studied, however many non-polymorphic MHC genes have also been reported to contribute to autoimmune diseases susceptibility. The aim of the present study was to evaluate the influence of SLC11A1 gene in systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA). Ninety-six patients with SLE, 37 with RA and 202 controls enrolled in this case-control study, were evaluated with regard to demographic, genetic, laboratorial and clinical data. SLE mainly affects females in the ratio of 18 women for each man, 88,3% of the patients aged from 15 to 45 years old and it occurs with similar frequency in whites and mulattos. The rate of RA between women and men was 11:1, with 77,1% of the cases occurring from 31 to 60 years. The genetic analysis of the point mutation -236 of the SLC11A1 gene by SSCP did not show significant differences between alleles/genotypes in patients with SLE or RA when compared to controls. The most frequent clinical manifestations in patients with SLE were cutaneous (87%) and joint (84.9%). In patients with RA, the most frequent out-joint clinical manifestation were rheumatoid nodules (13,5%). Antinuclear antibodies were present in 100% of the patients with SLE. There was no significant relation between activity of disease and presence of rheumatoid factor in patients with RA, however 55,6% of patients with active disease presented positive rheumatoid factor. Significant association between alleles/genotypes of point mutation -236 and clinical manifestations was not found

Otimização da caracterização de fibras musculares estriadas em cão (Canis familiaris) por histoquímica e imunohistoquímica com potencial aplicação ao diagnóstico

Dissertação de Mestrado Integrado em Medicina Veterinária

Similarities between the lipid proile of Mexican patients with lupus and the general population

Premature cardiovascular events have been observed in systemic lupus erythematosus (SLE) patients, but the reason for this accelerated process is still debatable; although traditional risk factors are more prevalent in such patients than in the general population, the do not seem to fully explain that enhanced risk. One of the most important conditions is a proatherogenic lipid proile. There is not enough data about it in Mexican SLE patients. Objective: To establish the differences in the lipid proiles between Mexican patients with SLE and the general population. Material and methods: Observational, transversal, descriptive and comparative study, between SLE patients and age-sex-matched healthy volunteers. We performed a full lipid proile (by spectrophotometry) 14 hours of fast. The results obtained were analyzed by the statistical program SPSS® Statistics version 17. Results: We studied the full lipid proiles of 138 subjects, 69 with a diagnosis of SLE and 69 agesex- matched healthy volunteers; 95.7% were females and 4.3% males. Average age was 30 years; average body mass index (BMI) 25.96 ± 5.96 kg/m² in SLE patients and 26.72 ± 4.36 kg/m² in the control group (p = 0.396). Average of total cholesterol 156 mg/dl in the SLE patients and 169.4 mg/dl in the control group (p =0.028); average of low density lipoprotein (LDL) cholesterol 85.27 mg/dl in the SLE patients and 97.57 mg/dl in the control group (p = 0.023). Conclusions: We did not ind statistical differences in the lipid proiles among patients and healthy volunteers, which could explain increased cardiovascular morbidity and mortality observed in SLE patients