1/32. factitious disorders mimicking systemic lupus erythematosus.factitious disorders are one of the most difficult challenges to the sagacity of the physician. Self-inflicted injuries and diseases have been recognized since Biblical times. In the Middle Ages, hysterics were known to place leeches in their mouths to simulate hemoptysis and to abrade their skin to reproduce skin conditions. munchausen syndrome, originally described in 1951, is the term applied to persons who seek medical care by feigning illness in the absence of any organic medical or surgical disease. Since the first report of the syndrome, many case reports have documented the performance of unneeded operations and the administration of dangerous drugs to these patients. Rheumatologic manifestations in this syndrome are rare, and include septic arthritis, osteomyelitis, destructive arthropathy, reflex sympathetic dystrophy and systemic lupus erythematosus (SLE). We reviewed the English literature for the past 29 years and found only 8 patients with munchausen syndrome who simulated SLE. It is interesting to consider the damage mechanisms (some of the patients satisfied 4 or more of the criteria for the classification of SLE) and how a complex disease with a broad spectrum of manifestations such as lupus can be simulated, the only limits being the patient's knowledge and imagination.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/32. Possible induction of systemic lupus erythematosus by zonisamide.An epileptic male to whom zonisamide and ethosuximide had been administered exhibited fever, pericarditis, pleuritis, arthralgia, and elevated titers of antinuclear antibody and anti-dna-antibody at 5 years, 11 months of age. It was suggested that zonisamide induced the systemic lupus erythematosus symptoms because the antinuclear antibody titers began to rise after zonisamide was administered, and clinical recovery and a decrease in the anti-dna-antibody levels promptly followed the discontinuation of the drug. The positive lymphocyte transformation test results against zonisamide further supports the etiologic relationship of the male's lupus and the drug. This first case of zonisamide-induced lupus should alert physicians to the possibility of this serious unwanted effect in patients receiving zonisamide.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/32. A rare initial manifestation of systemic lupus erythematosus--acute pancreatitis: case report and review of the literature.BACKGROUND: Acute pancreatitis as the initial manifestation of systemic lupus erythematosus (SLE) has been documented only nine times in the English literature. methods: We report the case of a 25-year-old woman patient with fever, abdominal pain and vomiting, elevated levels of pancreatic enzymes, and various other laboratory abnormalities. Further investigation led to a diagnosis of SLE. A literature search, using the key words "systemic lupus erythematosus" and "pancreatitis" was undertaken. RESULTS AND CONCLUSIONS: The treatment of SLE pancreatitis is steroids, which is somewhat controversial because steroids have been implicated in the cause. SLE can involve any organ system. It is important that the family physician, who treats patients as a whole, rules out SLE when a straightforward diagnosis is associated with inexplicable multiple concomitant abnormalities.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/32. Laryngeal involvement in systemic lupus erythematosus.Laryngeal involvement in systemic lupus erythematosus (SLE) can range from mild ulcerations, vocal cord paralysis, and edema to necrotizing vasculitis with airway obstruction. In this report, four cases showing the range of severity of this disease manifestation are presented, accompanied by a comprehensive review of the literature. The clinical course of 97 patients with laryngeal involvement with SLE are reviewed, of whom 28% had laryngeal edema and 11% had vocal cord paralysis. In the majority of cases, symptoms such as hoarseness, dyspnea, and vocal cord paralysis resolved with corticosteroid therapy. Other, less common causes of this entity included subglottic stenosis, rheumatoid nodules, inflammatory mass lesions, necrotizing vasculitis, and epiglottitis. The clinical presentation of laryngeal involvement in patients with SLE follows a highly variable course, ranging from an asymptomatic state to severe, life-threatening upper airway compromise. With its unpredictable course and multiple causations, this complication remains a diagnostic and therapeutic challenge to physicians involved in the care of patients with SLE.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/32. Systemic lupus erythematosus with presentation as vertigo and vertical nystagmus: report of one case.An 11-year-old boy suffered from fever, headache, severe vertigo and unsteady gait. physical examination showed bilateral vertical nystagmus, mild corneal reflex delay of the right eye and asymmetric facial expression. Laboratory data showed leukopenia, high ESR and normal CSF study. Brain CT showed diffuse brain edema. electronystagmography showed upbeat nystagmus and central vertigo. EEG revealed diffuse slow wave and mild to moderate cortical dysfunction. MRI of the head showed focal abnormal signal intensity at the ventral portion of the medulla oblongata on both sides. Under suspicion of enteroviral encephalitis, mannitol and IVIG were given. The virological profiles were negative, ANA 1:640 nucleolar type, low complements and proteinuria. Anti-ds dna was elevated and anti-ribosomal-P antibodies were positive. Under impression of SLE with CNS involvement, betamethasone was given. fever, nystagmus and ataxia subsided gradually. Steroid was tapered and imuran was added. The following laboratory data were normal. In his past history, the patient was diagnosed Kikuchi disease. The manifestations of SLE were rare initial presentations as vertigo or vertical nystagmus. We present a case with review of literature and conclusion that physicians should keep in mind the possibility of SLE if patients present with unspecific neurological symptoms and concomitant systemic symptoms.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/32. Gluten sensitivity masquerading as systemic lupus erythematosus.case reports: Three patients are described whose original presentation and immunological profile led to the erroneous diagnosis of systemic lupus erythematosus. The correct diagnosis of gluten sensitivity was made after years of treatment with steroids and other immunosuppressive drugs. CONCLUSIONS: The immunological profile of iga deficiency and/or raised double stranded dna in the absence of antinuclear factor together with raised inflammatory markers and symptoms suggestive of an immune diathesis should alert the physician to the possibility of gluten sensitivity. The presence of an enteropathy is no longer a prerequisite for the diagnosis of gluten sensitivity, which can solely present with extraintestinal symptoms and signs. knowledge of the diverse manifestations of gluten sensitivity is essential in avoiding such misdiagnosis.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
7/32. autoantibodies and the spectrum of sjogren's syndrome.In studies reported recently, the sera of patients with sjogren's syndrome were found to contain precipitating antibodies to nuclear antigens that can be identified by immunodiffusion analysis. These precipitating autoantibodies have been termed SS-A and SS-B antibodies. We show that identification of these autoantibodies helped in establishing the diagnosis of sjogren's syndrome in 12 of 30 patients in whom the diagnosis had not been considered at the time of the physician's initial examination. The reasons for this were related to lack of spontaneous complaints of keratoconjunctivitis sicca and xerostomia and prominence of symptoms associated with arthritis, myalgia, pulmonary fibrosis, and cardiac disease. This study re-emphasizes the importance of multisystem disease in sjogren's syndrome and shows that specific serologic assays for autoantibodies aided in diagnosis.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
8/32. ascites, pleural effusion, and CA 125 elevation in an SLE patient, either a Tjalma syndrome or, due to the migrated Filshie clips, a pseudo-meigs syndrome.BACKGROUND: The combination ascites, pleural effusion, and elevated CA 125 are usually associated with a malignancy. CASE: A 38-year-old SLE patient consulted her physician for shortness of breath. On clinical examination, she had a tender abdomen and reduced breathing sounds. X-ray and computed tomography of the chest showed pleural effusion. An adjustment of her SLE maintenance therapy was performed. Vaginal ultrasound and computed tomography of the abdomen revealed massive ascites and an intracavitair myoma of 2 cm, but no obvious mass in the pelvis. CA 125 was 887 U/ml. A laparoscopy was performed showing ascites and 2 Filshie clips embedded in the peritoneum of the vesicouterine pouch, but no sign of malignancy. Both clips were removed. The cytology of the aspirated ascites showed sings of acute inflammation. Within 10 weeks, the pleural effusion was resolved and the CA 125 normalized. CONCLUSION: The combination of ascites, pleural effusion, CA 125 elevation, and no tumor in an SLE patient is either a Tjalma syndrome or due to the migrated Filshie clips a pseudo-meigs syndrome.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
9/32. sternum insufficiency fracture presenting as acute chest pain: a case report and review of the literature.The spine, pelvic bones and long bones of the lower extremities are common sites for insufficiency fractures. Cases of sternum insufficiency fractures have been rarely reported in an elderly patient. Insufficiency fracture tends to occur in bones with decreased mechanical strength. It tends to occur in elderly patients, especially in postmenopausal women, with underlying diseases. We describe a case of sternum insufficiency fracture in a patient with rheumatoid arthritis and systemic lupus erythematosus on long-term corticosteroid therapy diagnosed in an emergency setting. sternum insufficiency fracture is a rare cause of chest pain. This case serves to remind the emergency physician to remain vigilant for other noncardiac and nontraumatic causes of chest pain. If diagnosed accurately, these patients can be discharged and treated as outpatients.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
10/32. Prolonged coma from refractory status epilepticus.OBJECTIVE: status epilepticus is a life-threatening medical condition. In its most severe form, refractory status epilepticus (RSE) seizures may not respond to first and second-line anti-epileptic drugs. RSE is associated with a high mortality and significant medical complications in survivors with prolonged hospitalizations. methods: We describe the clinical course of RSE in the setting of new onset lupus in a 31-year-old male who required prolonged barbiturate coma. RESULTS: Seizure stopped on day 64 of treatment. Prior to the resolution of seizures, discussion around withdrawal of care took place between the physicians and patient's family. Medical care was continued because of the patient's age, normal serial MRI studies, and the patient's reversible medical condition. CONCLUSION: Few evidence-based data exist to guide management of RSE. Our case emphasizes the need for continuous aggressive therapy when neuroimaging remains normal.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
| | Next -> |