A Case of Fibrinous Pericardial Effusion: Tuberculosis Versus Systemic Lupus Erythematosus | Chapter 5 | Achievements and Challenges of Medicine and Medical Science Vol. 12

Systemic lupus erythematosus (SLE) is a multisystem autoimmune disorder with varied presentations, ranging from nonspecific features like fever, malaise, and arthralgia to serious manifestations like serositis (pleural, pericardial effusions), neurological manifestations, and renal involvement (lupus nephritis). SLE is a great mimicker, especially for infections like tuberculosis (TB) which is rampant in low- and middle-income countries (LMIC). We report a case of massive pericardial effusion, which was initially diagnosed and treated as TB on clinico-radiological basis. The patient showed initial clinical improvement. But as the steroids were tapered and stopped, she developed new findings like joint pains, proteinuria, cytopenias, etc leading to reconsideration of diagnosis, which was later revised to SLE based on clinical and laboratory findings. This is one of the uncommon presentations of SLE, leading to misdiagnosis of tuberculosis especially in LMIC.

 

Author (s) Details

 

Kamal Joshi
Department of Pediatrics, All India Institute of Medical Sciences, Rishikesh, India.

 

Aman Elwadhi
Department of Pediatrics, All India Institute of Medical Sciences, Rishikesh, India.

 

Binita Poudel
Department of Pediatrics, All India Institute of Medical Sciences, Rishikesh, India.

 

Anukriti Agnihotry

Department of Pediatrics, All India Institute of Medical Sciences, Rishikesh, India.

 

Prashant K. Verma
Department of Pediatrics, All India Institute of Medical Sciences, Rishikesh, India.

 

Please see the book here:- https://doi.org/10.9734/bpi/acmms/v12/3789

Dengue Fever Triggering Systemic Lupus Erythematosus and Lupus Nephritis: Case Report with 10 Years Follow up | Chapter 5 | Current Practice in Medical Science Vol. 1

Numerous immunological problems might result from dengue disease. A middle-aged female patient who presented with symptoms of lupus nephritis brought on by a dengue fever infection was monitored for 10 years while having periodic laboratory parameters assessed. We evaluated this patient using the non-invasive endothelial function testing instrument, taking into consideration the endothelial dysfunction brought on by COVID-19 infection and COVID-19 immunisation (Angio defender). Even while the main condition did not worsen as a result of the COVID-19 infection or the two doses of COVID-19 vaccination (COVAXIN), the angio defender still indicated a moderate CVD risk.

Author(s) Details:

S. H. Talib,

Department of medicine, MGM Medical College, Aurangabad, India.

S. R. Bhattu,

Department of medicine, MGM Medical College, Aurangabad, India.

B. Pranita,

Department of medicine, MGM Medical College, Aurangabad, India.

P. Sachin,

Department of medicine, MGM Medical College, Aurangabad, India.

S. A. Amjad,

Department of medicine, MGM Medical College, Aurangabad, India.

Please see the link here: https://stm.bookpi.org/CPMS-V1/article/view/7324

Recent Study on Immunosuppressive Treatment for Lupus Nephritis: Long-term Results in 178 Patients | Chapter 11 | Research Trends and Challenges in Medical Science Vol. 2

Lupus nephritis is one of the most severe Systemic Lupus Erythematosus features, defining treatment modality and prognosis. Our retrospective study, including 178 patients treated for lupus nephritis during 23 years with mostly cyclophosphamide-based initial regimens followed by azathioprine or mycophenolic acid, demonstrates 84.8% of renal response with 19.2% of flares, 15-year patient survival 78.7% and kidney survival 76.3%, and low damage accrual. Both patient and kidney survival significantly differ for subgroups that achieved complete or partial renal response and nonresponders: patient 15-year survival 95% versus 65% versus 35%; kidney 15-year survival 100% versus 58% versus 0%, respectively. 51% (24 out of 47) of patients evaluated at the end of the study period sustained complete renal response; however, only 9 of them had 0 disease activity according to SELENA SLEDAI scale, while 13 patients had scores 2–4 due to the serological abnormalities only. We conclude that (1) initial treatment with cyclophosphamide followed by azathioprine is effective and can be used in agreement with International Guidelines until the evidence for biological treatments benefits becomes available; (2) complete and even partial renal response have positive prognostic value, and failure to achieve renal response negatively influences kidney and patient survival; (3) the validity of complete renal response in SLE is questioned by the absence of conventional definition of SLE remission.

Author(s) Details

Dr. Elena V. Zakharova
Department of Nephrology, City Botkin Memorial Hospital, Moscow, Russia and Department of Nephrology, State University of Medicine and Dentistry, Moscow, Russia

Dr. Tatiana A. Makarova
Department of Nephrology, City Botkin Memorial Hospital, Moscow, Russia.

Dr. Elena V. Zvonova
Department of Nephrology, City Botkin Memorial Hospital, Moscow, Russia.

Dr. Alina M. Anilina
Department of Nephrology, City Botkin Memorial Hospital, Moscow, Russia.

Dr. Ekaterina S. Stolyarevich
Department of Nephrology, State University of Medicine and Dentistry, Moscow, Russia.

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