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Journal articles on the topic 'Lupus erythematous disseminated'

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Published: 31 August 2024

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1

Moreno-Suarez, Fatima G., Angela Ayén-Rodriguez, and Ricardo Ruiz-Villaverde. "sQUIZ your knowledge! Disseminated erythematous annular macules and erosive crusted lesions in a patient with systemic lupus erythematosus." European Journal of Dermatology 31, no. 5 (October 2021): 677–79. http://dx.doi.org/10.1684/ejd.2021.4156.

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2

Rasool, Sheraz, Amr Afifi, and Denise De Lord. "Case of atypical cutaneous Mycobacteriumchelonae infection in patient of systemic lupus erythematosus after cyclophosphamide therapy." BMJ Case Reports 12, no. 12 (December 2019): e231930. http://dx.doi.org/10.1136/bcr-2019-231930.

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Mycobacteriumchelonae is one of the rapidly growing non-tuberculous mycobacteria that can be isolated from water, soils and aerosols. Localised infections have been reported associated with tattoo parlours, pedicures and cosmetic procedures. But disseminated infection is usually associated with individuals who are immunocompromised, predominantly affecting limbs but sparing abdomen and back. We herein present a case where patient was on immunosuppressive therapy and developed locally severe infection around right ankle. A 69-year-old woman known to rheumatology presents in outpatients with severe pain in right ankle, unable to bear weight, oedematous right foot and lower leg. There was extensive erythematous cellulitic skin rash around right ankle and lower leg. She had background history of systemic lupus erythematosus with previous history of cardiac myositis and left foot drop. She had six cycles of cyclophosphamide for flare of lupus and after last cycle developed this presentation. Skin biopsy was arranged with dermatologist, cultures from which grew M.chelonae. She was admitted and started on triple regimen for M.chelonae as per Microbiology guidelines with intention to complete 6–12 months treatment. Patient responded very well to treatment but unfortunately, she died after 5 months on treatment due to other comorbidities and likely cause of death was cardiac arrhythmia.

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3

Naga Subrahmanyam, S., D. Tagoore Vijaya Lakshmi, G. V. Naga Raju, and G. V. Pavan Kumar. "Carbamazepine Induced Drug Rash with Eosinophilia and Systemic Symptoms." Journal of Drug Delivery and Therapeutics 9, no. 1-s (February 15, 2019): 367–68. http://dx.doi.org/10.22270/jddt.v9i1-s.2330.

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Stabilizes inactivated state of sodium channels, thereby making neurons less excitable may reduce activity of nucleus ventralis of the thalamus or decrease synaptic transmission or summation of temporal stimulation leading to neuronal discharge.A adult of 68 years old patient came to dermatology department with chief complaints of neuralgia over scalp to relieve the symptoms physician prescribed carbamazepine 200mg Po OD. During his 2ndweek of treatment patient developed pain,fever,sore throat followed by skin rash.Better vigilance is necessary for implementation of safe and effective treatment for each individual patient.in order to prevent serious adverse drug reactions of this drug,close monitoring drug treatment course, creating awareness, recognition of the problem and careful management of all the patients who receive medication are essential,because use of carbamazepine causes thrombocytopenia, leukopenia, leukocytosis, eosinophilia, anemia, pruritic and erythematous rashes, urticaria, photosensitivity reactions, alterations in skin pigmentation, exfoliative dermatitis, erythema multiforme and nodosum, purpura, aggravation of disseminated lupus erythematosus,Abnormalities in liver function tests, cholestatic and hepatocellular jaundice, hepatitis; very rare cases of hepatic failure, Pancreatitis ,Pulmonary hypersensitivity characterized by fever, dyspnea, pneumonitis, or pneumonia Keywords: Carbamazepine, Induced Drug Rash with Eosinophilia and Systemic Symptoms, adverse drug reaction.

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4

Rangwala, Shivani D., Ben A. Strickland, Robert C. Rennert, Kristine Ravina, Joshua Bakhsheshian, Kyle Hurth, Steven L. Giannotta, and Jonathan J. Russin. "Ruptured Mycotic Aneurysm of the Distal Circulation in a Patient with Mucormycosis Without Direct Skull Base Extension: Case Report." Operative Neurosurgery 16, no. 3 (May 24, 2018): E101—E107. http://dx.doi.org/10.1093/ons/opy127.

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Abstract BACKGROUND AND IMPORTANCE Infectious intracranial aneurysms are a rare subset of intracranial aneurysms caused by bacterial, fungal, or viral sources. Intracranial aneurysms of fungal etiology carry a high mortality risk and typically occur in immunocompromised patients via direct extension of skull base infections, or more rarely, after intracranial surgery. CLINICAL PRESENTATION We present the case of a 27-yr-old female with systemic lupus erythematous and primary pulmonary mucormycosis, who suffered a subarachnoid hemorrhage from a ruptured fusiform distal middle cerebral artery aneurysm. Despite undergoing a successful extracranial-to-intracranial bypass and aneurysm excision, the patient ultimately died following progressive disseminated infection and a secondary intracranial hemorrhage of unknown etiology. Pathological examination of the excised artery confirmed Mucor infection. CONCLUSION To the best of our knowledge, this case represents one of the first mycotic cerebral aneurysms from mucormycosis in a patient without an underlying skull base infection or previous intracranial surgery. Despite optimal surgical management, clinical outcomes for mycotic cerebral aneurysms are largely dependent on the success of medical therapies at controlling systemic disease.

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5

Ateş, Öztürk. "Multidrug-Resistant Disseminated Nocardia Farcinica Infection in a Systemic Lupus Erythematosus Patient." Turkish Journal of Rheumatology 28, no. 4 (December 13, 2013): 278–81. http://dx.doi.org/10.5606/tjr.2013.2854.

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6

Skogrand, Aase. "LUPUS ERYTHEMATOSUS DISSEMINATUS." Acta Pathologica Microbiologica Scandinavica 38, no. 3 (August 18, 2009): 193–202. http://dx.doi.org/10.1111/j.1699-0463.1956.tb03167.x.

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7

VETNE, GUNNAR. "Lupus Erythematosus Disseminatus." Acta Medica Scandinavica 136, no. 5 (April 24, 2009): 368–77. http://dx.doi.org/10.1111/j.0954-6820.1950.tb09651.x.

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8

Furuya, H., K. Ikeda, K. Iida, K. Suzuki, S. Furuta, T. Tamachi, K. Suzuki, et al. "Disseminated toxoplasmosis with atypical symptoms which developed with exacerbation of systemic lupus erythematosus." Lupus 28, no. 1 (November 28, 2018): 133–36. http://dx.doi.org/10.1177/0961203318815583.

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Toxoplasma is a common parasite worldwide that mainly affects the brain, lungs and eyes. Although toxoplasmic encephalitis is a lethal disease without treatment, past case reports show most patients with systemic lupus erythematosus who developed toxoplasmic encephalitis were misdiagnosed and treated as neuropsychiatric systemic lupus erythematosus, which led to unfavorable outcomes. We herein describe a case of disseminated toxoplasmosis affecting all the above organs with atypical symptoms, which developed with exacerbation of systemic lupus erythematosus. She had initially manifested with retinochoroiditis without vitritis, mild cognitive impairment and an isolated lung mass. These are completely different from the classic symptoms of toxoplasmosis that have been reported in patients with HIV infection and/or those after hematopoietic transplantation. Our case, together with previously reported cases, suggests the manifestation of toxoplasmosis that develops in systemic lupus erythematosus patients can be different from that seen in conventional cases and varies between individual patients. Our case highlights both the difficulty in and the importance of diagnosing toxoplasmosis in patients with systemic lupus erythematosus and provides helpful information to identify this rare, devastating, yet treatable disease.

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9

BADEA, Mihail-Alexandru. "BULLOUS SUBACUTE CUTANEOUS LUPUS ERYTHEMATOSUS. A CASE REPORT." Bulletin of the Transilvania University of Brasov. Series VI:Medical Sciences 14(63), no. 2 (January 25, 2022): 45–48. http://dx.doi.org/10.31926/but.ms.2021.63.14.2.6.

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Lupus erythematosus is an autoimmune collagen disorder with multiple organs involvement. Subacute cutaneous lupus erythematosus represents about 10% of Lupus erythematosus cases and is frequently drug induced. A 83-year-old female patient, otherwise healthy, presented for disseminated annular lesions with mild pruritus lasting for 5 days.The patient denied any new drug usage in the last two months.Laboratory findings showed raised Anti-Ro antibodies and Anti-La (SS-B). The patient received systemic corticotherapy with the remission of the lesions in one month.Subacute cutaneous lupus erythematosus can present with bullous skin lesions and can arise in elderly people without drug usage.

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10

Sustretov, Vyacheslav A. "Effective laser correction of multiple teleangiectasia on the face." Russian Journal of Skin and Venereal Diseases 24, no. 6 (July 28, 2022): 597–604. http://dx.doi.org/10.17816/dv104391.

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Telangiectasia is a persistent dilation of small-caliber skin vessels (arterioles, venules, capillaries) of a non-inflammatory nature, manifested by polymorphously convoluted and dilated vessels. Telangiectasias are classified according to the cause of occurrence, the form of changes in the vascular pattern, time and localization, and are also divided into 3 large groups ― essential (idiopathic); symptomatic in various diseases; congenital and hereditary syndromes and diseases accompanied by vascular anomalies. In addition, telangiectasias can be single and multiple, located locally or disseminated, differ in shape, location, color; sometimes they bleed. Differential diagnosis is carried out with flaming and telangiectatic nevus; multiple senile, glomerular, bundle angiomas; Fabry angiokeratoma, Sivatts poikiloderma. In addition, telangiectasia is a typical clinical symptom in the erythematous-telangiectatic form of rosacea, systemic scleroderma, discoid lupus erythematosus, nodular form of basal cell carcinoma, hyper- and atrophic scars, late radiation dermatitis. The article describes a case from the clinical practice of effective treatment of telangiectasias on the skin of the face using a neodymium crystal laser, which is of interest, among other things, due to the complexity of diagnosis within the existing International Classification of Diseases 10 revision, therefore the diagnosis is made syndromally based on macro- and microscopic morphological features. In addition, there is no single approach to the treatment of the pathology in question. External therapy, as well as systemic drugs, are often ineffective, sclerotherapy and exposure to a high-power vascular laser have a more pronounced clinical effect (broadband light; neodymium laser; pulsed dye laser; alexandrite, diode, ruby laser). Based on the recommendations of the laser manufacturer on percutaneous vascular coagulation and modern theories about the pathogenesis of telangiectasias, an algorithm for treatment with a long-pulse laser with a wavelength of 1064 nm on a clinical example is proposed. By prescribing a course of treatment of vascular malformation by laser percutaneous coagulation, we expect to obtain the destruction of pathologically dilated vessels of the papillary and mesh layer of the dermis by gluing the walls of the vessels (preferably) or complete thrombosis of their lumen while maintaining the structures of the dermis and epidermis intact. Laser percutaneous vascular coagulation has demonstrated excellent treatment results in a short period of time, significantly reducing the number of pathologically altered vessels. The rehabilitation period after laser coagulation of blood vessels did not exceed 3 days and was manifested by moderate edema of soft tissues in the area of laser exposure, hyperemia and single petechial hemorrhages, which resolved themselves. Laser coagulation of skin telangiectsies is a highly effective method with a long-term clinical effect.

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11

Potekaev, N. N., I. V. Khamaganova, M. V. Novoseltsev, and S. A. Chizevskaya. "Disseminated lupus erythematosus in elderly patients." Klinicheskaya dermatologiya i venerologiya 15, no. 5 (2016): 21. http://dx.doi.org/10.17116/klinderma201615521-24.

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12

Halberg, P., U. Bertram, M. Søborg, and J. Nerup. "Organ Antibodies in Disseminated Lupus Erythematosus." Acta Medica Scandinavica 178, no. 3 (April 24, 2009): 291–99. http://dx.doi.org/10.1111/j.0954-6820.1965.tb04273.x.

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13

Bloxham, C. A., S. Carr, D. W. Ryan, P. J. Kesteven, R. S. Bexton, I. D. Griffiths, and J. Richards. "Disseminated zygomycosis and systemic lupus erythematosus." Intensive Care Medicine 16, no. 3 (March 1990): 201–7. http://dx.doi.org/10.1007/bf01724803.

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14

Nagata, Masahiko, Kenji Rinpou, and Hiroko Nanko. "Disseminated Discoid Lupus Erythematosus in a Dog." Japanese Journal of Veterinary Dermatology 10, no. 3 (2004): 119–24. http://dx.doi.org/10.2736/jjvd.10.119.

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15

Olhagen, Börje. "The Plasma Proteins in Disseminated Lupus Erythematosus." Acta Medica Scandinavica 154, S312 (April 24, 2009): 424–25. http://dx.doi.org/10.1111/j.0954-6820.1956.tb17028.x.

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16

Wong, Kee Lam, Yau Ting Tai, Shee Loong Loke, Edmond K. W. Woo, Woon Sing Wong, Man Kam Chan, and John T. C. Ma. "Disseminated Zygomycosis Masquerading as Cerebral Lupus Erythematosus." American Journal of Clinical Pathology 86, no. 4 (October 1, 1986): 546–49. http://dx.doi.org/10.1093/ajcp/86.4.546.

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17

Morozova, Elena A., and Evgeniia A. Bausheva. "Сlinical cases of newly diagnosed systemic lupus erythematosus at the appointment with a dermatologist." Russian Journal of Skin and Venereal Diseases 25, no. 2 (August 23, 2022): 141–49. http://dx.doi.org/10.17816/dv108211.

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Lupus erythematosus is a multisystemic connective tissue disease that has a wide range of manifestations affecting the skin and mucous membranes, joints, kidneys, heart, lungs, and central nervous system. In dermatology, cutaneous forms of lupus erythematosus can be classified into discoid, disseminated, centrifugal erythema, lupus panniculitis, subacute and chronic lupus, and systemic lupus erythematosus with damage to internal organs. It can develop as an independent disease or can be a result of progression of cutaneous forms. The skin is the second most commonly affected organ in systemic lupus erythematosus folowing the joints, with skin manifestations observed in 80% of patients throughout the course of the disease. And in 2030% of cases, the disease debuts with skin rash. Thus, these patients primarily present to dermatologists. Knowledge of the criteria for making a diagnosis, the clinical characteristics, in combination with performance of advanced laboratory diagnostic tests allow a dermatologist to suspect a systemic process in a timely manner and prescribe appropriate therapy. The article presents two clinical observations of male patients with systemic lupus erythematosus, the diagnosis of which could not have been established for several years. The diagnosis in these cases met the 2019 European League Against Rheumatism (EULAR) and the American College of Rheumatology (ACR) classification criteria for systemic lupus erythematosus, confirmed by laboratory tests. Patients had a positive trend to response to therapy.

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18

Новоселецкая, А. И., and А. А. Белазарович. "Lupus Erythematosus in the Practice of a Dermatologist." Дерматовенерология Косметология, no. 3 (November 11, 2020): 182–92. http://dx.doi.org/10.34883/pi.2020.6.3.005.

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На основании обзора литературы в статье представлены данные о наиболее частых причинах развития красной волчанки. Отмечено, что это заболевание чаще развивается у женщин и в возрастной группе старше 40 лет. В статье дана классификация красной волчанки по МКБ-10 и классификация J. Gilliam и соавт. Подробно описаны критерии диагностики системной красной волчанки. Представлены критерии, описанные в 1972 году В.А. Насоновой, а также классификационные критерии, предложенные Американской коллегией ревматологов (ACR) в 1997 году, и критерии Международного содружества клиник системной красной волчанки (SLICC) от 2012 года. Дана клиническая характеристика таким кожным формам красной волчанки, как дискоидная, диссеминированная, глубокая форма Ирганга – Капоши, центробежная или мигрирующая форма (эритема Биетта), себорейная форма, пигментная, бородавчатая или сосочковая разновидности, «гипсовая» волчанка, lupus erythematosus rosaceus, «chilblain» красная волчанка. Представлена дифференциальная диагностика кожных форм красной волчанки с наиболее часто встречающимися кожными заболеваниями: розацеа, псориазом, себорейной пузырчаткой, дерматомиозитом, эозинофильной гранулемой лица. Описаны современные методы лечения кожных форм красной волчанки. Based on a literature review, the article presents data on the most common causes of lupus erythematosus. It was noted that this disease often develops in women and in the age group older than 40 years. The article gives the classification of lupus erythematosus according to ICD-10 and the classification of J. Gilliam et al. The diagnostic criteria for systemic lupus erythematosus are described in detail. The criteria described in 1972 by V.A. Nasonova, as well as the classification criteria proposed by the American College of Rheumatology (ACR) in 1997 and the criteria for the Systemic Lupus International Collaborating Clinics (SLICC) from 2012. Clinical characteristics are given for such skin forms of lupus erythematosus as discoid, disseminated, lupus erythematosus profundus, Biett’s erythema, seborrheic form, pigmented, hypertrophic or verrucous form, "gypsum" lupus erythematosus, lupus erythematosus rosaceus and "chilblain" lupus erythematosus. Differential diagnosis of skin forms of lupus erythematosus with the most common skin diseases is presented: rosacea, psoriasis, seborrheic pemphigus, dermatomyositis, eosinophilic granuloma. Modern methods of treating skin forms of lupus erythematosus are described.

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19

Mortensen, Vagn, and Harald Gormsen. "LUPUS ERYTHEMATOSUS DISSEMINATUS (LIBMAN-SACKS‘ DISEASE)." Acta Medica Scandinavica 142, S266 (April 24, 2009): 743–74. http://dx.doi.org/10.1111/j.0954-6820.1952.tb13425.x.

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20

Myhre, Jon R. "Pleuropulmonary Manifestations in Lupus Erythematosus Disseminatus." Acta Medica Scandinavica 165, no. 1 (April 24, 2009): 55–60. http://dx.doi.org/10.1111/j.0954-6820.1959.tb14472.x.

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21

Plata-Menchaca, Erika P., V. M. De la Puente-Diaz de Leon, Adriana G. Peña-Romero, and Eduardo Rivero-Sigarroa. "Pulmonary Hemorrhage Secondary to Disseminated Strongyloidiasis in a Patient with Systemic Lupus Erythematosus." Case Reports in Critical Care 2015 (2015): 1–3. http://dx.doi.org/10.1155/2015/310185.

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Introduction. Pulmonary hemorrhage secondary to disseminated strongyloidiasis is an unusual, well-recognized entity in immunocompromised patients with autoimmune disease, which is associated with the hyperinfection syndrome, sepsis, and a high mortality rate.Case Presentation. We present a case of a 44-year-old Mexican woman with systemic lupus erythematosus and acute bacterial meningitis who developed pulmonary hemorrhage with acute respiratory failure requiring mechanical ventilation, treated with broad spectrum systemic antibiotics and high dose methylprednisolone, who subsequently developed a characteristic purpuric skin eruption and septic shock and died two days later of refractory hypoxemia caused by massive pulmonary bleeding. The postmortem examination reports filariform larvae ofS. stercolarisin lung, skin, and other organs.Conclusion. This case highlights the importance of considering disseminated strongyloidiasis in the differential diagnosis of diffuse alveolar hemorrhage in systemic lupus erythematosus, and screening forS. stercolarisinfection before initiation of immunosuppressive therapy should be considered, especially in endemic areas. Disseminated strongyloidiasis has a high mortality rate, explained in part by absence of clinical suspicion.

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22

Hati, Arpita, Subhadeep Mallick, Subhasmita Baisya, Shayeri Banerjee, and Gobinda Chatterjee. "Disseminated Superficial Porokeratosis Mimicking Disseminated Discoid Lupus Erythematosus: An Unusual Presentation." Journal of the Turkish Academy of Dermatology 16, no. 1 (March 1, 2022): 24–26. http://dx.doi.org/10.4274/jtad.galenos.2021.08370.

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23

Gopalan, Geetharani, Sudha R. Gopinath, Kothandaramasamy R., and Sathesh Pandian. "A clinical and epidemiological study on discoid lupus erythematosus." International Journal of Research in Dermatology 4, no. 3 (July 24, 2018): 396. http://dx.doi.org/10.18203/issn.2455-4529.intjresdermatol20183165.

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<p class="abstract"><strong>Background:</strong> Discoid lupus erythematosus (DLE) is the commonest form of cutaneous lupus erythematosus.The objective of our study is to analyze the clinical and epidemiological aspects of DLE.</p><p class="abstract"><strong>Methods:</strong> All clinically diagnosed cases of DLE attending the dermatology OPD from October 2010 to September 2012were included in the study. A detailed history, complete physical examination, biopsy for confirmation and other relevant investigations were done in all cases.<strong></strong></p><p class="abstract"><strong>Results:</strong> The incidence was 4.79 per 10000 cases (51 of 106368 dermatology patients) showing female to male ratio of 4.1:1. Localized type was more common than the disseminated type. Few lesions (less than five) in a localized area without head and neck involvement were also classified as localized type in this study. Mucosal, verrucous, tumid and lupus panniculitis were the variants of DLE encountered. The sites involved were face, scalp, trunk, upper and lower limb in descending order of frequency. Antinuclear antibody (ANA) was positive in 22 of 30 cases done (73%). The systemic involvement was seen in 15 patients all of whom were diagnosed as systemic lupus erythematosus (SLE). Squamous cell carcinoma was seen in 2 cases of disseminated DLE.</p><p class="abstract"><strong>Conclusions:</strong> Majority of patients had disease onset at 3<sup>rd</sup> to 5<sup>th</sup> decade showing female predominance. When compared to localized type, disseminated type was found more frequently in males. Early onset and severe disease was noted among offspring born to a patient suffering from disseminated DLE. Serious morbidity like lupus nephritis was observed only in 1 case. The occurrence of DLE over the herpes zoster scar was an interesting observation.</p>

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24

Singal, A., J. Rohtagi, and D. Pandhi. "Eyelid involvement in disseminated chronic cutaneous lupus erythematosus." Indian Journal of Dermatology, Venereology and Leprology 72, no. 5 (2006): 370. http://dx.doi.org/10.4103/0378-6323.27756.

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25

HAYAKAWA, KAZUHITO, and MASAJI NAGASHIMA. "SYSTEMIC SCLEROSIS ASSOCIATED WITH DISSEMINATED DISCOID LUPUS ERYTHEMATOSUS." International Journal of Dermatology 32, no. 6 (June 1993): 440–41. http://dx.doi.org/10.1111/j.1365-4362.1993.tb02817.x.

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26

LAPAUW S, WESTHOVENS R, and SPITZ B. "Lupus erythematodes disseminatus tijdens de zwangerschap." Tijdschrift voor Geneeskunde 57, no. 19 (January 1, 2001): 1331–42. http://dx.doi.org/10.2143/tvg.57.19.5001153.

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LAPAUW S, WESTHOVENS R, and SPITZ B. "Lupus erythematodes disseminatus tijdens de zwangerschap." Tijdschrift voor Geneeskunde, no. 19 (January 1, 2001): 1331–42. http://dx.doi.org/10.47671/tvg.57.19.5001153.

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28

Wenzel, J., S. Zahn, and T. Tüting. "Pathogenesis of cutaneous lupus erythematosus: common and different features in distinct subsets." Lupus 19, no. 9 (August 2010): 1020–28. http://dx.doi.org/10.1177/0961203310370046.

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The term ‘cutaneous lupus erythematosus’ (CLE) comprises several related autoimmune skin disorders, defined as ‘specific’ skin manifestations of lupus erythematosus (LE). The spectrum of clinical presentation of CLE is wide, reaching from mild erythema to disseminated scarring skin lesions. There is increasing knowledge concerning the pathogenesis of LE skin lesions and it has been shown that a complex network of cutaneous cytokines, chemokines and adhesion molecules orchestrate and promote tissue injury observed in LE skin lesions. However, a complete understanding of the diverse pathophysiological mechanisms in the different CLE subsets does not exist. Here we review the main pathological features described in CLE patients against the background of the clinical diversity of different CLE subtypes. Lupus (2010) 19, 1020—1028.

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Omo-Ogboi, A. C., S. Shirai, M. Buja, and J. Ederhion. "A rare case of Disseminated Histoplasmosis with Hemophagocytic Lymphohistiocytosis mimicking a flare of Systemic Lupus Erythematosus in a middle-aged man: A Case Report." American Journal of Clinical Pathology 160, Supplement_1 (November 1, 2023): S1. http://dx.doi.org/10.1093/ajcp/aqad150.001.

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Abstract Introduction/Objective Disseminated histoplasmosis is a progressive granulomatous disease caused by Histoplasmosis capsulatum which is an intracellular dimorphic fungus endemic to Ohio and Mississippi River valleys in the United States. The progressive spread of the infection to organs is thought to be due to the failure of the activation of the T-cell mediated immune response. Hemophagocytic lymphohistiocytosis is a rare but potentially fatal condition in which histiocytes and lymphocytes build up in and damage organs and other blood cells. Diagnosing Disseminated Histoplasmosis with Hemophagocytic Lymphohistiocytosis in a patient with Systemic Lupus Erythematosus is diagnostically challenging due to the rare presentation. Hence, we are reporting this case to alert physicians to keep a high index of suspicion in such presentations. Methods/Case Report We present a 37-year-old man with a past medical history of Systemic Lupus Erythematosus complicated by Lupus Nephritis on immunosuppressive therapy who presented to the emergency department with hypotension and was admitted for acute kidney injury. Prior to the presentation, he had persistent fever, myalgias, cough, mild shortness of breath, and back pain. CT Chest shows “eggshell” calcification and further parasitology evaluation revealed a diagnosis of histoplasmosis using a blood sample where intracellular Histoplasma organisms were identified. A diagnosis of Hemophagocytic lymphohistiocytosis was made clinically after “Clinical and Testing Criteria” was evaluated. Despite further management, he developed coagulopathy and sepsis which led to his death. Results (if a Case Study enter NA) At autopsy, we found organomegaly of the liver, spleen, and kidneys. Microscopically, these enlarged organs show old fibrotic granulomas and granulomatous inflammation with suspected fungal organisms. Periodic Acid Schiff (Fungus) and Gomori's Methenamine Silver special stain confirm these fungal organisms to be consistent with Histoplasma species (3-5 micron budding yeasts). Conclusion This case report highlights that physicians should be aware of the diagnostic challenge that Disseminated Histoplasmosis with Hemophagocytic Lymphohistiocytosis could pose in patients with Systemic Lupus Erythematosus, especially those on immunosuppression. The clinical presentation could easily mimic a flare of Systemic Lupus Erythematosus, leading to more aggressive immunosuppression. Failure to recognize the infection promptly could lead to grievous complications and sometimes death.

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LINDQVIST, TORSTEN. "Lupus Erythematosus Disseminatus after Administration of Mesantoin." Acta Medica Scandinavica 158, no. 2 (April 24, 2009): 131–38. http://dx.doi.org/10.1111/j.0954-6820.1957.tb15754.x.

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31

Robinett, Kathryn S., Bethany Weiler, and Avelino C. Verceles. "Invasive Aspergillosis Masquerading as Catastrophic Antiphospholipid Syndrome." American Journal of Critical Care 22, no. 5 (September 1, 2013): 448–51. http://dx.doi.org/10.4037/ajcc2013659.

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A 25-year-old woman with a history of systemic lupus erythematosus who was taking steroids came to the hospital because of vague signs and symptoms of weight loss, constipation, and oral ulcers. Multiorgan dysfunction developed, and catastrophic antiphospholipid syndrome was suspected. She was treated with an intravenous infusion of heparin, but she experienced a subdural hemorrhage and died on day 10 of the hospitalization. An autopsy revealed disseminated invasive aspergillosis. This case illustrates that invasive aspergillosis is a frequently missed diagnosis and should be part of the differential diagnosis for any patient who is immunosuppressed, including patients with autoimmune diseases such as systemic lupus erythematosus.

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Bhat, MRamesh, Sukumar Dandakeri, Rohan Gatti, Manjunath Hulmani, and SrinathM Kambil. "Disseminated discoid lupus erythematosus leading to squamous cell carcinoma." Indian Journal of Dermatology 57, no. 2 (2012): 158. http://dx.doi.org/10.4103/0019-5154.94298.

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Tanaka, Hiroshi, Koichi Suzuki, Tohru Nakahata, Takashi Tateyama, Kazuhiko Sugimoto, Etsuro Ito, and Shinobu Waga. "Disseminated candidiasis following prednisolone therapy in systemic lupus erythematosus." Pediatrics International 44, no. 6 (December 2002): 702–4. http://dx.doi.org/10.1046/j.1442-200x.2002.01618.x.

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Ordonez, Laura, Eli Skromne, Daniel Ontaneda, and Victor M. Rivera. "Multiphasic disseminated encephalomyelitis, systemic lupus erythematosus and antiphospholipid syndrome." Clinical Neurology and Neurosurgery 109, no. 1 (January 2007): 102–5. http://dx.doi.org/10.1016/j.clineuro.2006.03.009.

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Mohan, Alladi, J. Harikrishna, GSivaram Naik, SAparna Reddy, DPrabhath Kumar, BSiddhartha Kumar, BVijayalakshmi Devi, and N. Rukmangadha. "Disseminated tuberculosis in a patient with systemic lupus erythematosus." Journal of Clinical and Scientific Research 1, no. 4 (2012): 199. http://dx.doi.org/10.4103/2277-5706.241519.

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S. P., Gayathre, Niranjan Kumar, and Tharani Rajeswaran. "Cutaneous squamous cell carcinoma in a disseminated discoid lupus erythematosus lesion." International Surgery Journal 10, no. 3 (February 24, 2023): 497–500. http://dx.doi.org/10.18203/2349-2902.isj20230506.

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The incidence of skin cancers is low in India when compared to the western world. Malignant transformation of discoid lupus erythematosus (DLE) is a rare entity. Most common site is head and neck. Our case reported is a disseminated DLE with malignant transformation to squamous cell carcinoma (SCC) of a lesion over arm with axillary node involvement. We proceeded with wide local excision and axillary node dissection.

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Widasmara, Dhelya, and Fitri Firdausiya. "Disseminated Herpes Zoster on a Child with Systemic Lupus Erythematosus and Lupus Nephritis." Infection and Drug Resistance Volume 14 (July 2021): 2777–85. http://dx.doi.org/10.2147/idr.s314220.

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TANAKA, Mitsuhiko, Shigeto KOBAYASHI, Naoto TAMURA, Hiroshi HASHIMOTO, and Shun-ichi HIROSE. "Disseminated Intravascular Coagulation in a Patient with Systemic Lupus Erythematosus with Lupus Anticoagulant." Internal Medicine 32, no. 6 (1993): 513–17. http://dx.doi.org/10.2169/internalmedicine.32.513.

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BILLE, BO S. V. "Lupus Erythematosus Disseminatus with and without Skin Eruption." Acta Medica Scandinavica 140, no. 4 (April 24, 2009): 280–89. http://dx.doi.org/10.1111/j.0954-6820.1951.tb10179.x.

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Teilum, Gunnar. "MILIARY EPITHELIOID-CELL GRANULOMAS IN LUPUS ERYTHEMATOSUS DISSEMINATUS." Acta Pathologica Microbiologica Scandinavica 22, no. 1 (August 17, 2009): 73–79. http://dx.doi.org/10.1111/j.1699-0463.1945.tb04055.x.

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Li, Justin C. H., Warren Fong, Limin Wijaya, and Ying Y. Leung. "Disseminated tuberculosis masquerading as a presentation of systemic lupus erythematosus." International Journal of Rheumatic Diseases 21, no. 1 (October 2, 2017): 352–55. http://dx.doi.org/10.1111/1756-185x.13195.

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42

Gil Alzueta, M. C., M. E. Erro Aguirre, M. C. Herrera Isasi, and M. T. Cabada Giadás. "Acute disseminated encephalomyelitis as a complication of systemic lupus erythematosus." Neurología (English Edition) 31, no. 3 (April 2016): 209–11. http://dx.doi.org/10.1016/j.nrleng.2014.02.007.

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43

Den, S. "Disseminated keratoconjunctival epitheliopathy in a patient with systemic lupus erythematosus." British Journal of Ophthalmology 90, no. 8 (April 13, 2006): 1068–70. http://dx.doi.org/10.1136/bjo.2006.090498.

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SHIMAMOTO, Yoshinori, Masayuki SANO, Shoko KANEDA, Seiji TSUNADA, Kyosuke YAMAMOTO, and Masaya YAMAGUCHI. "Disseminated Intravascular Coagulation in Lupus Erythematosus with Acute Liver Damage." Internal Medicine 31, no. 12 (1992): 1392–95. http://dx.doi.org/10.2169/internalmedicine.31.1392.

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Hardie, Rochelle, Tracian James-Goulbourne, Monsoon Rashid, Jeremy Sullivan, and Yamen Homsi. "Fatal Disseminated Aspergillosis in a Patient with Systemic Lupus Erythematosus." Case Reports in Infectious Diseases 2020 (February 29, 2020): 1–5. http://dx.doi.org/10.1155/2020/9623198.

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Patients with systemic lupus erythematosus (SLE) are at increased risk for infection including opportunistic infections. Fungal infection in particular can be difficult to diagnose and treat and often can be life-threatening in the immunocompromised patient. We present a case in which a patient with SLE presented to the hospital with shortness of breath and cough. Throughout the hospital course, the patient’s condition continued to decline leading to acute respiratory failure, and eventually, the patient expired. Postmortem autopsy revealed invasive fungal aspergillosis infection involving the heart, lungs, and brain. Earlier diagnosis and treatment with empiric antifungals may improve survival in these patients.

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Riddell, Stanley R., and A. Majid Shojania. "Disseminated intravascular coagulation in lupus erythematosus responding to prednisone therapy." American Journal of Hematology 23, no. 1 (September 1986): 65–68. http://dx.doi.org/10.1002/ajh.2830230110.

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Souto Filho, João Tadeu Damian, Priscilla Damião Araújo Lima, Alex Batista Paulo, and Ana Luisa Silva Souza. "Hemophagocytic lymphohistiocytosis secondary to disseminated histoplasmosis in systemic lupus erythematosus." International Journal of Hematology 106, no. 6 (August 7, 2017): 727–28. http://dx.doi.org/10.1007/s12185-017-2308-z.

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To, Uyen, Joyce Kim, and David Chia. "Lupus Flare: An Uncommon Presentation of Disseminated Gonorrhea." Case Reports in Medicine 2014 (2014): 1–3. http://dx.doi.org/10.1155/2014/626095.

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Gonorrhea is one of the most common sexually transmitted diseases in the US with 700,000 annual cases. Although most cases of gonorrhea are localized, approximately 0.5–3% become disseminated. Here we discuss a rare case of a patient with systemic lupus erythematosus (SLE) who developed septic shock from disseminated gonorrhea infection (DGI). Our patient is a 24-year-old woman with SLE, mixed connective tissue disease with cutaneous vasculitis, and lupus nephritis who presented with several weeks of malaise and generalized body aches associated with a diffuse rash along her fingers, palms, and trunk. Infectious workup was unrevealing with the exception of a positive gonorrhea test obtained from a cervical swab. Given her symptoms of tenosynovitis, the appearance of her skin lesions, and her positive gonorrhea test, she was diagnosed with septic shock secondary to DGI. With antibiotic treatment, the patient reported a dramatic improvement of the pain in her swollen joints and her rash receded. Patients diagnosed with SLE carry an increased risk of gonorrhea regardless of whether or not they are being treated for their SLE. Although it is well-documented that SLE is associated with severe DGI, few describe it resulting in overt septic shock.

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Greitemann, B., M. Schneider, T. Pauly, and M. Waldendorf. "Multiple Gelenkdestruktionen infolge eines systemischen Lupus erythematodes disseminatus." Aktuelle Rheumatologie 17, no. 03 (May 1992): 90–93. http://dx.doi.org/10.1055/s-2008-1047355.

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50

Tang, Bone Siu-Fai, Jasper Fuk-Woo Chan, Min Chen, Owen Tak-Yin Tsang, M. Y. Mok, Raymond Wai-Man Lai, Rodney Lee, et al. "Disseminated Penicilliosis, Recurrent Bacteremic Nontyphoidal Salmonellosis, and Burkholderiosis Associated with Acquired Immunodeficiency Due to Autoantibody against Gamma Interferon." Clinical and Vaccine Immunology 17, no. 7 (May 5, 2010): 1132–38. http://dx.doi.org/10.1128/cvi.00053-10.

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ABSTRACT Acquired immunodeficiency due to autoantibody against gamma interferon has recently been associated with opportunistic nontuberculous mycobacteriosis, especially among Southeast Asians. We report another 8 cases, all except one apparently immunocompetent hosts who suffered from concomitant or sequential infections by other intracellular pathogens causing penicilliosis, extraintestinal nontyphoidal salmonellosis, and burkholderiosis. The only case with an underlying immunodeficiency syndrome had systemic lupus erythematosus that was quiescent throughout the multiple infective episodes. Eight out of 10 (80.0%) patients with serological evidence of penicilliosis, 5 out of 7 (71.4%) with culture-positive extraintestinal nontyphoidal salmonellosis, 5 out of 28 (17.9%) with serological evidence of melioidosis, and 7 out of 13 (53.8%) with culture-positive nontuberculous mycobacteriosis possessed autoantibody against gamma interferon, whereas only 1 out of 100 patients with systemic lupus erythematosus did. Our study represents the first and largest case series linking this emerging immunodeficiency syndrome with these atypical infections in apparently immunocompetent hosts. Thus, we advocate that any patient with unexplained recurrent or polymicrobial infections due to these intracellular pathogens should be screened for acquired immunodeficiency due to autoantibody against gamma interferon.

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