RESUMEN
The diagnosis of giant cell arteritis (GCA) when presenting with atypical features such as stroke is very challenging. Only 0.17% of first-ever strokes are caused by GCA, a life-threatening condition when left untreated. Very few cases have been reported on giant cell arteritis leading to acute stroke due to vertebral artery dissection. We present a case of a 76-year-old female with no medical history who presented with sudden onset right visual loss and left hemiparesis. She had been initially treated for acute stroke and upon further workup was found to have left vertebral artery dissection. She had erythrocyte sedimentation rate (ESR) of 71 mm/h, and bilateral temporal artery biopsy was consistent with giant cell arteritis. Patient received high doses of methylprednisolone which resolved her hemiparesis, but her vision loss did not improve. Stroke in the presence of significant involvement of vertebral arteries should raise suspicion of GCA especially if classic symptoms preceded stroke event. High clinical suspicion is required to prevent delay in diagnosis and treatment.
RESUMEN
INTRODUCTION: This is a case of new-onset systemic lupus erythematosus (SLE) manifesting as acute pneumonitis during pregnancy. No prior reports have documented pneumonitis as the presenting manifestation of SLE in pregnant women. Case Presentation. A 23-year-old pregnant female presented with high-grade fever, cough, arthralgias, and respiratory failure. Infectious workup was negative. She was positive for ANA, anti-dsDNA, anti-SSA, hypocomplementemia, and pulmonary infiltrates, supporting the diagnosis of SLE and pneumonitis. The patient received methylprednisolone achieving adequate clinical and serological response. CONCLUSION: When SLE patients present with fever, cough, and respiratory failure, pulmonary infiltrates should raise the suspicion of pneumonitis in the absence of infection and hemorrhage. Even though acute lupus pneumonitis (ALP) is rare and seen only in 2% of SLE patients, a high index of suspicion aids in prompt diagnosis of this life-threatening condition. Also, positive anti-SSA antibodies may be associated with lupus pneumonitis.
