RESUMO
Acute fibrinous and organizing pneumonia (AFOP) is rare in patients with systemic lupus erythematosus (SLE). We herein report a case of AFOP with SLE and hemophagocytic syndrome. Early-phase high-resolution computed tomography showed a fine granular lung pattern. A pathological examination revealed AFOP. An immunohistological examination revealed numerous CD163+ and fewer CD68+ macrophages present in the lung tissue and in alveolar spaces as well, including fibrin balls, the interstitium, and bronchial walls. Pneumonia and thrombocytopenia worsened during high-dose steroid therapy, plasma exchange, and intravenous immunoglobulin administration. The addition of intravenous cyclophosphamide successfully ameliorated the symptoms and radiographic lesions. Therefore, this therapy may be useful for treating severe AFOP.
Assuntos
Lúpus Eritematoso Sistêmico , Linfo-Histiocitose Hemofagocítica , Pneumonia , Antígenos CD , Antígenos de Diferenciação Mielomonocítica , Humanos , Lúpus Eritematoso Sistêmico/complicações , Lúpus Eritematoso Sistêmico/diagnóstico , Linfo-Histiocitose Hemofagocítica/complicações , Linfo-Histiocitose Hemofagocítica/diagnóstico , Macrófagos/patologia , Pneumonia/complicações , Receptores de Superfície CelularAssuntos
Anticorpos Monoclonais Humanizados/uso terapêutico , Antirreumáticos/uso terapêutico , Artrite Reumatoide/tratamento farmacológico , Dermatomiosite/tratamento farmacológico , Escleroderma Sistêmico/tratamento farmacológico , Adulto , Artrite Reumatoide/complicações , Dermatomiosite/complicações , Feminino , Humanos , Escleroderma Sistêmico/complicações , Resultado do TratamentoRESUMO
Takayasu's arteritis (TA) and Crohn's disease (CD) are chronic inflammatory diseases of uncertain etiology. Although co-existence of these rare diseases is estimated to occur in 1 in 10 billion individuals, a theoretically unexpected association has been reported in several patients and it is suggested that those associations may have been more than an unusual coincidence. Herein, we report a case of TA associated with clinically inactive CD. A Japanese woman was diagnosed with colonic CD at the age of 15, developed aortic valve regurgitation at 19, and then presented with general fatigue, low grade fever, and painful sensations in her left arm at 25. She was diagnosed with TA based on computed tomography scanning and magnetic resonance angiography findings, and treatments with prednisolone and cyclosporine were started. Thereafter, valve replacement and right coronary artery bypass graft surgery were performed. The possible pathophysiological mechanism responsible for concurrent existence of TA and CD may be associated with immune disorders. Early diagnosis of vascular lesions for patients with inflammatory bowel disease is highly encouraged.
Assuntos
Doença de Crohn/complicações , Arterite de Takayasu/complicações , Adolescente , Adulto , Insuficiência da Valva Aórtica/complicações , Insuficiência da Valva Aórtica/cirurgia , Aspirina/administração & dosagem , Ponte de Artéria Coronária , Doença de Crohn/diagnóstico , Ciclosporina/administração & dosagem , Quimioterapia Combinada , Feminino , Implante de Prótese de Valva Cardíaca , Humanos , Angiografia por Ressonância Magnética , Prednisolona/administração & dosagem , Arterite de Takayasu/diagnóstico , Arterite de Takayasu/tratamento farmacológico , Arterite de Takayasu/cirurgia , Tomografia Computadorizada por Raios X , Varfarina/administração & dosagem , Adulto JovemRESUMO
An 18-year-old woman who presented with photosensitivity, butterfly rash and acute visual disturbance was diagnosed as SLE with retinopathy. The level of IFN-alpha in the cerebrospinal fluid (CSF) was markedly elevated. Her visual acuity recovered with high-dose prednisolone therapy. IFN-alpha in the CSF also reduced to within the normal range. The mechanism causing lupus retinopathy is not clearly understood. Although the association between lupus retinopathy and a high level of IFN-alpha has not been reported, the injection of IFN-alpha is known to frequently cause retinopathy in hepatitis patients. We discuss the possibility of IFN-alpha causing retinopathy in SLE patients.