ABSTRACT
We present the case of a 22-year-old African American transgender women (male to female), who was admitted for fatigue, abdominal pain and lower extremity edema and was diagnosed with systemic lupus erythematosus (SLE) and lupus nephritis. Treatment with high-dose steroids and mycophenolate mofetil helped resolve her symptoms. She has remained off oestrogen therapy since admission and has not experienced any major complications. It is important to consider therapy outcomes in this specific patient population. A review of four other cases of transgender women on cross-sex hormone therapy who were diagnosed with lupus is also presented.
Subject(s)
Estrogens/pharmacology , Lupus Nephritis/chemically induced , Transgender Persons , Drug Therapy, Combination , Female , Humans , Immunosuppressive Agents/therapeutic use , Lupus Nephritis/drug therapy , Male , Mycophenolic Acid/therapeutic use , Steroids/therapeutic use , Young AdultABSTRACT
In SLE, scleroderma, and PM/DM, infections are important causes of morbidity and mortality. This increased risk of developing infections is the result of immune abnormalities and of organ system manifestations associated with these diseases and their treatments. Common bacteria are responsible for most mild and lethal infections; however, opportunistic microorganisms cause death in some patients, particularly in those receiving high doses of corticosteroid and immunosuppressive therapy. Various viral and fungal infections also contribute to the morbidity and mortality associated with these diseases. Regardless of the cause of infections, adequate and prompt recognition and proper treatment of the infected patient are imperative. Thus, patients with these diseases, especially when receiving high doses of corticosteroids and immunosuppressive therapy, need to be monitored closely for these infections. This care and concern is necessary to ensure optimal patient outcomes, both in terms of morbidity and mortality.
Subject(s)
Dermatomyositis/etiology , Infections/complications , Lupus Erythematosus, Systemic/etiology , Scleroderma, Systemic/etiology , Causality , Connective Tissue Diseases/complications , Dermatomyositis/epidemiology , Dermatomyositis/mortality , Humans , Lupus Erythematosus, Systemic/epidemiology , Lupus Erythematosus, Systemic/mortality , Scleroderma, Systemic/epidemiology , Scleroderma, Systemic/mortalityABSTRACT
Rheumatoid arthritis (RA) is a chronic inflammatory disease that, despite recent advances in therapy, still results in significant morbidity, mortality and disability. The aetiology remains unknown and past therapies, although helpful for the majority of patients, have been suboptimal. The recent introduction of newer agents has changed the treatment paradigm of RA. COX-2 inhibitors, anti-TNF agents and interleukin-1 antagonists have allowed us to treat RA more effectively with relatively low risk of side effects. Investigations of other possible treatment pathways, such as inhibition of angiogenesis, may produce still better treatment and rapid unraveling of the immune system and how it relates to RA greatly enhances the opportunities for improved therapeutics in RA.
