Rituximab for the treatment of acute exacerbation of interstitial lung disease associated with connective tissue disease.

BACKGROUND: Acute exacerbation of interstitial lung disease (AE-ILD) is a severe complication with a poor prognosis. No clinical trials have supported the use of rituximab in AE-ILD associated with connective tissue disease. METHODS: We present a series of four cases in which administration of rituximab was associated with appropriate clinical, radiological and functional progress. RESULTS: The four patients were alive 30 days after discharge following their exacerbation. CONCLUSIONS: Given the speed of action, safety and efficacy profile observed for rituximab, we believe that this agent should be further investigated in clinical trials so that it could be included in the daily clinical management of this severe condition.

Bilateral renal infarction in a lupus patient: an unusual pathology.

Acute renal infarction is still an underdiagnosed pathology. Most cases are secondary to arterial embolism in patients with atrial fibrillation or other cardiac illnesses; however, a less known etiology is the vascular affection of systemic lupus erythematosus (SLE). Renal infarction in lupus patients normally appears with positive antiphospholipid antibodies or lupus anticoagulant in the context of an antiphospholipid syndrome (APS). This is characterized by a state of hypercoagulability potentially affecting all segments of the vascular bed with thrombosis. A differential diagnosis with lupus nephritis, a very common pathology in SLE patients, must be carried out. We have to suspect this pathology in patients with SLE and APS who come to the emergency department complaining of abdominal pains or a renal colic. We present the case of a 69-year-old woman who was diagnosed of bilateral segmental renal infarction in the context of recently diagnosed SLE with no other vascular manifestations.