Tuberculous sacroiliitis in a patient with systemic lupus erythematosus: a case report and literature review.

Systemic lupus erythematosus (SLE) patients are at higher risk of developing opportunistic infections such as tuberculosis (TB), especially extrapulmonary forms like osteoarticular TB, compared to the general population. However, tuberculous sacroiliitis has been scarcely reported in these patients. We present a 34-year-old woman with SLE who developed articular tuberculosis simultaneously affecting the right sacroiliac joint and the left knee. The patient was successfully treated with antituberculosis therapy for nine months. In this case, in addition to the immunological abnormalities of lupus, the long-term glucocorticoid therapy at high dosages was the main risk factor for the development of osteoarticular tuberculosis.

Urinary neutrophil gelatinase-associated lipocalin and monocyte chemoattractant protein 1 as biomarkers for lupus nephritis in Colombian SLE patients.

Background Information regarding urinary biomarkers in Mestizo and Afro-Latin-American patients is very limited. We investigated whether levels of urinary neutrophil gelatinase-associated lipocalin (NGAL), and monocyte chemoattractant protein 1 (MCP-1) are good biomarkers to differentiate patients with lupus nephritis among Latin-American systemic lupus erythematosus (SLE) patients. Methods SLE patients meeting the revised American College of Rheumatology classification criteria for SLE were recruited. Urinary levels of NGAL and MCP-1 were measured using a commercial ELISA kit. Serum anti-C1q antibodies were measured by ELISA. SLE activity was measured with the systemic lupus erythematosus disease activity index (SLEDAI). Mann-Whitney tests were used to compare data and Spearman's rank correlations were used to examine associations between continuous variables. In addition, receiver operating characteristic curves were performed. Results One hundred and twenty SLE patients were recruited (87% women) with a median age of 32.8 ± 12.1 years and median disease duration of 7.3 ± 6.9 years. Afro-Latin-Americans had a significantly higher prevalence of lupus nephritis and higher SLEDAI scores than Mestizos. The three biomarkers were significantly higher in patients with lupus nephritis than in patients without lupus nephritis. In addition, urinary NGAL and MCP-1 were significantly higher in patients with active lupus nephritis than in inactive lupus nephritis. Urinary NGAL levels were significantly higher in Afro-Latin-American patients. A receiver operating characteristic curve for urinary biomarkers for lupus nephritis in all SLE patients showed a good level of sensitivity and specificity. Conclusion In our cohort of SLE patients, we found that urinary NGAL and MCP-1 in addition to anti-C1q antibodies were useful biomarkers for the identification of renal involvement and discrimination of active lupus nephritis among patients with renal disease.

IgE autoreactivity in bullous pemphigoid: eosinophils and mast cells as major targets of pathogenic immune reactants.

BACKGROUND: Bullous pemphigoid (BP) is an autoimmune disease characterized by tense blisters that are usually preceded by urticarial eruptions. Affected patients exhibit IgG and/or IgE autoantibodies against BP180 and/or BP230. Their relative importance in disease pathogenesis has not been fully elucidated. OBJECTIVES: The aim of this study was to provide a better characterization of the circulating and tissue-resident IgE in patients with BP at the serological, structural and functional levels. METHODS: Sera (n = 19) and skin (n = 33) from patients with BP were analysed via enzyme-linked immunosorbent assay (ELISA) and immunofluorescence, respectively. RESULTS: The results obtained show that many patients with BP exhibit elevated IgE levels in the serum and in the skin. In the skin, it is very rarely and only sparsely found along the basement membrane zone, but is prominently present on mast cells and eosinophils. At least a portion of these IgE antibodies are BP-specific, as evidenced by serum ELISA and by the colocalization of BP180 and FcεRI-bound IgE on mast cells and/or eosinophils. An important role of these immune reactants can be inferred from our additional finding that cross-linking of IgE, derived from BP sera, on FcεRI-expressing rat basophils with BP180 results in robust degranulation of these cells. CONCLUSIONS: We propose the existence of a disease pathway alternative to IgG and complement that may well be responsible for some of the clinical features of this autoimmune disease.

Evaluacón de las escalas de interpretación audiométrica para la detección temprana de hipoacusia neurosensorial por ruido / Evaluation of audiometric interpretation scales to early detection of neurosensorial hipoacustics by noise

La Hipoacusia Neurosensorial por Ruido es una patología progresiva e irreversible y se encuentra como la primera causa de enfermedad profesional en Colombia. Es indispensable una metodología de interpretación audiométrica que permita efectuar un diagnóstico precoz y una prevención oportuna. Los objetivos de este trabajo fueron analizar comparativamente los métodos utilizados en salud ocupacional para el diagnóstico de la Hipoacusia Neurosensorial por Ruido y proponer un criterio unificado para la detección temprana de esta enfermedad profesional. Se realiza un estudio descriptivo de morbilidad en donde se analizan las audiometrías tonales anuales, Por tres años consecutivos, de 243 personas expuestas a ruido industrial. Las audiometrías fueron interpretadas por los métodos ELI y SAL utilizados en el país y el método EPA recomendado por la Enviromental Protection Agency. Una persona expuesta al ruido tiene el 59 de probabilidad de enfermarse si tiene una audiometría considerada dentro del límite de normalidad, pero con un escotoma por debajo de los 20 dB en alguna banda de frecuencia alta. Si el estocoma está ubicado en la banda de los 6000 Hz. La probabilidad es del 68, y si está en la banda de los 4000 Hz. La probabilidad es de 50. De las personas cuyas audiometrías eran anormales con compromiso de una sola banda de frecuencia alta, el 61 tenían compromiso en la banda de los 6000 Hz. Y el 1 en la banda de los 3000 Hz.; una escala que solo evalua la banda de los 4000 Hz. Tiene un margen de error del 62. La escala ELI tuvo una sensibilidad del 21, la escala EPA del 6 y la escala SAL de solo el 1. Se propone la lectura completa de la audiometría (número de bandas comprometidas), método utilizado por el postgrado de salud ocupacional de la Universidad el Bosque