alexa Hibernating Lupus
ISSN: 2161-1149

Rheumatology: Current Research
Open Access

Like us on:
OMICS International organises 3000+ Global Conferenceseries Events every year across USA, Europe & Asia with support from 1000 more scientific Societies and Publishes 700+ Open Access Journals which contains over 50000 eminent personalities, reputed scientists as editorial board members.

Open Access Journals gaining more Readers and Citations

700 Journals and 15,000,000 Readers Each Journal is getting 25,000+ Readers

This Readership is 10 times more when compared to other Subscription Journals (Source: Google Analytics)

Case Report

Hibernating Lupus

Chun Tsu Lee1*, Tomoharu Suzuki2 and Aisha Lateef1,3

1Division of General Medicine, National University Hospital, Singapore

2Department of Medicine, Tsukuba University Hospital, Japan

3Division of Rheumatology, National University Hospital, Singapore

*Corresponding Author:
Chun Tsu Lee
Senior Resident, Division of General Medicine
1E Kent Ridge Road, 119228, Singapore
Tel: +65 67727692
E-mail: [email protected]

Received Date:: July 27, 2015 Accepted Date:: August 10, 2015 Published Date:: August 25, 2015

Citation: Lee CT, Suzuki T, Lateef A (2015) “Hibernating” Lupus. Rheumatology (Sunnyvale) 5:160. doi: 10.4172/2161-1149.1000160

Copyright: © 2015 Lee CT, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Abstract

We report a case of a 64-year-old Chinese lady, who was admitted for two weeks' history of fever, cough and breathlessness. She was diagnosed with community acquired pneumonia and treated with antibiotics. Her comorbidity include plaque psoriasis treated with topical steroids and oral methotrexate for 4 years by private physicians. Her symptoms persisted for weeks post-discharge. After workup, a diagnosis of basal interstitial lung disease with restrictive defect likely drug-induced was established. Her methotrexate therapy was switched to phototherapy. However, her psoriatic rashes worsened after phototherapy, thus, treatment was changed to subcutaneous injection of adalimumab. She then developed inflammatory arthritis, dry mouth and worsening dyspnoea and psoriasiform rashes. Repeat spirometry showed worsening of transfer factor (from 76% to 51%). In light of this peculiar development, her previous laboratory investigations performed in the other private hospitals were retrieved. They were remarkable for positive Anti-nuclear antibodies which were of homogenous pattern and high in titre with Anti-RO/SS-A positivity. Skin biopsy of the lesion displayed typical histology of psoriasis. This clinical scenario describes a case of psoriasis coexisting with "hibernating" lupus which was "awakened" by use of anti-TNF. With an assemblage of cutaneous signs, interstitial lung disease, arthritis without severe systemic involvement together with strong association with anti-Ro/SSa antibody, subacute cutaneous lupus erythematosus (SCLE) is suspected to be the most likely underlying lupus that remained dormant and smouldering until it was triggered and worsened by the use of adalimumab and phototherapy. These are the pitfalls associated with the diagnosis of connective tissue diseases which have protean manifestation. This is clinically significant as the diagnosis will affect the choice of immunosuppressants and biologics. The learning point is, in clinical practice, incongruity of enigmatic clinical and histo-pathological findings mandate critical scrutiny and second look as starting biologics without a clear clinical picture is potentially harmful.

Keywords

Share This Page

Additional Info

Loading
Loading Please wait..
 
Peer Reviewed Journals
 
Make the best use of Scientific Research and information from our 700 + peer reviewed, Open Access Journals
International Conferences 2017-18
 
Meet Inspiring Speakers and Experts at our 3000+ Global Annual Meetings

Contact Us

Agri & Aquaculture Journals

Dr. Krish

[email protected]

1-702-714-7001Extn: 9040

Biochemistry Journals

Datta A

[email protected]

1-702-714-7001Extn: 9037

Business & Management Journals

Ronald

[email protected]

1-702-714-7001Extn: 9042

Chemistry Journals

Gabriel Shaw

[email protected]

1-702-714-7001Extn: 9040

Clinical Journals

Datta A

[email protected]

1-702-714-7001Extn: 9037

Engineering Journals

James Franklin

[email protected]

1-702-714-7001Extn: 9042

Food & Nutrition Journals

Katie Wilson

[email protected]

1-702-714-7001Extn: 9042

General Science

Andrea Jason

[email protected]

1-702-714-7001Extn: 9043

Genetics & Molecular Biology Journals

Anna Melissa

[email protected]

1-702-714-7001Extn: 9006

Immunology & Microbiology Journals

David Gorantl

[email protected]

1-702-714-7001Extn: 9014

Materials Science Journals

Rachle Green

[email protected]

1-702-714-7001Extn: 9039

Nursing & Health Care Journals

Stephanie Skinner

[email protected]

1-702-714-7001Extn: 9039

Medical Journals

Nimmi Anna

[email protected]

1-702-714-7001Extn: 9038

Neuroscience & Psychology Journals

Nathan T

[email protected]

1-702-714-7001Extn: 9041

Pharmaceutical Sciences Journals

Ann Jose

[email protected]

1-702-714-7001Extn: 9007

Social & Political Science Journals

Steve Harry

[email protected]

1-702-714-7001Extn: 9042

 
© 2008- 2017 OMICS International - Open Access Publisher. Best viewed in Mozilla Firefox | Google Chrome | Above IE 7.0 version
adwords