Breast vasculitis in association with breast gigantism in a pregnant patient with systemic lupus erythematosus

Article Abstract:

Vasculitis (inflammation of blood vessels), with resulting blockage of blood flow and possible local tissue death, is a mechanism common to many autoimmune or rheumatic diseases, including systemic lupus erythematosus (SLE). Cutaneous vasculitis, which affects the vessels in the skin, may develop in patients with SLE. This article provides the first report of cutaneous vasculitis involving the breasts; breast gigantism also occurred. The patient was initially diagnosed with SLE when she was 21 years old, after a 6-month history of polyarthritis (inflammation of many joints). Symptoms were relieved with the anti-inflammatory drug indomethacin. The patient became pregnant a year later, and the arthritis worsened during the third trimester. Raynaud's phenomenon (bluish coloring to the fingers after exposure to cold) and death of tissue in the fingers also developed. Her breasts enlarged by over one-third. Indomethacin treatment was continued, but steroids, commonly used in autoimmune diseases, were not used. A healthy baby was delivered at term, and the patient was treated successfully with hydroxychloroquine. Her breasts returned to normal during the postpartum period. Hydroxychloroquine was halted for a second pregnancy, and breast gigantism again developed, this time with areas of ulceration and tissue death. The ulcers did not seem to be infected. The patient was treated with prednisolone (a steroid) and topical therapy; a maintenance dose of the steroid (30 milligrams per day) promoted ulcer healing. The only other complication of SLE was a perforation of nasal tissue. After delivery of a healthy baby at term, the steroid dosage was reduced and ulceration resolved completely. Breast enlargement did not resolve, and reduction surgery was performed a year later. The patient had no further symptoms of SLE following the second pregnancy. The stress on breast tissue caused by enlargement probably exacerbated the ulcers, and the pregnancies appeared to aggravate the SLE. (Consumer Summary produced by Reliance Medical Information, Inc.)

Case studies, Autoimmune diseases, Pregnancy, Cutaneous manifestations of general diseases, Skin manifestations, Autoimmune diseases in pregnancy

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Acute transverse myelopathy complicating systemic lupus erythematosus

Article Abstract:

Systemic lupus erythematosus (SLE), a chronic inflammatory disease of connective tissue, affects the skin, joints, kidneys, nervous system, and mucous membranes. SLE has been rarely associated with transverse myelopathy, a disease of the spinal cord, and outcome is generally poor. Some studies show that high-dose treatment with steroids may cause complete or partial recovery from transverse myelopathy. A case is described of a 16-year-old girl with SLE, who developed transverse myelopathy. The patient became paralysed in the upper body and limbs, and lost temperature and pain perception. She also retained urine but was fecally incontinent. The patient was treated with high doses of steroids, the drug cyclophosphamide, which suppresses the immune or natural defense system, and plasma exchange, a type of blood transfusion. Her neurological function improved, and she regained control of bladder and bowel functions and could walk with the aid of crutches. There are 44 reported cases of transverse myelopathy complicating SLE. Out of 26 cases of SLE and transverse myelopathy, seven regained full or partial neurological function, nine showed no change or deterioration, and 10 patients died. Most studies suggest that steroids improve myelopathy by treating the vasculitis (inflammation of the blood vessels) associated with myelopathy. The findings show that high doses of steroids may decrease the death rate and nerve deficits associated with transverse myelopathy in SLE. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Steroids (Drugs)

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Transverse myelopathy in systemic lupus erythematosus: an analysis of 14 cases and review of the literature

Article Abstract:

Transverse myelopathy in lupus patients appears to be amenable to treatment and may be curable, according to a study of 105 patients. Transverse myelopathy is a disease of the spinal cord and occurs in about 2% of all lupus patients.

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