Occlusive vasculopathy in systemic lupus erythematosus: association with anticardiolipin antibody
Article Abstract:
Patients with systemic lupus erythematosus (SLE) can experience sudden blockage of multiple blood vessels, often resulting in vasculitis, inflammation of the blood vessels. In a few cases, thrombotic thrombocytopenic purpura (TTP), a sometimes fatal disorder characterized by abnormally low platelet levels, anemia and neurologic abnormalities, may also occur. Recently antiphospholipid antibody (aPL) has been implicated in a number of blood-related and neurological disorders, as well as recurrent fetal loss. A number of studies have described the role of aPL in SLE and lupus-like illnesses, which have been termed aPL syndrome. Two cases of patients with previously mild SLE symptoms are described. Both had acute noninflammatory occlusive vasculopathy with tissue injury. One patient died of a heart attack. The cause of the acute vasculopathy with multisystem failure in these two patients is not known, although it does occur in TTP. The role of aPL is not yet clear. SLE ''flares'' are not well defined, and other events can trigger multisystem organ impairment that looks very much like active SLE. These two patients did not have the classic manifestations of SLE, and the conclusion is that SLE flare is not enough to account for the events, and that a diagnosis of SLE vasculitis is unsupported. These cases support the link between clotting in the blood vessels and aPL, and suggest that anti-inflammatory therapy will not be effective. Plasmapheresis (reconstitution and reinfusion of plasma withdrawn from the patient) may be more effective. The usefulness and safety of anticlotting agents are questionable. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: Archives of Internal Medicine
Subject: Health
ISSN: 0003-9926
Year: 1991
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A severe multisystem reaction to sulindac
Article Abstract:
Nonsteroidal anti-inflammatory drugs are widely used to treat musculoskeletal pain. However, some of these drugs may cause severe side effects, including systemic reactions. One of these drugs, sulindac, was developed to have effects similar to indomethacin but with less digestive irritation. It also seems to be less harmful to the kidneys than other nonsteroidal anti-inflammatory drugs. In this case, a 30-year-old woman with systemic lupus erythematosus was hospitalized with breathing difficulties, cough, low fever and itching, which began shortly after taking sulindac for back pain. Her blood pressure soon dropped precipitously; pulse and breathing were fast. Antibiotics, corticosteroids, dopamine, and fluid therapy were begun. The patient responded well, and was discharged on the eighth day. The sudden appearance of life-threatening illness just after sulindac ingestion indicates an anaphylactic reaction to the drug, with involvement of the heart and circulatory system, liver, lungs, and blood. Severe reactions to sulindac are uncommon, but those that have been described are similar to this case. Most often several organs were affected, and the reaction usually occurred after the patient had taken sulindac, stopped for a time, and then begun again. The benefits of nonsteroidal anti-inflammatory drugs usually outweigh the risks, but when reactions do occur, they are very difficult to diagnose. The four types of hypersensitivity reactions to drugs are briefly described. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: Archives of Internal Medicine
Subject: Health
ISSN: 0003-9926
Year: 1991
User Contributions:
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