Andrés F. Echeverri

Multiple endovascular stent-graft implantations in a patient with aortic thoracic and abdominal aneurysms due Takayasu arteritis.

We report an adult female patient with Takayasu arteritis (TA) receiving conventional medical treatment and anti-TNF therapy, which developed progressive thoracic and abdominal aortic aneurysms. She developed imminent rupture of the thoracic aneurysm and an endovascular stent-graft (EVSG) was emergency implanted and a year after this procedure the abdominal aneurysm increased in size requiring reoperation and placement of another EVSG. Both procedures had a very good outcome. This case shows the effectivity and security of multiple EVSG implantations in multiple aortic aneurisms in patients with TA.

Rituximab for Remission Induction and Maintenance in Refractory Systemic Lupus Erythematosus

Systemic lupus erythematosus (SLE) is a chronic inflammatory autoimmune disease with high morbidity if untreated. Sometimes, despite aggressive treatments, the disease remains active with cumulative organic damage. We conducted a retrospective and descriptive observational study of patients with SLE refractory to conventional treatment who were treated with rituximab (RTX) as remission induction therapy and maintenance. There was a significant reduction in the conventional immunosuppressive drug dose and the number of relapses of disease. RTX appeared to be effective and safe for the induction and maintenance of remission in patient with SLE refractory to conventional treatment.

Developing of Granulomatosis with Polyangiitis during Etanercept Therapy

We describe a 67-year-old woman who developed c-ANCA positive vasculitis with involvement in eyes, skin, kidney, peripheral nerves, and upper and lower airway during treatment with etanercept therapy for rheumatoid arthritis. A diagnosis of Granulomatosis with Polyangiitis was done. Thus, anti-TNF therapy may be associated with the development of ANCA positive vasculitis.

Total recovery from monoclonal gammopathy and autoimmune phenomena after parathyroidectomy.

Based on the observation of a patient with a causal relationship between hyperparathyroidism and development of both autoimmune disease and paraproteinemia, we hypothesize a novel cause of autoimmunity triggered in the context of hyperparathyroidism.

Is Bariatric Surgery a Trigger Factor for Systemic Autoimmune Diseases

Bariatric procedures are an effective option for weight loss and control of comorbidities in obese patients. Obesity is a proinflammatory condition in which some cytokines such as leptin, a proinflammatory protein, is elevated and adiponectin, an anti-inflammatory protein, is decreased. In patients undergoing weight reduction surgeries, these hormone levels behave paradoxically. It is not known whether bariatric surgery protects against development of autoinflammatory or autoimmune conditions; nevertheless, changes occurring in the immune system are incompletely understood. In this case series, we describe 4 patients undergoing bariatric surgery, who subsequently developed systemic autoimmune diseases. Patients in our case series were asymptomatic before surgery and developed an autoimmune disease within 11.2 months. Two women fulfilled criteria for systemic lupus erythematosus (one associated with antiphospholipid syndrome), and 2 men developed rheumatoid arthritis. A causal relationship is difficult to establish because factors that could trigger these diseases are multiple, including genetic susceptibility, time elapsed until achievement of ideal weight, and vitamin deficiencies, among others. However, clinicians must be attentive to this possible association.

Etanercept-Induced Pityriasis Lichenoides Chronica in a Patient with Rheumatoid Arthritis

We present a 74-year-old female patient who developed a pityriasis lichenoides chronica (PLC) during etanercept therapy. This association is not described in the literature and might be considered in the spectrum of cutaneous adverse reactions of etanercept.

Outcomes of Patients with Takayasu Arteritis Treated with Infliximab

To the Editor: Takayasu arteritis (TA) is a chronic vasculitis of unknown etiology involving the aorta and its main branches. Progression may lead to stenosis or formation of aneurysms1. Current therapy is based on corticosteroids and immunosuppressive agents. Treatment with anti-tumor necrosis factor-α (anti-TNF-α) has shown efficacy, as well as unfavorable outcomes2,3,4,5,6,7. From a cohort of 14 patients with TA refractory to conventional treatments, we treated 3 with infliximab (IFX), and describe the outcome. A 21-year-old woman was admitted because of 6 months of progressive chest pain, palpitations, and claudication in the left upper limb. Examination showed differential blood pressure between arms, decreased pulses in the left arm, bilateral carotid, and mitral murmur; erythrocyte sedimentation (ESR) rate was 54 mm/h and C-reactive protein (CRP) was 3 mg/dl. Angiography study showed stenosis in the thoracic aorta and supraaortic and renal vessels compatible with a diagnosis … Address correspondence to Dr. Canas; E-mail: cacd12{at}hotmail.com

A State of Possession-Like in a Patient with Flare of Systemic Lupus Erithematosus

Introduction: Symptoms and signs related to a state of “possession” have been associated with psychological disorders, but have not been described as manifestations of organic cerebral disease. Method: Case report of a 17 year-old female patient with episodic symptoms of a possession-like state manifested as aggressiveness, tremor, upper eye deviation, incoherent language, aversion to religious symbols, and demanding to be called by other names. Results: These symptoms were present during episodes of orthostatic hypotension, as a result of

Neutrophil CD64 expression, procalcitonin and presepsin are useful to differentiate infections from flares in SLE patients with SIRS

Background/Objective Differentiating systemic lupus erythematosus (SLE) activity from infections in febrile patients is difficult because of similar initial clinical presentation. The aim of this study is to evaluate the usefulness of a number of biomarkers for differentiating infections from activity in SLE patients admitted with systemic inflammatory response (SIRS). Methods Patients with SLE and SIRS admitted to the emergency room were included in this study. Measurements of different markers including procalcitonin, neutrophil CD64 expression and presepsin, were performed. Infection was considered present when positive cultures and/or polymerase chain reaction were obtained. Sensitivity and specificity were calculated for all biomarkers. Results Twenty-seven patients were admitted, 23 women (82.5%), mean age 33.2 years. An infectious disease was confirmed in 12 cases. Markers for SLE activity including anti-DNA titers by IIF (p = 0.041) and enzyme-linked immunosorbent assay (p = 0.009) were used for differentiating SLE flares from infection. On the contrary, increased procalcitonin (p = 0.047), neutrophil CD64 expression by flow cytometry (p = 0.037) and presepsin (p = 0.037) levels were observed in infected SLE patients. Conclusions High neutrophil CD64 expression, presepsin and procalcitonin levels are useful to differentiate infections from activity in SLE patients. In most cases, a positive bioscore that includes these three markers demonstrate the presence of an infectious disease.