Jasna Bolpacic

Sjögren's Syndrome and Silicosis - a Case Report.

Sjögren’s syndrome is an autoimmune disease of unknown etiology where immune response to self-antigens is believed to result from interactions between genetic and environmental factors. We describe the case of a patient who has been diagnosed with Sjögren’s syndrome based on typical clinical and immunological parameters. The clinical picture was dominated by the respiratory symptoms, and radiographic and multislice computed tomography examination of the chest showed certain changes characteristic of pneumoconiosis. Given that the patient has worked in a foundry where he has been exposed to the silica dust, he was subject to examination by occupational health specialists under the suspicion of lung silicosis, who confirmed the silicosis. This case report points to the possible connection between a professional exposure to silica and Sjögren’s syndrome. Occupational exposure to silica is a possible risk factor for the development of autoimmune diseases, and in the evaluation of patients with connective tissue diseases it is important to consider work-related history.

Vitamin D Status in Patients with Systemic Lupus Erythematosus in Serbia: Correlation with Disease Activity and Clinical Manifestations

BACKGROUND: Numerous studies indicate potential role of vitamin D as an important factor in the development of many autoimmune diseases including systemic lupus erythematosus (SLE). Patients with SLE are especially prone to the development of vitamin D deficiency due to the nature of their illness. AIM: The aims of our study were to determine the prevalence of vitamin D insufficiency and deficiency in patients with SLE in Serbia, to identify clinical variables associated with vitamin D status and to examine the impact of vitamin D status on disease activity and presence of specific lupus autoantibodies. MATERIAL AND METHODS: The study included 46 patients with SLE. Serum 25(OH)D concentration was measured by electrohemiluminiscent immunoassay. RESULTS: The mean serum concentration of 25(OH)D was 11.9 ± 7.3 ng/ml. The prevalence of insufficiency was 32.6%, while the prevalence of deficiency was 67.4%. There was no association between vitamin D status and photosensitivity, skin lesions, arthritis and lupus nephritis. Vitamin D status was not associated with the presence of specific autoantibodies. There was no correlation between disease activity assessed by SLEDAI scale with the concentration of 25(OH)D. Patients who used vitamin D supplements and calcium did not have a significantly higher concentration of 25(OH)D. CONCLUSION: In conclusion, vitamin D deficiency is common in patients with SLE.

Severe strongyloidiasis and systemic vasculitis: comorbidity, association or both? Case-based review

A possible association between strongyloidiasis and systemic vasculitis is rarely reported in the literature. We report the case of a patient with severe strongyloidiasis and an angiographic finding consistent with polyarteritis nodosa. Diagnosis of strongyloidiasis was made by finding of larvae and adult parasites in samples of the upper gastrointestinal tract mucosa and stool. The patient was treated with albendazole, ivermectin and corticosteroid withdrawal. This therapy led to the resolution of symptoms, with repeated stool samples negative for S. stercoralis. However, the clinical course was complicated with pulmonary tuberculosis. Despite tuberculostatic therapy and supportive measures, a lethal outcome occurred. The report is followed by a focused review of the available literature on the association of strongyloidiasis and systemic vasculitis.

Successful implementation of Rituximab in patients with severe refractory forms granulomatosis with poliangitis

Introduction. Wegeners’s granulomatosis is a disease characterized by granulomatous inflammation of the upper and/or lower respiratory tract, glomerulonephritis with varying degrees of small vessel vasculitis and classic anti-neutrophil cytoplasmic antibodies (c-ANCA) findings. The treatment uses different modalities of immunosuppressive therapy which does not always lead to remission. We presented the efficacy of biological therapy in a patient with refractory form of the Wegeners’s granulomatosis. Case report. A 23-years-old patient, was treated in August, 2011 at the Clinic of Otorhinolaryngology and Maxillofacial Surgery of the Clinical Center of Serbia because of suppurative otitis media, resulting twice in mastoidectomy. On the day 7 after the surgery, hemoptysis and fever occurred. Considering lung x-ray that showed presence of the round soft-tissue changes on both sides, nonspecific inflammatory syndrome in laboratory analysis and positive c-ANCA (1 : 160) with high titers the antibodies to the proteinase 3 (anti-PR 3), Wegeners granulomatosis was diagnosed. Due to the fact that administration of glucocorticoids, cyclophosphamide and immunomodulatory dose of immunoglobulin did not lead to clinical remission, it was decided to apply rituximab. After its application clinical remission occurred and it lasted fifteen months. Conclusion. Application of biologic therapy might be successful in the treatment of patients with severe form of refractory granulomatosis with polyangiitis.

Role of Vitamin D in Systemic Lupus Erythematosus

Vitamin D is a steroid hormone that in addition to its well known role in the metabolism of calcium and phosphorus exerts immunoregulatory properties. Data from animal studies and from prospective clinical trials on patients with rheumatoid arthritis, multiple sclerosis and type 1 diabetes point to the potential role of vitamin D as important environmental factor in the development of autoimmune diseases. Such role of vitamin D in systemic lupus erythematosus (SLE) has not yet been sufficiently studied. This review shows the sources, metabolism and mechanism of action of vitamin D, its effect on the cells of the immune system, prevalence and causes of vitamin D deficiency in patients with SLE, the link between vitamin D status and disease activity as well as recommendations for vitamin D supplementation.

[Importance of dysphagia examination in patient with dermatomyositis--case report].

INTRODUCTION Polymiositis belongs to the group of inflammatory myopathies which are manifested by muscle weakness of the shoulder blade and pelvic region. The presence of typical skin manifestations is suggestive of dermatomyositis. These patients may also develop dysphagia (10-54%) as a result of involvement of the oropharyngeal and upper oesophageal striated muscles. Dermatomyositis may also be associated with another systemic disease or malignancy. CASE REPORT Hereby is presented the case of a 42-year-old female patient hospitalized at the Department of Allergy and Immunology, Clinical Center of Serbia for the shoulder blade and pelvic muscle weakness and pains in the small and large joints, eyelid edema, facial and neckline redness, difficult swallowing and loss of body mass. Based on the presence of proximal muscle weakness, increased enzyme serum levels (lactic acid dehydrogenase, glutamic-oxalacetic transaminase), positive electroneuromyography findings, typical skin changes and positive muscle biopsy, the patient was diagnosed to have dermatomyositis. Both radioscopy and esophagography revealed some disturbances in all phases of swallowing, absence of all primary and secondary peristaltic waves accompanied by contrast medium aspiration. Additionally, esophageal manometry proved the absence of esophageal peristalsis. Additional examinations ruled out the presence of any malignancies. The patient underwent glycocorticoid and azatioprim treatment along with specific dietary regimen, symptomatic and physical therapy, which led to favorable clinical outcome. CONCLUSION Dermatomyositis-associated dysphagia may lead to severe complications such as cachexia and aspiration pneumonia. In addition to the management of underlying disease, the treatment includes special dietary regimen, rehabilitation and even interventional surgical procedures, if necessary.

Atopisches Asthma und dessen Risikofaktoren

Aim: To investigate the factors associated with atopic asthma in the adult Serbian population. Method: A case-control study of 134 atopic asthmatics and 134 non-asthmatics was carried out, during the period from March 2002 June 2003. The cases and controls were matched by sex, age (± 5 years) and place of residence (urban, rural). A detailed questionnaire based on the latest research results in the field was used to obtain information on the known risk factors. Stressful life events were recorded using Paykels Interview for Recent Life Events. Results: According to multivariate conditional logistic regression, the following factors were independently significantly associated with the occurrence of atopic asthma: allergic rhinitis (OR = 30.74, 95% CI = 7.62 - 123.98, p < 0.001), sinusitis (OR = 5.06,95% CI = 1.27 -20.17, p = 0.022), and lower respiratory tract infections in childhood (OR = 5.72, 95% CI = 1.65 - 19.87, p = 0.006). Conclusion: Our study indicates potentially important roles of allergic rhinitis, sinusitis and infections of the lower airways in childhood as factors increasing the risk of atopic asthma. Recognizing of the risk factors is important for the diagnosis and prevention of the disease.