Cerebral thrombosis in systemic lupus erythematosus with the antibody antiphospholipid syndrome.

Systemic lupus erythematosus (SLE) has numerous manifestations. Haematology is the common system influenced by the disease. The antibody antiphospholipid syndrome, secondary hematology disorder in SLE, is related to high incidence of thrombosis. The thrombosis events like myocardial infarction and stroke are high in mortality. We reported a-36-year old woman treated for lung tuberculosis (TB) with secondary infection, nephritis lupus, and pancytopenia. The general condition has improved and the patient was planned to discharge while she suddenly fell down, unconscious and had seizure. The CT-scan showed an area of hypodensity on the left thalamus. Haematology results showed high level of fibrinogen and D-dimer as the signs of thrombosis. The anticardiolipin antibody was intermediately positive for IgG and IgM, but lupus anticoagulan was weakly positive. The serial test within 2 months still showed positive IgG. The patient received supportive treatment, heparinization, neurotropic drugs and anticonvulsant. She was discharged in good condition while continuing oral anticoagulant to prevent recurrent seizure.

Drug provocation test in patient with antituberculosis drug allergy.

Hypersensitivity reaction is an unexpected drug adverse effect which sometimes can lead to fatal condition. Confirmation of the suspected drugs that cause hypersensitivity reaction is sometimes difficult. Drug provocation test is still a gold standard to establish the diagnosis of hypersensitivity to certain drugs or agents. Drug provocation test is a controlled drug treatment which aims at making diagnosis of hypersensitivity reaction to drugs. We reported a demonstration case of a 47 year-old female patient with hypersensitivity to anti tuberculosis drugs (isoniazid, rifampicin, pyrazinamid and ethambutol). Drug provocation test is important in this case to confirm which drug had caused hypersensitivity reaction because anti tuberculosis drugs were the treatment of choice for her illness.

Is there a relationship between serum C-reactive protein level and dyslipidaemia in systemic lupus erythematosus?

AIM: to look for the association between CRP and dyslipidaemia in SLE. METHODS: seventy six patients fulfilled the American College of Rheumatology criteria for classification of Systemic Lupus Erythematosus (SLE) (revised in 1997) were enrolled in our study. Clinical and laboratory measures included complete history and physical examination, determination of serum CRP level by latex agglutination test and lipid profile. Statistical significance of association was analysed by X2 test. T-test were used to compare values of each lipid component between positive and negative CRP group. All analyses were performed using the SPSS 10.0 computer software. RESULTS: the study was done in 76 (73 female and 3 male) SLE patients. Dyslipidaemia was found in 57 patients (75.0%). Hypercholesterolemia was found in 31 patients (40.8%), hypertriglyceridemia in 33 patients (43.4%), low HDL cholesterol in 19 patients (25%) and high LDL cholesterol in 28 patients (36.8%). Patients with positive CRP (66 patients) demonstrated dyslipidaemia in 49 patients (74.2%) and patients with negative CRP (10 patients) showed dyslipidaemia in 8 patients (80.0%)(P 1.0). There was no association between CRP and abnormal values of each lipid component (cholesterol, triglyceride, HDL and LDL cholesterol)(P value 0.30, 0.74, 0.43, 0.15 respectively). There was also no association between CRP and dyslipidaemia as a whole (P 1.00). The difference between serum level of each lipid component between positive and negative CRP group was also non significant (P value 0.68, 0.90, 0.96, 0.59 respectively). CONCLUSION: there was no association between CRP and dyslipidaemia in SLE patients. In the development of dyslipidaemia in SLE, factors other than inflammation should be put into consideration.

The proportion of dyslipidemia in systemic lupus erythematosus patient and distribution of correlated factors.

AIM: To understand the proportion of dyslipidemia in systemic lupus erythematosus (SLE) patients and the influencing factors of dyslipidemia. METHODS: AN observational, cross-sectional study was conducted on new and longstanding SLE patients who had been diagnosed based on ARA criteria 1982 with 1997 revision. They had been hospitalized and treated at Department of Internal Medicine, Cipto Mangunkusumo National Central General Hospital and the other private Hospitals in Jakarta, i.e. Kramat Hospital in July - November 2003. The sample was selected by non probability sampling method with consecutive sampling technique. Every participant underwent history taking, physical and laboratory examination. RESULTS: There were 77 patients satisfying the inclusion criteria. The proportion of dyslipidemia in this study was 75.3%. By confidence interval of 95%, the dyslipidemia in SLE patient was 65.3% - 84.6%. The distribution of lipid profile in sample population were 43% with total cholesterol > or = 200 mg/dL, 26% with HDL cholesterol level < 40 mg/dL, 26.4% with LDL cholesterol level > or = 130 mg/dl and 44.2% with triglycerides serum level > or = 150 mg/dL. The characteristics of influencing factors in dyslipidemia prevalence for sample population consisted of 24.7% with renal involvement, 53.2% with > or = 3 years illness periods, 26% had received > or = 30 mg/day prednisone, 94.8% had not received chloroquines, and 58.4% had illness activity of Mex-SLEDAI > or = 2. By bivariate analysis, we found that illness period < 3 years tends to affect dyslipidemia with OR value of 12.04 (CI 95%, 2.54-57.05, p = 0.001). After conducting multivariate analysis by backward methods, it appears that only one significant influencing factor of dyslipidemia prevalence in SLE patient i.e. Illness period od < 3 years with OR value 12.04 (CI 95% 2.54 - 57.05, p = 0.001). CONCLUSION: Illness period of 3 years is represent a significant correlative factor for dyslipedemia prevalence. Prednisone > or = 30 mg/dL is the correlative factor for total cholesterol > or = 200 mg.dL and triglycerides > or = 150 mg/dL. Mex-SLEDAI > or = 2 is the corrective factor for HDL cholesterol < 40 mg/dL.