Guillain-Barre Syndrome, Antiphospholipid Syndrome and Lupus Nephritis as Initial Manifestation of Systemic Lupus Erythematosus

Systemic lupus erythematosus (SLE) is an autoimmune disease with various manifestations, while its autoantibodies and immune reactions involve multiple organs. Neuropsychiatric involvement in SLE is known to be common, however, peripheral neuropathy is relatively rare. Guillain-Barre syndrome is clinically defined as an acute demyelinating peripheral neuropathy causing weakness and numbness in the legs and arms. We describe a case of Guillain-Barre syndrome with antiphospholipid syndrome and lupus nephritis. The patient was admitted with fever and diarrhea. He developed progressive weakness of the upper and lower extremities and dysarthria with characteristic nerve conduction patterns compatible with Guillain-Barre syndrome. He also had proteinuria and gangrene of the hand and toe with antiphospholipid antibody. He received intravenous immunoglobulin and plasmapheresis for progressive neuropathy, intravenous high dose steroid to control activity of SLE, and anticoagulation for antiphospholipid syndrome. Neuropsychiatric manifestation of SLE is related to lupus activity closely, so it is important to control lupus activity.

Transformation of Recurred Lupus Nephritis from Class IV to Class V

There are numerous studies about the transformation of renal pathology during lupus nephritis progression. A number of researchers suggest that patients with previous proliferative glomerulonephritis may not need to repeat renal biopsy in relation to treatment strategies. However, the pathology of renal biopsy could offer important information to clinicians about the progression of disease. Here, we report a rare case of the convertion of ISN/RPS classification from a proliferative lesion to a wholly non-proliferative lesion. A 40-year-old female was admitted complaining of generalized edema for 1 month. At the age of 33 she had been diagnosed as SLE with proliferative lupus nephritis. The renal remission was induced with corticosteroid pulse therapy and 12 cycles of intravenous cyclophosphamide treatment. The repeated renal biopsy revealed class V lupus nephritis compared with referential biopsy of class IV-G. A better prognosis is expected with lower activity and a lower chronicity index. Repeat renal biopsy may give useful information relating to the prognosis of nephritis.

Acute Renal Vein Thrombosis and Pulmonary Thromboembolism in a Patient with Rapid Weight Loss / 대한내과학회지

Renal vein thrombosis (RVT) is rare and primarily observed in children with severe dehydration or in adults in a hypercoagulable state. This diagnosis is rarely considered when it occurs in adults. We report a case of a young man who had weight loss of 8 kg in 2 weeks accompanied by dehydration with excessive exercise, and he developed a right RVT with a pulmonary thromboembolism. The man had a 3-year history of essential hypertension and was admitted to the hospital because of severe right-flank pain. A RVT and pulmonary thromboemboli were visualized by computed tomography. No abnormal results were observed on coagulation tests, and no evidence of malignancy was found. We concluded that the RVT and pulmonary thromboembolism were induced by dehydration. Even though the patient was an adult, rapid weight loss with dehydration may cause RVT and unusual thromboembolic events must be suspected to avoid a delay in the diagnosis.