ABSTRACT
Coexistence of moyamoya disease and Graves' disease is rare. A 41-year-old woman presented with symptoms of left-sided hemiparesis and dysarthria. Magnetic resonance imaging and angiography revealed acute infarction of the right thalamus and occipital lobe with complete obstruction of the distal internal carotid arteries and obstruction of the right P2. Free thyroxine, thyroid-stimulating hormone (TSH), and TSH receptor antibody levels were 79.33 pmol/L, 0.007 uIU/mL, and 151.5 u/L, respectively. She received antiplatelet therapy and standard antithyroid drug dose. After admission, seizure and unexplained fever occurred. The thyroid storm score (Burch and Wartofsky scale) was 90 points. After intensive treatment, mental status and thyrotoxicosis-related symptoms ameliorated and vital signs stabilized. We describe a case of thyroid storm following cerebrovascular ischemic events in a Korean woman with moyamoya disease and Graves' disease. Thyroid storm combined with cerebrovascular events can lead to severe morbidity and mortality. Prompt recognition and strict management are crucial.
Subject(s)
Adult , Female , Humans , Angiography , Carotid Artery, Internal , Cerebral Infarction , Dysarthria , Fever , Graves Disease , Infarction , Magnetic Resonance Imaging , Mortality , Moyamoya Disease , Occipital Lobe , Paresis , Receptors, Thyrotropin , Seizures , Thalamus , Thyroid Crisis , Thyroid Gland , Thyrotropin , Thyroxine , Vital SignsABSTRACT
SLE is an autoimmune disease with multiorgan involvement and a wide range of clinical manifestations, and inflammation of gallbladder also can be represented. There were a few cases of acute acalculous cholecystitis (AAC) in previous reports. Most of them tended to already know about underlying SLE when detected AAC at that time. It may be difficult to detect AAC caused by SLE not due to biliary stone if physician is not conscious of undiagnosed lupus. We introduce a 70-year old female patient, who is diagnosed with AAC. Her symptoms were satisfied the ACR classification criteria for SLE, and was diagnosed with SLE, simultaneously. After a high dose steroid pulse therapy, followed by cyclophosphamide, her symptoms have improved rapidly. In order to better diagnose and treat the disease, we need to be aware of AAC as a potential manifestation of SLE.
Subject(s)
Female , Humans , Acalculous Cholecystitis , Autoimmune Diseases , Cholecystitis , Classification , Cyclophosphamide , Gallbladder , Inflammation , Lupus Erythematosus, SystemicABSTRACT
Systemic lupus erythematosus (SLE) is an autoimmune disease characterized by the production of diverse autoantibodies with various systemic organ involvements. In patients with SLE, autoantibodies, such as antinuclear antibody (ANA) and anti-dsDNA antibody, play an important role not only in diagnosing the disease, but also representing the pathogenesis of the disease. ANA is the main screening tool in diagnosis and serum complement levels and anti-dsDNA antibody level are closely related to the disease activities. Nevertheless, exceptionally, some patients represent with negative ANA and/or anti-dsDNA antibody leading to difficulties in diagnosing the disease. Here, we report a case of 37-year old female SLE patient with negative ANA, negative anti-dsDNA antibody, and positive anti-Ro/SSA antibody, which manifested with nephrotic syndrome.