Manifestaciones clínicas tempranas de LES / Early clinical manifestations of SLE

El estudio de formas tempranas de presentación del lupus eritematoso sistémico (LES) permite optimizar su diagnóstico y tratamiento. Se revisaron las historias clínicas de pacientes con edad ≥12 años que cumplían con ≥4criterios del Colegio Americano de Reumatología (ACR). El término “presentación temprana del LES” se asignó al primer año de evolución de la enfermedad, comenzando con la fecha cuando el(los) primer(os) criterio(os) fue(ron) reportado(s) en la historia clínica. Los pacientes fueron agrupados si satisfacían cualquier combinación de ≥4, 2-3 ó 1 criterio(s) para la clasificación del LES a través del primer año de la enfermedad. El impacto sobre el diagnóstico temprano del LES fue estimado de acuerdo a la actitud del médico de atención primaria para descartar tempranamente la enfermedad. 115 pacientes fueron admitidos al estudio. Al final del primer año de evolución de la enfermedad, 68 (59,13%) reunieron <4 criterios vs. 47 (40,86%) que reunieron ≥4 criterios del CAR (p=0,05). Los pacientes que reunieron <4 criterios alcanzaron el mínimo número de criterios para LES (≥4) dentro de los siguientes 10 años (promedio 4,9 años). De los 68 pacientes que alcanzaron <4 criterios, 31 (45,58%) reunieron dos o tres criterios y 37 (54,41%) tan sólo un criterio (p=0,46). El más frecuente de los criterios solitarios fue el síndrome inflamatorio poliarticular, 26 (70,20%) comparado con un conjunto de manifestaciones cutáneas, hematológicas, neurológicas, cardiopulmonares, renales y falso VDRL positivo, 11 (29,72%) (p=0,01). Los pacientes con un número insuficiente de criterios para LES son más frecuentes que aquellos con ≥4 criterios positivos al final del primer año de presentación de la enfermedad. La manifestación de un solo criterio (comparado con los que tenían ≥2) se asoció con un retardo en el diagnóstico temprano del LES de por lo menos 1 año

The study of early systemic lupus erythematosus (SLE) presentation can optimize its diagnosis and treatment. The clinical charts of those patients ≥12 years old complied with ≥ 4 criteria for SLE of the American College of Rheumatology (ACR) were reviewed. The term “early presentation of SLE” corresponded to the first year of evolution of the disease, starting with the date when the first(s) criterion/criteria were reported in the chart. The patients were grouped if they complied with a combination of ≥4, 2-3 or 1 ACR criteria for the classification of SLE through the first year of disease. The impact over the early diagnosis of SLE was estimated according to the early performance of the primary care doctor in ruling out the disease. 115 patients were included. At the end of the first year, 68 patients (59.13%) met <4 ACR criteria vs. 47 (40.86%) who met ≥4 (p=0.05). Patients who met <4 criteria fulfilled ≥4 criteria within the next 10 years (mean= 4.9 years). Of the 68 cases with <4 ACR criteria, 31 (45.58%) met two or three criteria and 37 (54.41%) met one solitary criterion (p=0.46). The most frequent early single onset ACR criterion for SLE was the polyarticular inflammatory syndrome, 26 (70.20%) followed by a group of other single criterion that included cutaneous, hematologic, neurologic, cardiopulmonary, renal, and false-positive VDRL, 11 cases (29.72%) (p=0.01). An early solitary criterion-compared with those patients with ≥2- was associated with a lack of documentation in the medical chart- of constitutional symptoms, indication of serum antibodies and referral to specialist. Patients with an insufficient quota of ACR criteria for SLE exceeded those with ≥4 positive criteria at the end of the first year of the disease. Patients with a single criterion of presentation compared with those patients who started with ≥2 early criteria-were associated with a delay in the early diagnosis of SLE by at least one year

A Case of Psoriasiform Sarcoidosis as Early Manifestation of Systemic Sarcoidosis / 대한피부과학회지

Sarcoidosis is a granulomatous disease with undetermined etiology, and shows variable skin manifestations. Although there have been numerous reports on cutaneous sarcoidosis, the early manifestations of systemic sarcoidosis are not clearly defined. Occurrence of both psoriasiform lesions and subcutaneous nodules in the same patient is rarely seen. A 39-year-old woman had psoriasiform lesions on her extremities for 1 year, and was treated with a topical steroid and calcipotriol ointment. One and half years after the initial skin lesions, pulmonary lesions were developed and treated with anti-tuberculosis medication for three months without any improvement. Since then, subcutaneous nodules on the upper extremities subsequently developed. Histopathological examination revealed non-caseous epithelioid granulomas in subcutaneous tissue and psoriasiform lesions. Furthermore, routine laboratory tests revealed anemia, leukopenia, hypercalcemia and elevated serum level of angiotensin converting enzyme (ACE), and chest X-ray revealed disseminated air space nodules on both lungs with non-segmental distribution. Considering initial poor response to anti-tuberculosis medication and subsequent good response to systemic steroid treatment, this condition was diagnosed as systemic sarcoidosis. Since we considered psoriasiform sarcoidosis as the early cutaneous manifestation of systemic sarcoidosis, we herein reported the case.