A 20-year-old female with impending foot gangrene: How to interpret her laboratory results.

A 20-year-old female presented with multi-system involvement. At first, she had acute cholecystis and was treated by cholecystectomy. After the operation she had neurological symptoms and was diagnosed with herpes encephalitis, confirmed by CSF serology. One month later she developed left foot arterial occlusion. Autoimmune hemolytic anemia with immune thrombocytopenia (Evan’s syndrome) and myocarditis were also detected concurrently. Her primary disease was suspected to be systemic lupus erythematosus. However, her antinuclear antibody assayed by the enzyme-link immunoassay (ELISA) method was negative twice but became positive by indirect immunofluorescence method. Other positive laboratory results were lupus anticoagulant, antineutroplil cytoplasmic antibody (ANCA), and anti proteinase 3 (anti-PR3). Their relevance will be discussed in details. She was given steroids, anticoagulants and underwent a femerofemoral bypass. Her clinical status improved afterwards.

Cognitive dysfunction in systemic lupus erythematosus patients at Siriraj Hospital.

Objectives: To determine the prevalence of cognitive dysfunction in SLE patients with overt neuropsychiatric manifestations (NPSLE) or without ovent neuropsychiatric manifestation (nSLE) and its association with disease duration, disease activity, previous neuropsychiatric involvement and medications. Methods: A cross-sectional study of 33 SLE patients, 33 rheumatoid arthritis (RA) patients and 32 healthy subjects (age, sex, and education matched) were evaluated using the standardized neuropsychological battery tests recommended by the American College of Rheumatology Ad HOC Committee on neuropsychiatric lupus nomenclature and the Thai Mental State Examination (TMSE). Disease activity was measured by the SLE Activity Measure (SLAM). Current medications and previous NPSLE syndrome were documented. Results: Cognitive dysfunction in SLE patients (51.5%) and RA patients (48.5%) was significantly more than that in control subjects (18.8%). Cognitive dysfunction was not associated with disease duration, disease activity, previous NPSLE syndrome and current medications. Conclusion: The results suggest that cognitive dysfunction is common in Thai SLE patients even when there is no overt evidence of neuropsychiatric involvement.

Drug-induced stevens-johnson syndrome.

A patient with arthritis receiving allopurinol for 4 weeks developed Stevens-Johnson syndrome (SJS). SJS is a potentially life-threatening adverse drug reaction and is most commonly associated with the sulfa antibiotics, allopurinol, NSAIDs, and anticonvulsants. The skin reaction spread symmetrically over the body and involved the conjunctiva. The diagnosis and different models of treatment for this case are discussed. Alternative treatments for gouty arthritis are presented. Strategic planning for novel research opportunities arising from this disease is outlined.