RESUMEN
A 32-year-old woman with systemic lupus erythematosus came to the rheumatology outpatient clinic reporting abdominal pain for a week, along with fever, arthralgias, myalgias, alopecia, asthenia and dyspnea on exertion over the last two months. She was hypotensive and tachycardic, requiring admission to the intensive care unit. She was diagnosed with lupus-related acute pancreatitis, an unusual complication occurring in less than 1% of cases. Most cases are mild and self-limited; however, severe and life-threatening events with multiple organ failure are possible. This article is a case report of lupus-related critical acute pancreatitis, and a literature review.
Mujer de 32 años con lupus eritematoso sistémico acude a consulta externa de reumatología por dolor abdominal de una semana de evolución, además de fiebre, artralgias, mialgias, alopecia, astenia y disnea de esfuerzo de 2 meses de evolución. También presentó hipotensión y taquicardia, por lo que requirió ingreso en la unidad de cuidados intensivos. Le diagnosticaron pancreatitis aguda relacionada con el lupus, que es una complicación inusual que ocurre en menos del 1% de los pacientes. La mayoría de los casos son leves y autolimitados, sin embargo, es posible que se presenten eventos graves y potencialmente mortales, con disfunción multiorgánica. Este artículo es un reporte de caso de una pancreatitis aguda crítica relacionada con lupus y una revisión de la literatura.
RESUMEN
Abstract INTRODUCTION: The pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has greatly challenged public health worldwide. A growing number of studies have reported gastrointestinal (GI) symptoms. We performed a systematic review of GI symptoms associated with coronavirus disease 2019 (COVID-19) as well as of the serum levels of biomarkers related to liver function and lesion in SARS-CoV-2-infected individuals. METHODS: We surveyed relevant articles published in English, Spanish, and Portuguese up to July, 2020 in the PubMed, MEDLINE, SciELO, LILACS, and BVS databases. Moreover, we surveyed potentially important articles in journals such as the NEJM, JAMA, BMJ, Gut, and AJG. RESULTS: This systematic review included 43 studies, including 18,246 patients. Diarrhea was the most common GI symptom, affecting 11.5% of the patients, followed by nausea and vomiting (6.3%) and abdominal pain (2.3%). With regard to clinical severity, 17.5% of the patients were classified as severely ill, whereas 9.8% of them were considered to have a non-severe disease. Some studies showed increased aspartate transaminase and alanine aminotransferase levels in a portion of the 209 analyzed patients and two studies. CONCLUSIONS: Our results suggest that digestive symptoms are common in COVID-19 patients. In addition, alterations in cytolysis biomarkers could also be observed in a lesser proportion, calling attention to the possibility of hepatic involvement in SARS-CoV-2-infected individuals.
Asunto(s)
Humanos , Infecciones por Coronavirus/patología , Enfermedades Gastrointestinales/virología , Vómitos/virología , Dolor Abdominal/virología , Diarrea/virología , Pandemias , Náusea/virologíaRESUMEN
Children systemic rheumatic diseases are characterized by multisystem involvement,the underlying pathogenesis for gastrointestinal manifestations is deposition of immune complexes in blood vessel walls resulting in ischemia or thrombosis.Gastrointestinal manifestations of these diseases often can't be diagnosed early and correctly,because children can't demonstrate the clinical features accurately,the clinical manifestation varies and often nonspecific,and often confused with the side effect of medicine.Gastrointestinal manifestations are considered rare,comparing with other system involvement,but the consequence can be life-threatening.This makes early and immediate diagnosis and management very important.This paper reviews the various children systemic rheumatic diseases that affect the gastrointestinal tract,including systemic lupus erythematosus,Henoeh Schonlein Purpura,Bechet's disease,mixed connective tissue disease,scleroderma,polyarteritis nodosa,Wegener's granulomatosis,Sjogm's syndrome,dermatomyositis.
RESUMEN
PURPOSE: Henoch-Schonlein purpura(HSP) is a systemic vasculitis involving small vessels of skin, gastrointestinal(GI) tract and kidney. Digestive involvement of HSP can be serious with massive GI bleeding, perforation, and intussusception. However, some patients do not respond to conventional corticosteroid therapy. In this study, we investigated the efficacy of intravenous immunoglobulin (IVIG) for serious digestive manifestations not responding to steroid. METHODS: From April 1999 to January 2005, 22 children diagnosed as HSP with severe GI symptoms were included. Initially, all patients were treated with intravenous methylprednisolone. IVIG 2 g/kg of body weight was infused in children refractory to steroid therapy. Clinical data were reviewed retrospectively. RESULTS: Among 22 children, 12 children underwent IVIG therapy. The mean duration of corticosteroid therapy was 5.61+/-4.9 days before IVIG therapy, and 11 of 12 patients experienced disappearance of GI manifestations after the initiation of IVIG infusion. In one patient, IVIG was ineffective in relieving abdominal pain, but melena subsided. Comparison of the duration of hospitalization between IVIG group and corticosteroid group revealed no significant difference(12.8+/-7.6 days vs. 13.2+/-7.8 days, P=0.777). But, the total duration of abdominal pain decreased in IVIG group although the difference between two groups was not significant(8.8+/-8.1 days vs. 14.8+/-16.9 days, P=0.306). Among 10 children treated with steroid only, 2 children were operated for bowel perforation and intussusception. In contrast, there was no perforation in 12 children who underwent IVIG therapy. CONCLUSION: IVIG could be the alternative therapy to corticosteroids in children with severe digestive manifestations of HSP.