Drug-induced lupus or systemic lupus erythematosus after experimental COVID-19 therapy: difficulties in differential diagnosis

PO.8.170 Figure 1[Figure omitted. See PDF]ConclusionDIL is an autoimmune phenomenon with clinical and laboratory manifestations similar to those of SLE, chronologically associated with the intake of drugs and regressing after their withdrawal. There are a lot of cases of development of DIL on therapy with monoclonal antibodies, mainly TNF-α inhibitors. However, no cases of DIL after treatment with a ’cocktail’ of monoclonal antibodies to the SARS-CoV-2 surface protein have been described in the literature. The use of drugs can also lead to the development of SLE, which is difficult to distinguish from DIL at the initial stage. Thus, careful dynamic follow-up of the patient is necessary for final verification of the diagnosis.

Vaccination in persons with systemic lupus erythematosus: the current state of the problem

Vaccination plays an important role in the prevention of infectious diseases in patients with immunoinflammatory diseases. When vaccinating patients with systemic lupus erythematosus (SLE), as with other immunoinflammatory rheumatic diseases, its safety is of great importance, including mitigating the risks of the primary disease or the development of new autoimmune phenomena. Many practitioners continue to consider autoimmune diseases as a contraindication for vaccination due to the perceived possibility of their exacerbation and reduced vaccine effectiveness during active immunosuppressive therapy. The lecture presents current data on the immunogenicity, efficacy and safety of vaccines against a number of infections caused by influenza viruses, hepatitis B, Herpes zoster, human papilloma viruses, COVID-19 and pneumococcus in patients with SLE. It has been shown that the benefits of vaccination in patients with SLE significantly outweigh the risk of adverse events or exacerbations of the disease. At the same time, it was noted that the problem of vaccination of such patients requires further study. © 2022, Ima-Press Publishing House. All rights reserved.

The first 50 COVID-19 positive patients at the Department of Haemato-oncology, Faculty Hospital Ostrava in 2020

Aim: The novel coronavirus (SARS-CoV-2) is a highly contagious disease with a significant mortality rate. Haematological patients are among those most at risk. We evaluate here the disease course, association between comorbidities and COVID-19 severity and seroconversion potential in 50 positive patients at our clinic. Methods: We performed 1,600 diagnostic PCR nasopharyngeal swabs over a period of 8 months. We introduced a set of preventive measures so as to protect our patients and personnel. In 50 COVID-19 positive patients, we closely evaluated the course of the disease, the impact of underlying risk factors and the principal haematological diagnoses. We also evaluated the potential for seroconversion in 15 COVID-19 positive patients. Results: Strict barrier measures, especially in patients undergoing autologous stem cell transplantation, have been shown as being crucial for reducing the spread of disease.We did not record any disease outbreak and registered only one positive case during the peri-transplant period at our facility. The most common comorbidities were arterial hypertension or other cardiovascular disease, type 2 diabetes and renal impairment. Two-thirds of positive patients were on first line treatment. Hypogammaglobulinemia did not prove to be a risk factor for a severe COVID-19 course and we did not observe it to be an obstacle for seroconversion. Conclusion: Preventive measures are significant for reducing the spread of disease, especially in haematology centres. In our single centre experience, we report a mortality of 14%. Although we report a relatively small cohort and much remains yet to be clarified, our results can even now be implemented in daily practice.

Problems of early diagnosis of systemic lupus erythematosus during the COVID-19 pandemic

Systemic lupus erythematosus (SLE) is an autoimmune rheumatic disease of unknown etiology, characterized by overproduction of organ-nonspecific autoantibodies to various components of the cell nucleus and cytoplasm and the development of immune-inflammatory damage to internal organs. The debut of SLE is preceded by an asymptomatic period, characterized by impaired immunological tolerance to its own autoantigens, determined by the multifaceted interaction of external, genetic and epigenetic factors, hormonal disorders, microbiome pathology, stress effects, etc. Development of a certain spectrum of clinical symptoms characteristic of SLE along with the detection of a reflects the progression of the immunopathological process in SLE, however, there is no generally accepted term that defines the patient’s condition, which has individual serological and clinical signs characteristic of this disease. In rheumatology, the concept of «incomplete» SLE is currently most often used. The problems of early diagnosis of SLE, clinical and laboratory predictors of the transformation of “incomplete” SLE into “reliable” SLE, difficulties in diagnosing SLE during the COVID-19 pandemic are considered. Particular attention is paid to the comparative characteristics of the immunopathological mechanisms of SLE and COVID-19. © 2021 Ima-Press Publishing House. All rights reserved.