Unusual eye signs in Wegener's granulomatosis.

Wegener's granulomatosis is a rare necrotising vasculitis not easily diagnosed due to the obscurity of its diverse clinical features. Despite its comparatively low incidence, the unusual ophthalmic manifestations seen in this disease warrant extra caution from attending rheumatologists. In this case, bilateral peripheral ulcerative keratitis preceded any systemic symptoms. Timely recognition of the significance of this ophthalmic complaint and prompt ophthalmological consultation can help achieve early diagnosis and treatment of this potentially fatal rheumatological disease.

Cerebellum vasculopathy and normal tension glaucoma in systemic lupus erythematosus: report of a case and review of the literature.

Cerebellar vasculopathy is an uncommon but clinically important neuropsychiatric syndrome of systemic lupus erythematosus (NP-SLE) for its ominous outcome and need for prompt interventions. We described a young Chinese lady with systemic lupus erythematosus and normal tension glaucoma, who had sudden headache, nausea and vomiting coupled with rapid neurological deterioration leading to comatose status. Diagnosis of lupus cerebellar vasculopathy was made and intense immunosuppressive therapy consisting of prednisolone and cyclophosphamide was commenced. Clinical condition was salvaged with marked improvement of both sensorium and general well-being.

Electric shock wave lithotripsy (ESWL) as a pain control measure in dermatomyositis with calcinosis cutis-old method, new discovery.

A 23-year-old Chinese man with dermatomyositis associated calcinosis cutis received electric shock wave lithotripsy (ESWL) as an alternate to a conventional pharmacological regimen to reduce pain associated with the complications of subcutaneous calcinosis nodules. He became symptom and opioid free after two courses of ESWL. No significant adverse effect had been noted. ESWL may serve as a means of pain killing in patients suffering from debilitating pain caused by complicated calcinosis cutis.

Successful treatment of pure red cell aplasia associated with systemic lupus erythematosus with oral danazol and steroid.

We describe a middle-aged Chinese systemic lupus erythematosus (SLE) patient developing steroid refractory and transfusion dependent red cell aplasia. Oral danazol 200 mg twice per day was started together with low-dose prednisolone therapy. There was no further recurrence of anemia 1 month after this combined therapy.

Increased prevalence of squamous intraepithelial lesions in systemic lupus erythematosus: association with human papillomavirus infection.

OBJECTIVE: To compare the prevalence of abnormal Pap smears in patients with systemic lupus erythematosus (SLE) with that in a large group of healthy controls, and to determine whether SLE itself is an independent risk factor. The association of human papillomavirus (HPV) infection and the use of immunosuppressive agents with abnormal Pap smears in SLE was also assessed. METHODS: Eighty-five SLE patients participated in this cross-sectional study. A sample of cervical cells was collected from each patient for routine cytologic examination. HPV was typed by restriction and sequencing analysis. A structured questionnaire was administered to the subjects to ascertain the possible behavioral and biologic risk factors associated with cervical atypia. Data on 2,080 healthy female subjects were retrieved for comparison. RESULTS: The mean (+/-SD) age of SLE patients and controls was 42 +/- 9 years and 44 +/- 10 years, respectively. The prevalence of abnormal Pap smears was significantly increased in SLE patients compared with controls (16.5% versus 5.7%). The prevalence of squamous intraepithelial lesions was increased approximately 6-fold in SLE patients (11.8%) compared with controls (2.0%). SLE itself remained an independent risk factor for abnormal Pap smears (odds ratio 3.5, 95% confidence interval 1.8-6.9). The overall prevalence of HPV infection in SLE patients and controls was 11.8% and 7.3%, respectively. However, 10.6% of SLE patients were infected with at least 1 high-risk type of HPV, compared with 4.2% of controls. Multiple infections were also more common in SLE patients than in controls (4.7% versus 1.1%). There were no significant differences in the use of immunosuppressive agents between SLE patients with normal Pap smears and those with abnormal Pap smears. CONCLUSION: Abnormal Pap smears were more common among SLE patients than controls, even after adjusting for HPV status. SLE-associated immunosuppression increases susceptibility to high-risk HPV infection and multiple HPV infections. The use of immunosuppressant agents was not associated with abnormal Pap smears.