Effect of propolis on Th2 and Th17 cells: interplay with EtxB- and LPS-treated dendritic cells.

Dendritic cells (DCs) are antigen-presenting cells that drive the differentiation of T CD4+ cells into different profiles according to the nature of the antigen or immunomodulator. Propolis is a resinous product made by bees that has numerous pharmacological properties, including an immunomodulatory action. To assess whether propolis can modulate the activation of CD4+ T cells by stimulating DCs with heat-labile enterotoxin B subunit (EtxB) or lipopolysaccharide (LPS), we aimed to elucidate the mechanisms affected by propolis in the differential activation of T lymphocytes. Cell viability, lymphocyte proliferation, gene expression (GATA-3 and RORc), and cytokine production (interleukin (IL)-4 and IL-17A) were analyzed. Propolis, EtxB, and LPS induced a higher lymphoproliferation compared with the control. Propolis induced GATA-3 expression and, in combination with EtxB, maintained the baseline levels. Propolis alone or in combination with LPS inhibited RORc expression. EtxB alone and in combination with propolis increased IL-4 production. Propolis in combination with LPS prevented LPS-induced IL-17A production. These results opened perspectives for the study of biological events that may be favored by propolis by promoting Th2 activation or helping in the treatment of inflammatory conditions mediated by Th17 cells.

Effect of propolis on Th2 and Th17 cells: interplay with EtxB- and LPS-treated dendritic cells

Dendritic cells (DCs) are antigen-presenting cells that drive the differentiation of T CD4+ cells into different profiles according to the nature of the antigen or immunomodulator. Propolis is a resinous product made by bees that has numerous pharmacological properties, including an immunomodulatory action. To assess whether propolis can modulate the activation of CD4+ T cells by stimulating DCs with heat-labile enterotoxin B subunit (EtxB) or lipopolysaccharide (LPS), we aimed to elucidate the mechanisms affected by propolis in the differential activation of T lymphocytes. Cell viability, lymphocyte proliferation, gene expression (GATA-3 and RORc), and cytokine production (interleukin (IL)-4 and IL-17A) were analyzed. Propolis, EtxB, and LPS induced a higher lymphoproliferation compared with the control. Propolis induced GATA-3 expression and, in combination with EtxB, maintained the baseline levels. Propolis alone or in combination with LPS inhibited RORc expression. EtxB alone and in combination with propolis increased IL-4 production. Propolis in combination with LPS prevented LPS-induced IL-17A production. These results opened perspectives for the study of biological events that may be favored by propolis by promoting Th2 activation or helping in the treatment of inflammatory conditions mediated by Th17 cells.

Can COVID-19 pandemic worsen previous neurological/psychiatric diseases?

Introduction: The SARS-CoV-2 pandemic has been affecting the world since January 2020. Although its pathogenesis is primarily directed to the respiratory tract, other organs may be affected, including the nervous system. It has also been shown that the social context (confinement, lack of treatment) has affected neurological patients during this period. The aim of the study it was to assess the subjective worsening of neurological/psychiatric diseases in the context of the SARS-Cov-2 pandemic. Methods: Three groups of neurological/psychiatric patients were included: Patients who had symptomatic COVID-19 (n = 89), patients who had asymptomatic COVID-19 (n = 40), and a control group (n = 47), consisting of neurological/psychiatric patients without a history of SARS-Cov-2 infection. Results: 30.7% of the included individuals considered that their basal pathology had worsened during the study period. This feeling was significantly more frequent (P = 0.01) in patients with symptomatic COVID-19 (39.3%) than in patients of the other 2 groups (21.8%). Worsening was not related to the severity of COVID-19. The neurological conditions that significantly worsened after COVID-19, comparing symptomatic COVID-19 with the other 2 groups, were demyelinating and degenerative diseases. Conclusions: These results confirmed the impact of the SARS-Cov-2 pandemic on patients with neurological/psychiatric diseases. Confinement, lack of medical care, and the threat of diagnosis are surely contributing factors. Although the finding of a higher frequency of worsening in symptomatic COVID-19 patients may be related to greater anxiety/depression in this group of patients, we cannot exclude the role of direct affectation of the nervous system by the virus or damage due to neuroinflammation.

Introducción: La pandemia por SARS-CoV-2 afecta al mundo desde enero de 2020. Aunque su patogenia se dirige principalmente a las vías respiratorias, otros órganos pueden verse afectados, incluido el sistema nervioso. También se ha demostrado que el contexto social (confinamiento, falta de tratamiento) ha afectado a los pacientes neurológicos durante este periodo. El objetivo del estudio fue evaluar el empeoramiento subjetivo de enfermedades neurológicas/psiquiátricas en el contexto de la pandemia por SARS-Cov-2. Métodos: Se incluyeron tres grupos de pacientes neurológicos/psiquiátricos: pacientes que tenían COVID-19 sintomático (n = 89), pacientes que tenían COVID-19 asintomático (n = 40) y un grupo control (n = 47), formado por pacientes neurológicos/psiquiátricos sin antecedentes de infección por SARS-Cov-2. Resultados: El 30,7% de los individuos incluidos consideró que su patología basal había empeorado durante el período de estudio. Este sentimiento fue significativamente más frecuente (p = 0,01) en pacientes con COVID-19 sintomático (39,3%) que en pacientes de los otros 2 grupos (21,8%). El empeoramiento no estuvo relacionado con la gravedad de COVID-19. Las condiciones neurológicas que empeoraron significativamente después de la COVID-19, comparando la COVID-19 sintomática con los otros 2 grupos, fueron las enfermedades desmielinizantes y degenerativas. Conclusiones: estos resultados confirmaron el impacto de la pandemia del SARS-Cov-2 en pacientes con enfermedades neurológicas/psiquiátricas. El encierro, la falta de atención médica y la amenaza del diagnóstico son seguramente factores contribuyentes. Aunque el hallazgo de una mayor frecuencia de empeoramiento en pacientes sintomáticos de COVID-19 puede estar relacionado con una mayor ansiedad/depresión en este grupo de pacientes, no podemos excluir el papel de la afectación directa del sistema nervioso por el virus o el daño por neuroinflamación.

Oral Health Status and Oral Health-Related Quality of Life of First Nations and Metis Children.

OBJECTIVES: To assess the oral health status and oral health-related quality of life (OHRQoL) of young First Nations and Metis children. METHODS: This cross-sectional study assessed the oral health status of Indigenous children <72 mo of age while their parents/caregivers completed a questionnaire, including the Early Childhood Oral Health Impact Scale (ECOHIS), to assess OHRQoL. Analysis included descriptive statistics, bivariate analyses, and multiple regression. A P value ≤0.05 was considered significant. RESULTS: Overall, 146 children were recruited with a mean age of 40.1 ± 21.2 (SD) months, and 49% were male. Among First Nations children, 65.4% had early childhood caries (ECC) as compared with 45.2% among Metis children (P = 0.025). However, there was no statistically significant difference in the prevalence of severe ECC (S-ECC) between First Nations and Metis children (60.6% v. 42.9%, P = 0.051). The mean decayed, missing, and filled primary teeth (dmft) score was 4.9 ± 5.3 (range 0-20), and the mean decayed, missing, and filled surfaces (dmfs) score was 14.5 ± 20.4 (range 0-80). The total mean ECOHIS score was 4.4 ± 5.9 (range 0-25), while the mean Child Impact Section and Family Impact Section scores were 2.6 ± 4.0 (range 0-10) and 1.8 ± 2.8 (range 0-8), respectively. Multiple linear regression showed S-ECC was associated with total mean ECOHIS scores (P = 0.02). Higher total mean ECOHIS scores (which indicates poorer OHRQoL) were observed in children with ECC compared with caries-free children (5.8 v. 2.4, P = 0.0001). CONCLUSION: Oral health disparities such as ECC and reduced OHRQoL exist among many First Nations and Metis children in Manitoba. This is the first Canadian study exploring the OHRQoL of Indigenous children in addition to their oral health status. KNOWLEDGE TRANSFER STATEMENT: This study is the first to report on the oral health-related quality of life and its relationship to early childhood caries (ECC) among young Canadian First Nations and Metis children. Metis children are just as likely to suffer from severe ECC than First Nations children. The findings of this study have informed community-based and community-developed oral health promotion and ECC prevention activities.

Impact of a large dam on reproduction of a non-migratory teleost species, Acestrorhynchus lacustris (Characiformes: Acestrorhynchidae) / Impacto de uma grande barragem na reprodução de uma espécie de teleósteo não migradora, Acestrorhynchus lacustris (Characiformes: Acestrorhynchidae)

The release of water from the reservoir hypolimnion, lower concentration of oxygen and the anthropogenic regulation of the river flow, could affect the reproduction of fish, especially migratory species. However, little is known about the effects of these changes in water on non-migratory species. In this sense, the reproduction of Acestrohynchus lacustris was evaluated in two sections of São Francisco River, Minas Gerais, Brazil. Section 1, located immediately downstream from Três Marias Dam (18°09'31.65"S and 45°13'36.00"W) and section 2, located at the confluence of the São Francisco and the Abaeté Rivers (18°02'47.78"S and 45°1057.95"W). For this, we obtained the physico-chemical parameters of water of each study section. Additionally, biometric data and biological indices ofall specimens were measured. Fecundity and follicles diameters were measured in females. Temperature, dissolvedoxygen and flow showed lower values in section 1. Fish captured in this section, had lower values of GSI in bothsexes, and females presented decreased values of fecundity and follicles diameter. This species showed reproductiveactivity in the two sections analyzed, however, in section 1 where the temperature and dissolved oxygen presentedsignificant lower values, the reproductive capacity of A. lacustris, was negatively affected.

A liberação de água do hipolímnio do reservatório, baixa concentração de oxigênio e a regulação antropogênica do fluxo do rio podem afetar a reprodução de peixes, principalmente espécies migradoras. No entanto, pouco se sabe sobre os efeitos dessas mudanças nas condições da água em espécies não migradoras. A reprodução de Acestrohynchus lacustris foi avaliada em duas seções do rio São Francisco. Seção 1, localizada imediatamente a jusante da barragem de Três Marias e seção 2, localizada na confluência dos rios São Francisco e Abaeté. Para isso, foram obtidos os parâmetros físico-químicos da água de cada seção do estudo. Além disso, dados biométricos e índices biológicos de todos os peixes capturados foram obtidos. Adicionalmente, nas fêmeas foram medidos os diâmetros dos folículos vitelogênicos e a fecundidade. Temperatura, oxigênio dissolvido e fluxo apresentaram valores mais baixos na seção 1. Os peixes capturados nesta seção apresentaram menores valores de IGS em ambos os sexos, e as fêmeas apresentaram menores valores de fecundidade e diâmetro dos folículos. Essa espécie apresentou atividade reprodutiva nas duas seções analisadas, porém, na seção 1, onde os parâmetros da água apresentam piores condições para o processo reprodutivo de peixes, a capacidade reprodutiva de A. lacustris foi afetada negativamente.

Impact of a large dam on reproduction of a non-migratory teleost species, Acestrorhynchus lacustris (Characiformes: Acestrorhynchidae)

Abstract The release of water from the reservoir hypolimnion, lower concentration of oxygen and the anthropogenic regulation of the river flow, could affect the reproduction of fish, especially migratory species. However, little is known about the effects of these changes in water on non-migratory species. In this sense, the reproduction of Acestrohynchus lacustris was evaluated in two sections of São Francisco River, Minas Gerais, Brazil. Section 1, located immediately downstream from Três Marias Dam (18°0931.65S and 45°1336.00W) and section 2, located at the confluence of the São Francisco and the Abaeté Rivers (18°0247.78S and 45°1057.95W). For this, we obtained the physico-chemical parameters of water of each study section. Additionally, biometric data and biological indices of all specimens were measured. Fecundity and follicles diameters were measured in females. Temperature, dissolved oxygen and flow showed lower values in section 1. Fish captured in this section, had lower values of GSI in both sexes, and females presented decreased values of fecundity and follicles diameter. This species showed reproductive activity in the two sections analyzed, however, in section 1 where the temperature and dissolved oxygen presented significant lower values, the reproductive capacity of A. lacustris, was negatively affected.

Resumo A liberação de água do hipolímnio do reservatório, baixa concentração de oxigênio e a regulação antropogênica do fluxo do rio podem afetar a reprodução de peixes, principalmente espécies migradoras. No entanto, pouco se sabe sobre os efeitos dessas mudanças nas condições da água em espécies não migradoras. A reprodução de Acestrohynchus lacustris foi avaliada em duas seções do rio São Francisco. Seção 1, localizada imediatamente a jusante da barragem de Três Marias e seção 2, localizada na confluência dos rios São Francisco e Abaeté. Para isso, foram obtidos os parâmetros físico-químicos da água de cada seção do estudo. Além disso, dados biométricos e índices biológicos de todos os peixes capturados foram obtidos. Adicionalmente, nas fêmeas foram medidos os diâmetros dos folículos vitelogênicos e a fecundidade. Temperatura, oxigênio dissolvido e fluxo apresentaram valores mais baixos na seção 1. Os peixes capturados nesta seção apresentaram menores valores de IGS em ambos os sexos, e as fêmeas apresentaram menores valores de fecundidade e diâmetro dos folículos. Essa espécie apresentou atividade reprodutiva nas duas seções analisadas, porém, na seção 1, onde os parâmetros da água apresentam piores condições para o processo reprodutivo de peixes, a capacidade reprodutiva de A. lacustris foi afetada negativamente.

Impact of a large dam on reproduction of a non-migratory teleost species, Acestrorhynchus lacustris (Characiformes: Acestrorhynchidae) / Impacto de uma grande barragem na reprodução de uma espécie de teleósteo não migradora, Acestrorhynchus lacustris (Characiformes: Acestrorhynchidae)

The release of water from the reservoir hypolimnion, lower concentration of oxygen and the anthropogenic regulation of the river flow, could affect the reproduction of fish, especially migratory species. However, little is known about the effects of these changes in water on non-migratory species. In this sense, the reproduction of Acestrohynchus lacustris was evaluated in two sections of São Francisco River, Minas Gerais, Brazil. Section 1, located immediately downstream from Três Marias Dam (18°09'31.65"S and 45°13'36.00"W) and section 2, located at the confluence of the São Francisco and the Abaeté Rivers (18°02'47.78"S and 45°10'57.95"W). For this, we obtained the physico-chemical parameters of water of each study section. Additionally, biometric data and biological indices of all specimens were measured. Fecundity and follicles diameters were measured in females. Temperature, dissolved oxygen and flow showed lower values in section 1. Fish captured in this section, had lower values of GSI in both sexes, and females presented decreased values of fecundity and follicles diameter. This species showed reproductive activity in the two sections analyzed, however, in section 1 where the temperature and dissolved oxygen presented significant lower values, the reproductive capacity of A. lacustris, was negatively affected.

A liberação de água do hipolímnio do reservatório, baixa concentração de oxigênio e a regulação antropogênica do fluxo do rio podem afetar a reprodução de peixes, principalmente espécies migradoras. No entanto, pouco se sabe sobre os efeitos dessas mudanças nas condições da água em espécies não migradoras. A reprodução de Acestrohynchus lacustris foi avaliada em duas seções do rio São Francisco. Seção 1, localizada imediatamente a jusante da barragem de Três Marias e seção 2, localizada na confluência dos rios São Francisco e Abaeté. Para isso, foram obtidos os parâmetros físico-químicos da água de cada seção do estudo. Além disso, dados biométricos e índices biológicos de todos os peixes capturados foram obtidos. Adicionalmente, nas fêmeas foram medidos os diâmetros dos folículos vitelogênicos e a fecundidade. Temperatura, oxigênio dissolvido e fluxo apresentaram valores mais baixos na seção 1. Os peixes capturados nesta seção apresentaram menores valores de IGS em ambos os sexos, e as fêmeas apresentaram menores valores de fecundidade e diâmetro dos folículos. Essa espécie apresentou atividade reprodutiva nas duas seções analisadas, porém, na seção 1, onde os parâmetros da água apresentam piores condições para o processo reprodutivo de peixes, a capacidade reprodutiva de A. lacustris foi afetada negativamente.

Impact of a large dam on reproduction of a non-migratory teleost species, Acestrorhynchus lacustris (Characiformes: Acestrorhynchidae).

The release of water from the reservoir hypolimnion, lower concentration of oxygen and the anthropogenic regulation of the river flow, could affect the reproduction of fish, especially migratory species. However, little is known about the effects of these changes in water on non-migratory species. In this sense, the reproduction of Acestrohynchus lacustris was evaluated in two sections of São Francisco River, Minas Gerais, Brazil. Section 1, located immediately downstream from Três Marias Dam (18°09'31.65"S and 45°13'36.00"W) and section 2, located at the confluence of the São Francisco and the Abaeté Rivers (18°02'47.78"S and 45°10'57.95"W). For this, we obtained the physico-chemical parameters of water of each study section. Additionally, biometric data and biological indices of all specimens were measured. Fecundity and follicles diameters were measured in females. Temperature, dissolved oxygen and flow showed lower values in section 1. Fish captured in this section, had lower values of GSI in both sexes, and females presented decreased values of fecundity and follicles diameter. This species showed reproductive activity in the two sections analyzed, however, in section 1 where the temperature and dissolved oxygen presented significant lower values, the reproductive capacity of A. lacustris, was negatively affected.

Comprehensive germline mutation analysis and clinical profile in a large cohort of Brazilian xeroderma pigmentosum patients.

BACKGROUND: Xeroderma pigmentosum (XP) patients present a high risk of developing skin cancer and other complications at an early age. This disease is characterized by mutations in the genes related to the DNA repair system. OBJECTIVES: To describe the clinical and molecular findings in a cohort of 32 Brazilian individuals who received a clinical diagnosis of XP. METHODS: Twenty-seven families were screened for germline variants in eight XP-related genes. RESULTS: All patients (N = 32) were diagnosed with bi-allelic germline pathogenic or potentially pathogenic variants, including nine variants previously undescribed. The c.2251-1G>C XPC pathogenic variant, reported as the founder mutation in Comorian and Pakistani patients, was observed in 15 cases in homozygous or compound heterozygous. Seven homozygous patients for POLH/XPV variants developed their symptoms by an average age of 7.7 years. ERCC2/XPD, DDB2/XPE and ERCC5/XPG variants were found in a few patients. Aside from melanoma and non-melanoma skin tumours, a set of patients developed skin sebaceous carcinoma, leiomyosarcoma, angiosarcoma, mucoepidermoid carcinoma, gastric adenocarcinoma and serous ovarian carcinoma. CONCLUSIONS: We reported a high frequency of XPC variants in 32 XP Brazilian patients. Nine new variants in XP-related genes, unexpected non-skin cancer lesions and an anticipation of the clinical manifestation in POLH/XPV cases were also described.

Implementación de un sistema de imagenología infrarroja para la detección vascular del antebrazo y mano / Implementation of an infrared imaging system for vascular detection in the forearm and hand

RESUMEN: En el área clínica son procedimientos comunes la venopunción, la colocación de catéteres, inyecciones intravenosas, etc. La visualización de las venas en algunas personas es compleja. En este trabajo se presenta el desarrollo de un sistema capaz de realzar la distribución de las venas en el antebrazo de una persona para, en un trabajo futuro, ayudar de forma no invasiva a localizar las venas en los procedimientos de venopunción. Para llevar a cabo el desempeño de esta tarea se utilizó una cámara web, a la cual se le ha extraído el filtro que impide el paso de luz infrarroja y es sustituido por otro que lo permite. Para mejorar la detección de las venas se le agregó a la cámara un arreglo de LEDs emisores de luz infrarroja (830nm). Las imágenes obtenidas fueron procesadas mediante la ecualización del histograma adaptable y clasificadas por dos métodos, el primero basado en el algoritmo Fuzzy C-Means, el segundo basado en un modelo probabilístico de tipo Bayes, técnicas del área de inteligencia artificial, presentadas como alternativa en el procesamiento de imágenes. Para la obtención de las imágenes se consideraron las regiones anteriores y exteriores del antebrazo izquierdo y derecho de cada sujeto generando una base de datos. Este sistema también tiene aplicación en la detección de venas varicosas debido a que se puede dar un seguimiento a la dilatación de las venas.

ABSTRACT: The venipuncture, the catheterization and intravenous (IV) injections are some of the common procedures in the clinical practice. The location of the veins may be complex in some patients. In this paper a system able to enhance the vein distribution in a patient's forearm in order to help, in future works, to locate the veins in a non-invasive way and accomplish the IV procedures, is described. To carry out this work a web cam was used, the filter that blocks out the infrared light has been removed and replaced for one who does not. To increase the vein detection an array of infrared LEDs (830 nm) was attached. The resulting images were processed using the adaptive histogram equalization and then classified by two methods, the first one based on the Fuzzy C-Means Algorithm, and the second based in a Bayesian probabilistic model. For the image acquisition, the anterior-exterior regions of the left and right forearm of each subject were considered to generate a data base. This system also has relevance in the detection of varicose veins since is able to monitor the vein dilatation.

Monocyte-derived dendritic cells from patients with severe forms of chromoblastomycosis induce CD4+ T cell activation in vitro.

Dendritic cells (DCs) have been described as initiators and modulators of the immune response. Recently we have shown a predominant production of interleukin-10 cytokine, low levels of interferon-gamma and inefficient T cell proliferation in patients with severe forms of chromoblastomycosis. Chromoblastomycosis starts with subcutaneous inoculation of Fonsecaea pedrosoi into tissue where DCs are the first line of defence against this microorganism. In the present study, the interaction of F. pedrosoi and DCs obtained from patients with chromoblastomycosis was investigated. Our results showed that DCs from patients exhibited an increased expression of human leucocyte antigen D-related (HLA-DR) and co-stimulatory molecules. In the presence of conidia, the expression of HLA-DR and CD86 was up-regulated by DCs from patients and controls. Finally, we demonstrate the reversal of antigen-specific anergy and a T helper type 1 response mediated by DCs incubated with F. pedrosoi conidea.

The Native Hawaiian Health Professions Scholarship program's impact on the community of Ko'olau Loa: a program report.

The Native Hawaiian Health Professions Scholarship was established as one component of the Native Hawaiian Health Care Act of 1988, which was later reauthorized as the Native Hawaiian Health Care Improvement Act of 1992. The Scholarship program was designed to develop Native Hawaiian primary health care professionals who would return to work in Native Hawaiian communities. To ensure this, scholarship recipients fulfill their scholarship agreement by working in medically unserved and underserved communities throughout Hawai'i. Since 1991, 121 scholarships have been awarded to Native Hawaiians training in different primary care professions including medicine, dentistry, nursing, midwifery, social work, and public health. Although the service obligation is attached to the scholarship as a means of "paying back," the intent is to provide an opportunity for graduates to establish a sense of social responsibility for the communities most in need. One of the communities benefiting from this program is Ko'olau Loa, a community that spans from Ka'a'awa to Pupukea on Windward O'ahu. Native Hawaiian Health Scholarship recipients, Kehau Santiago, Michele Shimizu, and Stephany Vaioleti live and continue to serve in the very community in which they fulfilled their service obligations. This article focuses on how the Native Hawaiian Health Scholarship Program--in particular, the three scholars--affected Ko'olau Loa.

Fine-needle aspiration of cytomegalovirus sialadenitis in a patient with acquired immunodeficiency syndrome: pitfalls of diff-quik staining.

A case of cytomegalovirus (CMV) sialadenitis in a patient with acquired immunodeficiency syndrome (AIDS) diagnosed by fine-needle aspiration biopsy (FNAB) is reported. Although a diagnosis of CMV sialadenitis can be established on Diff-Quik-stained slides, the characteristic viral changes are the best appreciated on slides stained by the Papanicolaou (Pap) technique. Differential pitfalls are discussed. It needs to be stressed that clinically unsuspected diagnosis of CMV infection may uncover congenital or acquired defects of cellular immunity, and particularly AIDS. Diagn. Cytopathol. 2000;22:101-103.

Selective lithiation of 2-methyloxazoles. Applications to pivotal bond constructions in the phorboxazole nucleus.

[formula: see text] The lithiation of 2-methyloxazoles with alkyllithium and hindered lithium amide bases generally results in the competitive formation of a mixture of 5-lithio- and 2-(lithiomethyl)oxazole isomers. Herein a synthetically useful lithiation method which allows for the selective formation of 2-(lithiomethyl)oxazole is described. Diethylamine has been found to be a kinetically competent proton source that will mediate the equilibration of the kinetically formed 5-lithiooxazole to its more stable 2-(lithiomethyl)oxazole counterpart. Application of this metalation strategy with lithium diethylamide to two important bond constructions relevant to a projected phorboxazole synthesis is presented.

A 31-year-old woman with lupus erythematosus and fatal multisystem complications.

A 31-year-old woman with systemic lupus erythematosus presented with respiratory and renal symptoms followed by abdominal pain and seizure. Clinical diagnoses of lupus pneumonitis, nephritis, vasculitis, and cerebritis were made. The patient had a progressively downhill course with pancytopenia and hemolysis treated with aggressive immunosuppressive therapy and extended plasmapheresis. Lupus pneumonitis leading to diffuse alveolar damage was the immediate cause of death. Diffuse proliferative lupus nephritis was seen in the biopsy, and the autopsy demonstrated thrombotic microangiopathy. Extra-renal complications of lupus and response to therapy are discussed in the format of a Tulane Clinicopathologic Conference.