ABSTRACT
Viral arthritis and vasculitis are important differential diagnoses primarily in patients with acute polyarticular arthritis in association with fever and rash, in populations specially at risk and in returning travellers. Parvovirus B19 is the most frequent cause of viral arthritis in Europe, whereas rubella, hepatitis B and C viruses have become less common. Due to worldwide tourism arthritogenic alphaviruses, which are transmitted by mosquito vectors have come into the focus of tropical medicine and rheumatology. Viral arthritis is typically self-limiting but due to severe pain often requires symptomatic therapy with nonsteroidal antirheumatic drugs; however, arthritis and vasculitis may also be a manifestation of an important treatable viral infection, such as hepatitis B, C and human immunodeficiency viruses (HIV).
Subject(s)
Arthritis, Infectious/diagnosis , Arthritis, Infectious/therapy , Vasculitis/diagnosis , Vasculitis/therapy , Virus Diseases/diagnosis , Virus Diseases/therapy , Anti-Inflammatory Agents, Non-Steroidal/administration & dosage , Antirheumatic Agents/administration & dosage , Antiviral Agents/administration & dosage , Arthritis, Infectious/virology , Diagnosis, Differential , Drug Therapy, Combination/methods , Evidence-Based Medicine , Humans , Treatment Outcome , Vasculitis/virology , Virus Diseases/virologyABSTRACT
HISTORY AND ADMISSION FINDINGS: A now 34-year old female patient with long-standing systemic lupus erythematosus (SLE) had successfully been treated with mycophenolate mofetil (MMF) because of former pleuropericardial and pulmonal lupus manifestations when she was admitted with edema for the first time. INVESTIGATIONS: Laboratory investigations of urine and blood showed findings compatible with lupus nephritis. Kidney biopsy revealed lupus nephritis type IV. TREATMENT AND COURSE: Despite the initiation of cyclophosphamide bolus and corticosteroid therapy, the kidney function and renal hypertension worsened and the patient developed cerebral manifestations. Finally, synchronization of plasmapheresis with subsequent pulse cyclophosphamide led to remission of SLE. CONCLUSION: Although MMF is a promising innovative agent for induction and maintenance therapy of lupus nephritis that can be used instead of cyclophosphamide, there may be cases like the one reported here, in which MMF cannot prevent lupus flares in first manifestation of severe renal disease.
