Coroidopatía y neuropatía óptica en lupus eritematoso sistémico, reporte de caso / Choroidopathy and optic neuropathy in systemic lupus erythematosus, a case report

Si bien la patología ocular asociada a lupus eritematoso sistémico no es infrecuente, sus manifestaciones e importancia pueden ser a veces pasadas por alto por reumatólogos y oftalmólogos. Se describe el caso de un varón de 44 años con antecedente de lupus eritematoso sistémico que inicia enfermedad con metamorfopsias y alteración subjetiva de campos visuales de ambos ojos, presentando disminución marcada de agudeza visual secundaria a desprendimiento de retina seroso bilateral y neuropatía óptica. Recibió tratamiento con corticoides sistémicos, terapia biológica e inyecciones subtenonianas posteriores de triamcinolona, presentando mejoría de la agudeza visual. Las manifestaciones oftálmicas deben ser consideradas como signo de actividad del lupus eritematoso sistémico, por ese motivo el tratamiento es esencialmente sistémico, asociado a tratamiento coadyuvante local.

Although the associated ocular pathology to systemic lupus erythematosus is not infrequent, its manifestations and importance can be overlooked by rheumatologists and ophthalmologists. We present the case of a 44-year-old male with a history of systemic lupus erythematosus whose disease started with metamorphopsia and subjective alteration of the visual fields of both eyes, with a marked decrease in visual acuity, secondary to bilateral serous retinal detachment and optic neuropathy. He received systemic corticosteroids, biological therapy and posterior subtenon triamcinolone acetonide injections, showing an improvement in visual acuity. Ophthalmic manifestations should be considered a sign of systemic lupus erythematosus activity, therefore the treatment is essentially systemic, in combinationed with local coadjutant treatment.

Choroidopathy and optic neuropathy in systemic lupus erythematosus, a case report.

Although the associated ocular pathology to systemic lupus erythematosus is not infrequent, its manifestations and importance can be overlooked by rheumatologists and ophthalmologists. We present the case of a 44-year-old male with a history of systemic lupus erythematosus whose disease started with metamorphopsia and subjective alteration of the visual fields of both eyes, with a marked decrease in visual acuity, secondary to bilateral serous retinal detachment and optic neuropathy. He received systemic corticosteroids, biological therapy and posterior subtenon triamcinolone acetonide injections, showing an improvement in visual acuity. Ophthalmic manifestations should be considered a sign of systemic lupus erythematosus activity, therefore the treatment is essentially systemic, in combinationed with local coadjutant treatment.

Onset of action of loratadine and placebo and other efficacy variables in patients with seasonal allergic rhinitis.

In a double-blind study, 185 patients with seasonal allergic rhinitis were randomly assigned to receive 10 mg of loratadine or placebo once daily for three days. On day 1 of treatment, the onset of relief of symptoms within 30 minutes of drug administration was reported by 13% of the loratadine-treated patients and by 4% of the placebo patients (P less than 0.05). At two hours after drug administration, 65% of the loratadine-treated patients and 48% of the placebo patients reported symptom relief. On day 3, the loratadine-treated patients reported a significantly greater relief of symptoms, and according to both physician and patient evaluations, the treatment response was significantly superior in the loratadine-treated than in the placebo patients. The incidence of sedation was 2% in the loratadine group and 1% in the placebo group.

Clinical evaluation of the efficacy and safety of noberastine, a new H1 antagonist, in seasonal allergic rhinitis: a placebo-controlled, dose-response study.

Noberastine (NOB), a new histamine H1 antagonist, has potent and specific peripheral antihistaminic activity. To evaluate the efficacy and safety of NOB in ragweed seasonal allergic rhinitis, 250 eligible patients were randomized to one of four parallel, double-blind treatment groups: NOB, 10, 20, and 30 mg, or placebo, each administered once daily for 3 weeks. Rescue medication was prohibited. Efficacy parameters included global response rate (percentage of responders), physician visit, patient-diary symptom scores, and onset of action. Efficacy analyses used alpha = 0.0167 (adjusted for multiple comparisons). Efficacy parameters demonstrated universal superiority of NOB therapy over placebo therapy with statistical significance achieved frequently; no statistically or clinically significant separation was demonstrated among NOB-treated groups. Global-response rates for all active-treatment groups (range, 62.7% to 71.1%) were statistically significantly greater than rates for the placebo-treated group (39.6%). Median time to first relief of symptoms was within 2 to 4 hours for NOB-treated groups versus 72 hours for the placebo-treated group. No significant abnormalities in safety parameters were ascribed to NOB treatment. Incidence and severity of adverse experiences of NOB-treated groups were comparable in incidence and severity to placebo treatment. NOB treatment did not appear to cause weight gain or sedation. Once-daily NOB, 10, 20, and 30 mg, is equally and highly effective and safe in the symptomatic management of seasonal allergic rhinitis compared to placebo.

Efficacy and safety of loratadine (10 mg once daily), terfenadine (60 mg twice daily), and placebo in the treatment of seasonal allergic rhinitis.

A total of 317 patients received loratadine, 10 mg once daily, terfenadine 60 mg twice daily, or placebo in a 14-day, double-blind, randomized study in seasonal allergic rhinitis. Four nasal and four nonnasal symptoms were evaluated. At the end point evaluation, mean total scores of combined nasal and nonnasal symptoms decreased from baseline (improved) 46%, 44%, and 35%, respectively, for loratadine, terfenadine, and placebo. The difference between loratadine and placebo treatment was significant (p = 0.03). Loratadine was particularly effective compared with placebo in relieving nasal discharge, sneezing, and itching/burning eyes. Therapeutic response to treatment was good or excellent in 66 (64%) of 103 loratadine-treated patients, 58 (56%) of 104 terfenadine-treated patients, and 48 (47%) of 102 placebo-treated patients. Adverse experiences reported during the study were usually mild or moderate and were not significantly different among the three treatment groups. Sedation (somnolence) was reported by 10 loratadine-treated patients, seven terfenadine-treated patients, and eight placebo-treated patients. Loratadine, 10 mg once daily, was comparable to terfenadine, 60 mg twice daily, and significantly superior to placebo in the symptomatic relief of seasonal allergic rhinitis.

Comparison of the efficacy and safety of loratadine, terfenadine, and placebo in the treatment of seasonal allergic rhinitis.

The efficacy and safety of loratadine, 40 mg once daily, were compared with terfenadine, 60 mg twice daily, and placebo in controlling symptoms of ragweed hay fever. The study was a randomized, multicentric, parallel-group, double-blind design involving 280 patients divided into three groups receiving either loratadine, terfenadine, or placebo for a period of 14 days in the autumn of 1984. Both loratadine and terfenadine demonstrated a statistically greater reduction in symptom score compared to placebo. They were not statistically different from each other, and there was no statistical difference in the incidence of side effects between the two drugs.

Ra5G, a homologue of Ra5 in giant ragweed pollen: isolation, HLA-DR-associated activity and amino acid sequence.

Recent studies [Marsh et al. (1982) J. exp. Med. 155, 1439-1451; Coulter (1983) M.Sc. thesis, McGill University, Montreal, Canada; Coulter et al. (1983) in Genetic and Environmental Factors in Clinical Allergy (Edited by Marsh D.G., Blumenthal M.N. and Santilli J., Jr), University of Minnesota Press, Minneapolis, MN] have shown a highly significant association between HLA-Dw2/DR2 and host sensitivity to the 5000-D, 4-disulfide bonded protein Ra5S of short ragweed pollen. To extend these findings, we isolated Ra5G, an Ra5S-like protein, from giant ragweed pollen by gel and ion-exchange chromatography. The protein was homogeneous by polyacrylamide gel electrophoresis (pH 4.3), reverse-phase high-performance liquid chromatography, and antigenic assays. Its mol. wt and amino acid composition (including 8 half-cystine residues) were closely similar to Ra5S, but the two proteins had little or no antigenic or allergenic cross-reactivity. In a study of 200 ragweed-sensitive individuals, host sensitivity simultaneously to Ra5G and Ra5S was significantly associated with the DR2 allele. The amino acid sequence of Ra5G was determined and showed close homology with Ra5S. The potential function of a highly homologous decapeptidyl sequence stretch is discussed in relation to Ir gene control of immune response to the 2 proteins.

Comparative study of the efficacy, tolerance and side-effects of dexchlorpheniramine maleate 6 mg b.i.d. with terfenadine 60 mg b.i.d.

Dexchlorpheniramine maleate 6 mg b.i.d. was compared with Terfenadine 60 mg b.i.d. for efficacy in controlling Ragweed Hay Fever symptoms, as well as tolerance and occurrence of adverse reactions. The study was a randomized, multicentric, parallel group, blind evaluator design which involved 174 patients equally divided, eighty-seven receiving dexchlorpheniramine and eighty-seven terfenadine, for a period of 2 weeks during the latter half of August and the first half of September 1983. The study indicated that dexchlorpheniramine at the doses tested, was significantly more effective in controlling hay fever symptoms than terfenadine.

A comparison of the effects of ketotifen and clemastine on cutaneous and airway reactivity to histamine and allergen in atopic asthmatic subjects.

We compared the effects of ketotifen, a drug with antihistaminic and antianaphylactic properties, with those of clemastine, a conventional H1 antihistamine, on cutaneous and airway reactions to histamine and allergen in atopic asthmatic subjects. Eight subjects received ketotifen, and seven subjects received clemastine, 1 mg twice daily, for two periods of 3 wk. A 2-week interval separated the periods of medication. Maximum expiratory flow rates were measured before and after each treatment period and did not change significantly. Bronchial provocation testing to histamine was performed before and after the first period of medication, and the provocative concentration of histamine required to reduce the forced expiratory volume in 1 sec by 20% from control was increased 4.9-fold by ketotifen (p less than 0.02) and 6.5-fold by clemastine (p less than 0.01). Quantitative histamine and allergen skin testing performed before and after the second period of medication demonstrated significant attenuation of the cutaneous reactions by both medications. Neither medication, however, afforded significant protection against inhaled allergen. Our results suggest that, in the doses used, ketotifen has antihistaminic actions in man equivalent in potency to clemastine but does not appear to have significant additional effects on immediate skin or bronchial responses to allergen.

Anaphylaxis following the use of bacitracin ointment. Report of a case and review of the literature.

A 52-year-old woman suffered an acute anaphylactic reaction to topically applied bacitracin. An investigation disclosed the presence of concurrent type I and IV hypersensitivity to bacitracin. We review five other cases of anaphylactic reactions to topical medications and describe the clinical characteristics common to all six cases.

Lymphomatoid granulomatosis with isolated involvement of the brain.

A patient with biopsy-proven lymphomatoid granulomatosis of the brain as the sole manifestation of the disease is described. During 14 months of follow-up since surgical excision of the cerebral mass, no evidence of recurrent brain involvement or of extracranial lesions has been found. This case is unusual in the confinement of the disease to the central nervous system and in the favorable outcome following surgical treatment alone.

Transient monoclonal proteins in drug hypersensitivity reactions.

Two patients were studied in whom monoclonal (M) immunoglobulin G (IgG) proteins developed during the course of a serum sickness-like drug hypersensitivity reaction to cloxacillin (Orbenin) and sodium cephalothin (Keflin), respectively. The clinical evidence and time sequence of events support this association. In both patients there was evidence of an active antibody response to the given antibiotic and to the benzylpenicilloyl group as well. However, protein fractions obtained by agar gel preparative electrophoresis failed to show a higher antibody concentration where the M peak was located, and absorption experiments performed with penicillin G-, cloxacillin- and cephalothin-coated red cells failed to absorb these M proteins. These transient paraproteins can be seen in association with antibiotic(s) administration in the context of a hypersensitivity reaction and do not apparently represent a specific immune response.

Rheumatoid pericarditis. Rapid deterioration with evidence of local vasculitis.

In a patient with classical rheumatoid arthritis and pericardial involvement, accelerated restriction of cardiac filling resulting from pericardial constriction developed. Pericardiectomy was necessary to relieve this condition. Examination of the synovial and pericardial fluid showed noteworthy decreases in total hemolytic complement (CH50) and C3 levels, while these were normal in the serum. Immunofluorescence staining of the pericardium showed plasma cell infiltration and immune deposit staining of pericardial vessels with IgG, IgM, IgA, or C3. These findings suggest that immune complexes deposition plays an important role in the pathogenesis of this condition.