Lupus nephritis in Lebanon.

This is a retrospective study of the clinicopathological characteristics of 50 systemic lupus erythematosus patients with nephritis who underwent a kidney biopsy and were admitted to the American University of Beirut Medical Center, in Lebanon, between 1979 and 1999. There were 43 females and seven males, with a median age of 24 y. Renal histology slides from these patients were assessed according to the World Health Organization classification, and were distributed as follows: class I (n = 3, 6%); class II (n = 14, 28%); class III (n = 11, 22%); class IV (n = 19, 38%); class V (n = 1, 2%); class VI (n = 2, 4%). All the patients received oral prednisone, in addition the following treatments were used: pulse intravenous (i.v.) cyclophosphamide (n = 23, 46%); azathioprine (n = 22, 44%); pulse i.v. steroids (n = 19, 38%); chloroquine sulfate (n = 17, 34%); methotrexate (n = 5, 10%); and plasmapheresis (n = 2, 4%). The median duration of follow-up was 5 y (range 1-33 y). On their last evaluation, out of 37 patients who were followed, 20 patients (54%) had controlled disease, eight patients (22%) were still on active medical treatment, four patients (11%) were on chronic hemodialysis, and five patients (13%) had died. Unlike three other Arab populations studies from Kuwait, United Arab Emirates and Saudi Arabia, where the most frequent histopathologic abnormality was class III, diffuse proliferative LN (class IV) was the most common type of lupus nephritis in Lebanon, similarly to reports from USA, France, Netherlands, South Africa, Thailand and Taiwan.

Autoerythrocyte sensitization (Gardner-Diamond) syndrome.

We describe the clinical presentation and course of a patient with autoerythrocyte sensitization (Gardner-Diamond) syndrome, and review the literature for similar cases. A 37-yr-old female presented with recurrent episodes of painful ecchymotic bruising over the anterior aspect of both thighs. These episodes were precipitated by emotional stress. The diagnosis was confirmed by induction of similar lesions by intradermal injection of the patient's own washed red blood cells and hemoglobin. The lesions did not recur for 6 months after the cause of her emotional stress was relieved. Autoerythrocyte sensitization (Gardner-Diamond) syndrome should be considered in the differential diagnosis of purpura, especially in patients with psychiatric problems.

Peritoneal sarcoidosis: case report and review of the literature.

OBJECTIVES: This study was performed to report a patient with peritoneal sarcoidosis and review the literature for similar cases. METHODS: We described the clinical presentation, course, and outcome of the patient, and reviewed the medical literature from 1966 till 1997 using MEDLINE and the key words sarcoidosis, scar, and peritoneum. RESULTS: Our patient presented with a rapidly growing tumor-like mass at the site of an old appendectomy scar. Laparoscopy showed a large peritoneal mass and multiple small peritoneal nodules that were found to be noncaseating granulomas by pathology. The MEDLINE search uncovered only 16 cases of peritoneal sarcoidosis, most of which presented with ascites. CONCLUSION: This case illustrates the need to consider sarcoidosis, in addition to infections and neoplasms, in the differential diagnosis of peritoneal nodules and exudative ascites.

Takayasu's arteritis presenting as fever of unknown origin: report of two cases and literature review.

OBJECTIVES: This study reports two patients with Takayasu's arteritis presenting with a fever of unknown origin (FUO) and reviews the literature on that association. METHODS: We describe the clinical presentation, course, and outcome of the two patients, and reviewed the medical literature from 1968 till 1997 using MEDLINE and the key words fever, diagnosis, and Takayasu's arteritis. RESULTS: Takayasu's arteritis is rarely reported as a cause of FUO. Noninvasive diagnostic techniques such as magnetic resonance imaging, computed tomography scanning, gallium-67 scintigraphy, and ultrasonography may help in the diagnosis of Takayasu's arteritis in the prepulseless stage. CONCLUSION: Takayasu's arteritis should be considered in the differential diagnosis of FUO, especially in young women.