背景:一些流行病学研究表明,二氧化硅暴露会引发系统性红斑狼疮(SLE)的发作;然而,二氧化硅相关性SLE的临床特征尚未得到很好的研究.
方法:一名67岁患有矽肺病的男子因发烧和咳嗽就诊于基层医院。他的呼吸状况恶化了,不管抗生素药物,他被转诊到我们医院.
方法:患者出现白细胞减少,淋巴细胞减少,血肌酐升高伴蛋白尿和血尿,血清C3水平降低,抗双链DNA抗体阳性,抗核抗体,和直接Coombs测试。他被诊断为SLE。进行肾活检,患者被诊断为狼疮性肾炎(IV-G(A/C)+V级由国际肾脏病学会/肾病理学学会分类定义)。计算机断层扫描显示急性间质性肺炎,支气管肺泡灌洗液显示淋巴细胞分数升高,他被诊断出患有狼疮肺炎。
方法:开始使用泼尼松龙(50mg/天)和环磷酰胺(500mg/体)静脉注射。
结果:患者对这些疗法表现出良好的反应。他从我们医院出院,并接受了泼尼松龙的门诊治疗。他在治疗期间有巨细胞病毒和带状疱疹病毒感染,用抗病毒治疗治愈。
方法:我们搜索了关于sSLE的文献,并选择了11例病例报告和2例基于人群的研究。sSLE患者SLE表现的患病率与一般SLE相比,尤其是老年SLE。我们的肾活检报告和以前的报告表明,sSLE患者的狼疮性肾炎表现出与普通SLE患者一样的组织学模式。在病例报道的20例sSLE患者中,三名患者出现了狼疮肺炎,其中两名死亡。此外,两名患者死于细菌性肺炎,一个发展为曲霉脓肿,一个得了肺结核,还有一个患了肺癌.
结论:需要密切关注,特别是呼吸系统事件和传染病,使用免疫抑制疗法治疗二氧化硅相关SLE患者时。
BACKGROUND: Several epidemiological studies have shown that silica exposure triggers the onset of systemic lupus erythematosus (SLE); however, the clinical characteristics of silica-associated SLE have not been well studied.
METHODS: A 67-year-old man with silicosis visited a primary hospital because of a fever and cough. His respiratory condition worsened, regardless of antibiotic medication, and he was referred to our hospital.
METHODS: The patient showed leukopenia, lymphopenia, serum creatinine elevation with proteinuria and hematuria, decreased serum C3 level, and was positive for anti-double stranded DNA antibody, anti-nuclear antibody, and direct Coombs test. He was diagnosed with SLE. Renal biopsy was performed, and the patient was diagnosed with lupus nephritis (class IV-G(A/C) + V defined by the International Society of Nephrology/Renal Pathology Society classification). Computed tomography revealed acute interstitial pneumonitis, bronchoalveolar lavage fluid showed elevation of the lymphocyte fraction, and he was diagnosed with lupus pneumonitis.
METHODS: Prednisolone (50 mg/day) with intravenous cyclophosphamide (500 mg/body) were initiated.
RESULTS: The patient showed a favorable response to these therapies. He was discharged from our hospital and received outpatient care with prednisolone slowly tapered off. He had cytomegalovirus and herpes zoster virus infections during treatment, which healed with antiviral therapy.
METHODS: We searched for the literature on sSLE, and selected 11 case reports and 2 population-based studies. The prevalence of SLE manifestations in sSLE patients were comparative to that of general SLE, particularly that of elderly-onset SLE. Our renal biopsy report and previous reports indicate that lupus nephritis of sSLE patients show as various histological patterns as those of general SLE patients. Among the twenty sSLE patients reported in the case articles, three patients developed lupus pneumonitis and two of them died of it. Moreover, two patients died of bacterial pneumonia, one developed aspergillus abscesses, one got pulmonary tuberculosis, and one developed lung cancer.
CONCLUSIONS: Close attention is needed, particularly for respiratory system events and infectious diseases, when treating patients with silica-associated SLE using immunosuppressive therapies.