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Marie-Angélique De Scheerder, O Boey, E Mahieu, J Vanuytsel, Anne-Marie Bogaert
We describe the case of a 26-year-old African female who was treated successfully with belimumab in a case of severe membranous lupus nephritis and retinal vasculitis, resistant to first line therapy. She presented initially with chronic dacryoadenitis and screening showed nephrotic-range proteinuria. Biopsy of the kidney confirmed the diagnosis of membranous lupus nephritis. Clinical features (joint pain, dacryoadenitis, retinal vasculitis and lupus nephritis) in combination with serology (positive anti-double-stranded DNA (ds-DNA) antibodies, hypocomplementemia) confirmed the diagnosis of systemic lupus erythematosus (SLE)...
June 2016: Clinical Rheumatology
Eduardo V Navajas, Hatem Krema, Dena S Hammoudi, Jeffrey H Lipton, E Rand Simpson, Shelley Boyd, Michael Easterbrook
OBJECTIVE: To evaluate retinal toxicity in patients treated with high-dose hydroxychloroquine (HCQ) (Plaquenil, Sanofi Pharmaceuticals) for chronic graft-versus-host disease (GVHD). DESIGN: Cohort study. PARTICIPANTS: Twelve patients with chronic GVHD treated with 800 mg/day HCQ between June 2005 and December 2010. METHODS: Patients in this study underwent ophthalmologic examination yearly and ancillary studies including colour vision, Amsler grid, fundus photographs, Humphrey 10-2 automated perimetry, spectral-domain optical coherence tomography (SD-OCT), and multifocal electroretinography (mfERG)...
December 2015: Canadian Journal of Ophthalmology. Journal Canadien D'ophtalmologie
Christina H Wei, Andrew Penunuri, George Karpouzas, Wayne Fleishman, Anuj Datta, Samuel W French
OBJECTIVES: A case of drug-induced hepatitis mediated by troxis necrosis, a form of autoimmune hepatitis, is described. METHODS: Clinical data, light and electron microscopy of an ultrasound-guided core needle liver biopsy specimen, were examined to investigate the cause of transaminitis in a 26year old male patient on Cellcept and Plaquenil for the treatment of lupus erythematosus. A systematic PUBMED review of troxis necrosis as the underlying mechanism for drug-induced hepatitis was performed...
October 2015: Experimental and Molecular Pathology
Jiunn-Min Wang, Jen-Ying Li, Wei-Chang Huang, Chih-Yu Wen, Ching-Hsiao Lee, Chin-Yao Yang, Ming-Feng Wu
BACKGROUND: A false-positive screening result is associated with harmful treatment or follow-up costs. This study aimed to estimate the rate of false positive proteinuria with the dipstick in patients with systemic lupus erythematosus (SLE) taking hydroxychloroquine. METHODS: A total of 334 patients with a positive dipstick and confirmed by total urine protein with quantification assay were enrolled. The experimental group included those with SLE taking hydroxychloroquine, and the rest was the control group...
2015: Clinical Laboratory
M Jallouli, L Galicier, N Zahr, O Aumaître, C Francès, V Le Guern, F Lioté, A Smail, N Limal, L Perard, H Desmurs-Clavel, D Le Thi Huong, B Asli, J-E Kahn, J Pourrat, L Sailler, F Ackermann, T Papo, K Sacré, O Fain, J Stirnemann, P Cacoub, G Leroux, J Cohen-Bittan, J Sellam, X Mariette, B Blanchet, J S Hulot, Z Amoura, J C Piette, N Costedoat-Chalumeau
OBJECTIVE: Blood concentrations of hydroxychloroquine (HCQ) vary widely among patients with systemic lupus erythematosus (SLE). A pharmacokinetic/pharmacodynamic relationship has been found in different situations, and a very low blood concentration of HCQ is a simple marker of nonadherence to treatment. Therefore, interest in blood HCQ concentration measurement has increased, but little is known about factors that influence blood HCQ concentration variability. This study was undertaken to analyze determinants of blood HCQ concentrations...
May 2015: Arthritis & Rheumatology
S Jaumouillé, D Espargillière, F Mouriaux, B Mortemousque
PURPOSE: To compare the results, in clinical practice, of screening procedures for hydoxychloroquine retinopathy, according to the new recommendations of the American Academy of Ophthalmology of 2011. METHODS: Hundred and eighty-four patients on long-term hydroxychloroquine underwent ophthalmologic evaluation, including fundus examination, 10.2 automated visual field, fundus autofluorescence, SD-OCT optical coherence tomography, and multifocal ERG, whenever possible, in a prospective monocentric study...
May 2015: Journal Français D'ophtalmologie
Adrian C Tsang, Sina Ahmadi Pirshahid, Gianni Virgili, Chloe C Gottlieb, John Hamilton, Stuart G Coupland
PURPOSE: To determine the validity of multifocal electroretinography (mfERG) as a screening tool for detecting chloroquine (Aralen, Sanofi Aventis, Bridgewater, NJ) (CQ) and hydroxychloroquine (Plaquenil, Covis Pharmaceuticals, Inc, Zug, Switzerland) (HCQ) retinal toxicity in patients using these medications. To evaluate the sensitivity and specificity of mfERG when compared with automated visual fields (AVFs), fundus autofluorescence (FAF), and optical coherence tomography (OCT). CLINICAL RELEVANCE: The 2011 American Academy of Ophthalmology recommendations on screening for CQ/HCQ retinopathy recommended a shift toward more objective testing modalities...
June 2015: Ophthalmology
Amy E Lin, Nadine Shehata, Heather Reich, David Barth, Carl Laskin, Stephen Lapinsky, Shital Gandhi
OBJECTIVES: We outline a case of a woman with lupus (SLE) and antiphospholipid syndrome (APLA) at 26 weeks' gestation who develops a complex multiorgan condition with a broad differential. METHODS: Case report. RESULTS: A 34 year old woman, G1P0, presented at 26 weeks gestation with a 5 day history of epigastric pain and emesis. She has a history of lupus anticoagulant (LAC), anticardiolipin (ACL) and anti-dsDNA (ADD) positive SLE and APLA syndrome diagnosed at age 13 with multiple small cerebral infarcts...
January 2015: Pregnancy Hypertension
Brittany E Yee, Casey A Carlos, Tissa Hata
BACKGROUND: Crusted scabies is a severe, hyperkeratotic, psoriasiform disorder associated with immune suppression. Affected individuals typically present with crusted hyperkeratotic lesions in a variety of locations. This condition can lead to severe complications: institutional outbreaks and secondary bacterial infections associated with sepsis and high mortality. MAIN OBSERVATIONS: A 37-year-old woman with a 12-year history of systemic lupus erythematosus treated with prednisone, methotrexate, and plaquenil presented with a three-week history of a painful scalp rash with adherent yellow scale...
2014: Dermatology Online Journal
Yoland Schoindre, Moez Jallouli, Marie-Laure Tanguy, Pascale Ghillani, Lionel Galicier, Olivier Aumaître, Camille Francès, Véronique Le Guern, Frédéric Lioté, Amar Smail, Nicolas Limal, Laurent Perard, Hélène Desmurs-Clavel, Du Le Thi Huong, Bouchra Asli, Jean-Emmanuel Kahn, Laurent Sailler, Félix Ackermann, Thomas Papo, Karim Sacré, Olivier Fain, Jérôme Stirnemann, Patrice Cacoub, Gaëlle Leroux, Judith Cohen-Bittan, Jean-Sébastien Hulot, Philippe Lechat, Lucile Musset, Jean-Charles Piette, Zahir Amoura, Jean-Claude Souberbielle, Nathalie Costedoat-Chalumeau
OBJECTIVES: Growing evidence suggests that vitamin D plays a key role in the pathogenesis and progression of autoimmune diseases, including systemic lupus erythematosus (SLE). Recent studies have found an association between lower serum 25-hydroxyvitamin D (25(OH)D) levels and higher SLE activity. We studied the relationship between 25(OH)D levels and Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) score, and we assessed for the first time the role of vitamin D in predicting SLE flare-ups...
2014: Lupus Science & Medicine
Brandon N Phillips, Dal W Chun
PURPOSE: To report an unusual case of hydroxychloroquine toxicity after short-term therapy. METHODS: Observational case report. RESULTS: A 56-year-old woman presented to the Ophthalmology Clinic at Walter Reed Army Medical Center (WRAMC) with a 6-month history of gradually decreasing vision in both eyes. The patient had been taking hydroxychloroquine for the preceding 48 months for the treatment of rheumatoid arthritis. Examination of the posterior segment revealed bilateral "bull's eye" macular lesions...
2014: Retinal Cases & Brief Reports
Karan Mahajan, Allen Burke, Whitney Burrows, Ashutosh Sachdeva
SESSION TITLE: Bronchology/Interventional Student/Resident Case Report Posters ISESSION TYPE: Medical Student/Resident Case ReportPRESENTED ON: Tuesday, October 28, 2014 at 01:30 PM - 02:30 PMINTRODUCTION: Organizing pneumonia (OP) has various etiologies and lung cancer is one of them. OP generally occurs near the vicinity of tumor, with or without airway obstruction. We present an unusual case of OP presenting as cough and bilateral lung opacities as a result of carcinoid tumor, which resolved completely with bronchoscopic partial relief of obstruction without the need for steroid therapy...
October 1, 2014: Chest
Veeral Oza, Andrea Johnson, Sheryl Pfeil
Patients with multiple comorbidities often develop decreased intestinal motility resulting in abdominal distention. A variety of etiologies such as electrolyte abnormalities, medications, and sometimes unusual anatomical pathologies are responsible for this distention. Cecal bascule represents an exceedingly rare anatomical variance that leads to abdominal distention, and mimics a potentially isolated cecal distention. This rare diagnosis, if missed, can lead to severe complications. We present a case of a 64-year-old male with a past medical history of emphysema, rheumatoid arthritis for which he was recently started on Plaquenil, and alcohol abuse who was admitted with a diffuse rash and was noted to have worsening abdominal distention...
2013: Journal of Interventional Gastroenterology
Marc Lamphier, Wanjun Zheng, Eicke Latz, Mark Spyvee, Hans Hansen, Jeffrey Rose, Melinda Genest, Hua Yang, Christina Shaffer, Yan Zhao, Yongchun Shen, Carrie Liu, Diana Liu, Thorsten R Mempel, Christopher Rowbottom, Jesse Chow, Natalie C Twine, Melvin Yu, Fabian Gusovsky, Sally T Ishizaka
The discovery that circulating nucleic acid-containing complexes in the serum of autoimmune lupus patients can stimulate B cells and plasmacytoid dendritic cells via Toll-like receptors 7 and 9 suggested that agents that block these receptors might be useful therapeutics. We identified two compounds, AT791 {3-[4-(6-(3-(dimethylamino)propoxy)benzo[d]oxazol-2-yl)phenoxy]-N,N-dimethylpropan-1-amine} and E6446 {6-[3-(pyrrolidin-1-yl)propoxy)-2-(4-(3-(pyrrolidin-1-yl)propoxy)phenyl]benzo[d]oxazole}, that inhibit Toll-like receptor (TLR)7 and 9 signaling in a variety of human and mouse cell types and inhibit DNA-TLR9 interaction in vitro...
March 2014: Molecular Pharmacology
E Mitchel Opremcak
No abstract text is available yet for this article.
2013: Insight
Moez Jallouli, Camille Francès, Jean-Charles Piette, Du Le Thi Huong, Philippe Moguelet, Cecile Factor, Noël Zahr, Makoto Miyara, David Saadoun, Alexis Mathian, Julien Haroche, Christian De Gennes, Gaelle Leroux, Catherine Chapelon, Bertrand Wechsler, Patrice Cacoub, Zahir Amoura, Nathalie Costedoat-Chalumeau
IMPORTANCE: Hydroxychloroquine-induced pigmentation is not a rare adverse effect. Our data support the hypothesis that hydroxychloroquine-induced pigmentation is secondary to ecchymosis or bruising. OBJECTIVE: To describe the clinical features and outcome of hydroxychloroquine (HCQ)-induced pigmentation in patients with systemic lupus erythematosus (SLE). DESIGN, SETTING, AND PARTICIPANTS: In a case-control study conducted at a French referral center for SLE and antiphospholipid syndrome, 24 patients with SLE, with a diagnosis of HCQ-induced pigmentation, were compared with 517 SLE controls treated with HCQ...
August 2013: JAMA Dermatology
R V Jivrajka, M A Genead, J J McAnany, C C Chow, W F Mieler
PURPOSE: The purpose of this study was to measure macular sensitivity using microperimetry in patients on Plaquenil therapy without evidence of retinopathy as assessed by recommended screening standards. METHODS: Sixteen patients from a clinical practice treated with 200 or 400 mg/day of Plaquenil for more than 5 years, without visual complaints (visual acuity 20/25 or better), and without a history of diabetes or macular disease were included. Participants underwent a complete ophthalmic examination with spectral-domain optical coherence tomography (SD-OCT), 10-2 Humphrey visual field (HVF), fundus autofluoresecene (FAF), multifocal electroretinography (mfERG), and microperimetry that covered the central 12° of the visual field...
September 2013: Eye
Norbert Gleicher, Uri Elkayam
Offspring of women with anti-SSA/Ro-SSB/La antibodies are believed to be at risk for congenital heart block (CHB). Whether this risk can be reduced, and what constitutes standard of care treatment is, however, unclear. The objective of this review therefore was to determine whether currently proposed standard of care treatments to avoid CHB in offspring of mothers at risk are evidence-based. To do so, we conducted a review of the literature under appropriate keywords and phrases in Medline/PubMed and Google Scholar for the years 2000-2013...
September 2013: Autoimmunity Reviews
Joseph Pikkel, Otzem Chassid, Adi Sharabi-Nov, Itchak Beiran
BACKGROUND: To investigate a possible structural difference in the retina of hydroxychloroquine (Plaquenil)-treated patients as an explanation for the protective effect of this medication against age-related macular degeneration (AMD). METHODS: In this retrospective study, we compared the mean thickness of the retinal outer band (consisting of the Bruch's membrane and retinal pigment epithelium layer), as measured by optical coherence tomography (OCT), of 54 eyes of 27 hydroxychloroquine-treated rheumatoid arthritis patients (study group), 40 eyes of 20 healthy similar aged individuals (control group I), and 22 eyes of 11 non-hydroxychloroquine-treated rheumatoid arthritis patients (control group II)...
July 2013: Graefe's Archive for Clinical and Experimental Ophthalmology
Elizabeth Martha Winter, Anita Schrander-van der Meer, Carmen Eustatia-Rutten, Martien Janssen
The authors report a remarkable glucose lowering side effect of the often used drug hydroxychloroquine (Plaquenil) in an otherwise healthy non-diabetic patient, who presented with severe hypoglycaemia. Although the mechanism has not been clarified yet, increased insulin sensitivity as well as decreased insulin degradation is suggested to contribute to the reduction in serum glucose levels. Clinicians prescribing this drug must be warranted and check glucose levels in the initial phase. Moreover, hydroxychloroquine might be applied as therapeutic in refractory diabetic rheumatics or rheumatic patients at risk to develop diabetes mellitus...
2011: BMJ Case Reports
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