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Coexistence of sickle cell disease and systemic lupus erythematosus is associated with quantitative and qualitative impairments in circulating regulatory B cells. Hum Immunol 2022; 83:818-825. [DOI: 10.1016/j.humimm.2022.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Revised: 09/15/2022] [Accepted: 09/19/2022] [Indexed: 11/20/2022]
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Li-Thiao-Te V, Uettwiller F, Quartier P, Lacaille F, Bader-Meunier B, Brousse V, de Montalembert M. Coexistent sickle-cell anemia and autoimmune disease in eight children: pitfalls and challenges. Pediatr Rheumatol Online J 2018; 16:5. [PMID: 29343274 PMCID: PMC5772694 DOI: 10.1186/s12969-017-0221-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2017] [Accepted: 12/26/2017] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Patients with sickle cell disease (SCD) present a defective activation of the alternate complement pathway that increases the risk of infection and is thought to predispose to autoimmune disease (AID). However, coexisting AID and SCD is rarely reported, suggesting possible underdiagnosis due to an overlapping of the symptoms. STUDY DESIGN Among 603 patients with SCD followed between 1999 and June 2016, we retrospectively searched for patients with coexisting SCD and AID. RESULTS We identified 8 patients aged from 7 to 17 years diagnosed with AID; juvenile idiopathic arthritis (n = 3), systemic lupus erythematosus (n = 2), Sjögren's syndrome (n = 1) and autoimmune hepatitis (n = 2). The diagnosis of AID was often delayed due to similarities of the symptoms with those of SCD. Patients treated with steroids experienced multiple vaso-occlusive crises and received prophylactic chronic blood transfusions when it was possible. Tolerance to other immunosuppressive and biological treatments, such as anti-TNF agents, was good. A remission of AID was achieved in 4 patients, without worsening the course of the SCD. One patient underwent a geno-identical hematopoietic stem cell transplantation that cured both diseases. Another one underwent a successful liver transplantation. CONCLUSION Coexistence of AID and SCD generates diagnostic and therapeutic challenges. Early diagnosis of AID is important to define the best treatment, which may include targeted biological therapy.
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Affiliation(s)
- Valerie Li-Thiao-Te
- Onco-Hématologie Pédiatrique, Centre Hospitalier Universitaire Amiens, Amiens, France.
| | - Florence Uettwiller
- 0000 0004 0593 9113grid.412134.1Unité d’Immunologie-Hématologie et Rhumatologie Pédiatrique, Centre de référence pour la Rhumatologie et les maladies Auto-immunes Systémiques de l’Enfant, Hôpital Necker-Enfants Malades, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Pierre Quartier
- 0000 0004 0593 9113grid.412134.1Unité d’Immunologie-Hématologie et Rhumatologie Pédiatrique, Centre de référence pour la Rhumatologie et les maladies Auto-immunes Systémiques de l’Enfant, Hôpital Necker-Enfants Malades, Assistance Publique Hôpitaux de Paris, Paris, France ,0000 0001 2188 0914grid.10992.33Université Paris-Descartes, Paris, France ,grid.462336.6IMAGINE Institute, Paris, France
| | - Florence Lacaille
- 0000 0004 0593 9113grid.412134.1Hépatologie-Gastroentérologie-Nutrition Pédiatrique, Hôpital Necker-Enfants Malades, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Brigitte Bader-Meunier
- 0000 0004 0593 9113grid.412134.1Unité d’Immunologie-Hématologie et Rhumatologie Pédiatrique, Centre de référence pour la Rhumatologie et les maladies Auto-immunes Systémiques de l’Enfant, Hôpital Necker-Enfants Malades, Assistance Publique Hôpitaux de Paris, Paris, France ,0000 0001 2188 0914grid.10992.33Université Paris-Descartes, Paris, France ,grid.462336.6IMAGINE Institute, Paris, France
| | - Valentine Brousse
- 0000 0004 0593 9113grid.412134.1Pédiatrie Générale, Centre de Référence des Hémoglobinopathies, Hôpital Necker-Enfants Malades, Assistance Publique Hôpitaux de Paris Labex-GR-Ex, Paris, France
| | - Mariane de Montalembert
- 0000 0004 0593 9113grid.412134.1Pédiatrie Générale, Centre de Référence des Hémoglobinopathies, Hôpital Necker-Enfants Malades, Assistance Publique Hôpitaux de Paris Labex-GR-Ex, Paris, France
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Elficki Y, Rawas A, Bossei AA, Bdawod A, Zabani R, Shams B. Coexistence of lupus nephritis and sickle cell trait, an electron microscopic assessment of renal glomerular damage: Case report of a rare association. Electron Physician 2017; 9:5298-5302. [PMID: 29038713 PMCID: PMC5633229 DOI: 10.19082/5298] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 07/11/2017] [Indexed: 11/20/2022] Open
Abstract
Because of similarities of the musculoskeletal, central nervous system, and renal manifestations in both diseases, diagnosing systemic lupus erythematosus (SLE) in sickle cell disease (SCD) patients can be difficult to establish. Although Sickle Cell Trait (SCT) is still considered a benign form of SCD, its impact on kidney injury and other renal manifestations is well recognized in the literature. In this case report, we look at the challenges that develop when diagnosing patients with a concurrence of both diseases and the importance of early recognition and treatment of lupus nephritis in SCT patients. We present a case of a male patient with sickle-cell trait who was admitted to our hospital complaining of low grade fever and pancytopenia for investigations proven to be SLE. A renal biopsy on electron microscopy assessment with different staining modalities as well as immune fluorescence revealed mixed pathological changes. We emphasize the importance in considering the presence of a coexisting autoimmune disease in a patient with sickle hemoglobinopathies even in the milder forms like SCT which may display an atypical and/or multisystem presentation. Also, the impact of the two conditions on the renal pathological changes should be expected to be more damaging even at early onset of SLE flare, and hence, an urge to start with more intensified immunosuppressive medications.
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Affiliation(s)
- Yahya Elficki
- Consultant of Internal Medicine, FRCP-UK, King Abdulaziz Hospital, Jeddah, Kingdom of Saudi Arabia
| | - Atif Rawas
- Research Assistant and Coordinator, MD, King Abdulaziz Hospital, Jeddah, Kingdom of Saudi Arabia
| | - Asseil Ali Bossei
- Research Assistant and Coordinator, MBBS student, Ibn Sina National College for Medical Science, Jeddah, Kingdom of Saudi Arabia
| | - Areej Bdawod
- Research Assistant and Coordinator, MBBS student, Ibn Sina National College for Medical Science, Jeddah, Kingdom of Saudi Arabia
| | - Reem Zabani
- Research Assistant and Coordinator, MBBS student, Ibn Sina National College for Medical Science, Jeddah, Kingdom of Saudi Arabia
| | - Bayan Shams
- Research Assistant and Coordinator, MBBS student, Ibn Sina National College for Medical Science, Jeddah, Kingdom of Saudi Arabia
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Robazzi TCM, Alves C, Abreu L, Lemos G. Coexistência de lúpus eritematoso sistêmico e doença falciforme: relato de caso e revisão da literatura. REVISTA BRASILEIRA DE REUMATOLOGIA 2015; 55:68-74. [DOI: 10.1016/j.rbr.2013.05.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2012] [Revised: 02/26/2013] [Accepted: 05/14/2013] [Indexed: 10/24/2022] Open
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Lupus nephritis in a patient with sickle cell disease. Case Rep Hematol 2013; 2013:907950. [PMID: 24312737 PMCID: PMC3838810 DOI: 10.1155/2013/907950] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Accepted: 10/02/2013] [Indexed: 11/18/2022] Open
Abstract
Introduction. The diagnosis of systemic lupus erythematosus (SLE) in patients with sickle cell disease (SCD) can be difficult to establish because the musculoskeletal, central nervous system, and renal manifestations are similar in both diseases. In the presented case, we highlight the diagnostic challenge that can evolve in patients with a concurrence of both diseases and we establish the importance of early recognition and treatment of lupus nephritis in patients with SCD. Case Presentation. We present a case of a 31-year-old African American female with sickle-C disease (hemoglobin SC) who was admitted to our hospital with complaints of periumbilical abdominal pain associated with intractable nausea and vomiting, abdominal distension, and worsening lower extremity edema. Urine studies revealed nephrotic range proteinuria and the immunological investigations were consistent with lupus. A renal biopsy revealed focal proliferative lupus nephritis. Conclusion. It is important to consider the presence of a coexisting autoimmune disease in a patient with sickle hemoglobinopathy who displays an atypical and multisystem presentation that is unresponsive to conventional therapies. When a significant kidney disease is present, a renal biopsy is critical in identifying the etiology of a renal abnormality in the setting of coexisting SLE and SCD.
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Maamar M, Tazi-Mezalek Z, Harmouche H, Mounfaloti W, Adnaoui M, Aouni M. Systemic lupus erythematosus associated with sickle-cell disease: a case report and literature review. J Med Case Rep 2012; 6:366. [PMID: 23101910 PMCID: PMC3512532 DOI: 10.1186/1752-1947-6-366] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2012] [Accepted: 09/28/2012] [Indexed: 11/17/2022] Open
Abstract
Introduction The occurrence of systemic lupus erythematosus has been only rarely reported in patients with sickle-cell disease. Case presentation We describe the case of a 23-year-old North-African woman with sickle-cell disease and systemic lupus erythematosus, and discuss the pointers to the diagnosis of this combination of conditions and also present a review of literature. The diagnosis of systemic lupus erythematosus was delayed because our patient’s symptoms were initially attributed to sickle-cell disease. Conclusions Physicians should be alerted to the possible association of sickle-cell disease and systemic lupus erythematosus so as not to delay correct diagnosis and initiation of appropriate treatment.
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Affiliation(s)
- Mouna Maamar
- Department of Internal Medicine, Ibn Sina Hospital, Rabat, Morocco.
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da Silva Junior GB, Daher EDF, da Rocha FAC. Osteoarticular involvement in sickle cell disease. Rev Bras Hematol Hemoter 2012; 34:156-64. [PMID: 23049406 PMCID: PMC3459393 DOI: 10.5581/1516-8484.20120036] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2011] [Accepted: 12/21/2011] [Indexed: 12/31/2022] Open
Abstract
The osteoarticular involvement in sickle cell disease has been poorly studied and it is mainly characterized by osteonecrosis, osteomyelitis and arthritis. The most frequent complications and those that require hospital care in sickle cell disease patients are painful vaso-occlusive crises and osteomyelitis. The deoxygenation and polymerization of hemoglobin S, which results in sickling and vascular occlusion, occur more often in tissues with low blood flow, such as in the bones. Bone microcirculation is a common place for erythrocyte sickling, which leads to thrombosis, infarct and necrosis. The pathogenesis of microvascular occlusion, the key event in painful crises, is complex and involves activation of leukocytes, platelets and endothelial cells, as well as hemoglobin S-containing red blood cells. Osteonecrosis is a frequent complication in sickle cell disease, with a painful and debilitating pattern. It is generally insidious and progressive, affecting mainly the hips (femur head) and shoulders (humeral head). Dactylitis, also known as hand-foot syndrome, is an acute vaso-occlusive complication characterized by pain and edema in both hands and feet, frequently with increased local temperature and erythema. Osteomyelitis is the most common form of joint infection in sickle cell disease. The occurrence of connective tissue diseases, including rheumatoid arthritis and systemic lupus erythematosus, has rarely been reported in patients with sickle cell disease. The treatment of these complications is mainly symptomatic, and more detailed studies are required to understand the pathophysiological mechanisms involved in the complications and propose more adequate and specific therapies.
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Affiliation(s)
- Geraldo Bezerra da Silva Junior
- Department of Internal Medicine, Faculdade de Medicina, Universidade Federal do Ceará - UFC, Fortaleza, CE, Brazil ; School of Medicine, Centro de Ciências da Saúde, Universidade de Fortaleza - UNIFOR, Fortaleza, CE, Brazil
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Chattopadhyay P, Dhua D, Philips CA. Reversible diffuse neurological deficits in systemic lupus erythematosus: Report of a case. Lupus 2011; 20:1079-85. [DOI: 10.1177/0961203310396268] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We report a case of lupus presenting with focal as well as diffuse neurological deficits with intracranial and subarachnoid haemorrhages and diffuse hyperintense lesions in T2-weighted and fluid-attenuated inversion recovery images of brain magnetic resonance imaging proved by further investigation as demyelination, which completely recovered with intravenous methylprednisolone therapy. During the patient’s hospital stay there was one episode of transient hypertensive episode lasting a few hours, promptly reverting to normal with low-dose ramipril therapy. Complete neurological and radiological recovery of such diffuse leucoencephalopathy-like central nervous system lesions has been rarely reported before.
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Affiliation(s)
- P Chattopadhyay
- Department of Medicine, Nil Ratan Sircar Medical College, Kolkata, India
| | - D Dhua
- Department of Medicine, Nil Ratan Sircar Medical College, Kolkata, India
| | - CA Philips
- Department of Medicine, Nil Ratan Sircar Medical College, Kolkata, India
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Toly-Ndour C, Rouquette AM, Obadia S, M'bappe P, Lionnet F, Hagege I, Boussa-Khettab F, Tshilolo L, Girot R. High titers of autoantibodies in patients with sickle-cell disease. J Rheumatol 2010; 38:302-9. [PMID: 21123321 DOI: 10.3899/jrheum.100667] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Frequency and titers of autoantibodies in patients with sickle-cell disease (SCD) have been reported as relatively high. In a prospective study of 88 patients, we examined this "hyper-autoreactivity" and its clinical consequences. METHODS For 1 year, patients with SCD were screened for the presence in their serum of antinuclear, anti-double-stranded DNA, antiextractible nuclear antigens, anticardiolipin antibodies, and rheumatoid factors. A population of 85 sex-matched individuals of similar ethnic origin served as controls. RESULTS Whereas prevalence of autoantibodies did not differ between the 2 groups, the type and rate of antinuclear antibodies were different. Autoantibodies from the SCD patients showed various immunofluorescence patterns, whereas only speckled patterns at low titers were present in controls. No antibody specificity was found in either group. SCD patients and controls displayed similar rates of anticardiolipin antibodies, but the SCD patients tended to be more frequently positive for rheumatoid factors. Six-year followup of the SCD patients did not provide any clinical evidence for onset of an autoimmune disease, except for 1 patient who developed rheumatoid arthritis, with increasing antinuclear antibodies followed by emergence of specific markers 5 years later. CONCLUSION Patients with SCD displayed high titers of autoantibodies. This observation may be due only to immune activation and/or dysfunction in SCD, as neither pathogenic specificity of autoantibodies nor autoimmune clinical signs appeared in the majority of cases in our study.
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Affiliation(s)
- Cécile Toly-Ndour
- Department of Immunology, Laboratory of Hematology, Tenon Hospital, AP-HP, 4 rue de la Chine, 75020 Paris, France.
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Kanodia KV, Vanikar AV, Goplani KR, Gupta SB, Trivedi HL. Sickle cell nephropathy with diffuse proliferative lupus nephritis: a case report. Diagn Pathol 2008; 3:9. [PMID: 18307766 PMCID: PMC2275218 DOI: 10.1186/1746-1596-3-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2007] [Accepted: 02/28/2008] [Indexed: 12/02/2022] Open
Abstract
Background Sickle cell nephropathy (SCN) is an important cause of mortality in patients with sickle cell disease. SCA with systemic lupus erythematosus (SLE) is known in children and less common in adults, however diffuse proliferative lupus nephritis (DPLN) with SCN has rarely been reported in adults. It requires early diagnosis and aggressive management. Case presentation We present here a 35 years old lady with sickle cell disease who presented with edema, dyspnoea on exertion, pyuria and had raised s. creatinine of 7 mg%. Her biopsy revealed SCN with DPLN. She is on maintenance hemodialysis after 2 months of diagnosis. Conclusion DPLN with SCN is a rare entity with poor prognosis, which may be overlooked and needs aggressive management.
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Affiliation(s)
- Kamal V Kanodia
- Department of Pathology, Laboratory Medicine and Transfusion Services, and Immunohematology, G.R. Doshi and K.M. Mehta Institute of Kidney Diseases and Research Centre and Dr. H. L. Trivedi Institute of Transplantation Sciences, Civil Hospital Campus, Asarwa, Ahmedabad, India.
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Michel M, Habibi A, Godeau B, Bachir D, Lahary A, Galacteros F, Fifi-Mah A, Arfi S. Characteristics and outcome of connective tissue diseases in patients with sickle-cell disease: report of 30 cases. Semin Arthritis Rheum 2008; 38:228-40. [PMID: 18177923 DOI: 10.1016/j.semarthrit.2007.10.003] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2007] [Revised: 10/13/2007] [Accepted: 10/21/2007] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To analyze the main characteristics of adults with sickle cell disease (SCD) and concurrent connective tissue disease (CTD). METHODS A retrospective investigational study was performed. CTD was diagnosed according to standard international criteria. Severity of SCD was assessed by a clinical severity score. RESULTS Thirty patients, 23 women (76%) and 7 men, with hemoglobin S/S (n = 25) or S/C (n = 5) SCD were included. The subtypes of CTD were rheumatoid arthritis (RA) (n = 15), definite systemic lupus erythematosus or "incomplete lupus" requiring treatment (n = 13), primary Sjögren's syndrome with central nervous system involvement (n = 1), and systemic sclerosis (n = 1). Twenty-five of the 30 patients (83%) received steroid treatment, and 15 (50%) received at least 1 immunosuppressive agent (methotrexate in 14 cases) to control CTD. Four RA patients were given antitumor necrosis factor (TNF)alpha and 1 was treated with rituximab without SCD exacerbation. After a median follow-up of 4.5 years [range: 6 months to 30 years] from CTD diagnosis, 11 of the 25 (44%) patients receiving steroids had at least 1 episode of severe infection (mostly due to Staphylococcus aureus or Escherichia coli). SCD exacerbated in 13 of the 30 (43%) patients after CTD onset; 12 of these patients were receiving prednisone and/or methotrexate. Six patients (20%) had died from sepsis (n = 2), stroke (n = 2), or acute chest syndrome (n = 2). CONCLUSIONS CTD-related clinical manifestations and outcome were not particularly severe in patients with SCD. However, those with active CTD and undergoing steroid +/- methotrexate treatment had more serious SCD-related manifestations, a higher rate of severe infections, and an overall patient mortality rate of 20%. Thus, the management of patients with CTD and underlying SCD should consider the risk/benefit ratio of each treatment and steroid-sparing strategies should be implemented.
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Affiliation(s)
- M Michel
- Department of Internal Medicine, Henri-Mondor University Hospital, Créteil, France.
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Systemic lupus erythematosus in patients with sickle cell disease. Clin Rheumatol 2007; 27:359-64. [DOI: 10.1007/s10067-007-0779-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2007] [Revised: 10/07/2007] [Accepted: 10/08/2007] [Indexed: 10/22/2022]
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