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Bendstrup E, Lynn E, Troldborg A. Systemic Lupus Erythematosus-related Lung Disease. Semin Respir Crit Care Med 2024; 45:386-396. [PMID: 38547915 DOI: 10.1055/s-0044-1782653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/24/2024]
Abstract
Systemic Lupus Erythematosus (SLE) is a multifaceted, multisystem autoimmune disorder with diverse clinical expressions. While prevalence reports vary widely, pulmonary involvement accounts for significant morbidity and mortality in SLE. This comprehensive review explores the spectrum of pulmonary disease in SLE, including upper airway manifestations (e.g., laryngeal affection), lower airway conditions (e.g., bronchitis, bronchiolitis, bronchiectasis), parenchymal diseases (e.g., interstitial lung disease, acute lupus pneumonitis, diffuse alveolar hemorrhage), pleural diseases (e.g., serositis, shrinking lung syndrome), and vascular diseases (e.g., pulmonary arterial hypertension, pulmonary embolism, acute reversible hypoxemia syndrome). We discuss diagnostic modalities, treatment strategies, and prognosis for each pulmonary manifestation. With diagnostics remaining a challenge and with the absence of standardized treatment guidelines, we emphasize the need for evidence-based guidelines to optimize patient care and improve outcomes in this complex disease.
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Affiliation(s)
- Elisabeth Bendstrup
- Center for Rare Lung Disease, Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Evelyn Lynn
- Department of Respiratory Medicine, St. Vincent's University Hospital, Dublin, Ireland
- School of Medicine, University College Dublin, Dublin, Ireland
| | - Anne Troldborg
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark
- Biomedicine, Aarhus University, Aarhus, Denmark
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Motoda A, Matsubara T, Tanei Z, Sakashita Y, Yamazaki M, Kawakami I, Sengoku R, Arai T, Maruyama H, Saito Y, Murayama S. Morphological study of the phrenic nerve to determine a reference value for the myelinated fiber density in elderly individuals. Neuropathology 2022; 43:129-134. [PMID: 37005009 DOI: 10.1111/neup.12856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 07/12/2022] [Accepted: 07/22/2022] [Indexed: 12/01/2022]
Abstract
Phrenic nerves (PNs) play an important role in respiration; however, very few morphological studies have assessed them. This study aimed to provide control reference values, including the density of large and small myelinated PN fibers, for future pathological studies. We assessed a total of nine nerves from eight cases among consecutive autopsy cases registered to the Brain Bank for Aging Research between 2018 and 2019 (five men and three women, mean age 77.0 ± 7.0 years). The nerves were sampled distally, and their structures were analyzed using semi-thin sections stained with toluidine blue. The mean and standard deviation of the density of each myelinated fiber of the PN was 6908 ± 1132 fibers/mm2 (total myelinated fiber), 4095 ± 586 fibers/mm2 (large diameter myelinated fiber; diameter ≥7 μm), and 2813 ± 629 fibers/mm2 (small diameter myelinated fiber; diameter <7 μm). There was no correlation between myelinated fiber density and age. This study provides the density measurement of the human PN myelinated fiber, and these findings can be used as reference values for the PN in elderly individuals.
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Affiliation(s)
- Atsuko Motoda
- Department of Neuropathology (the Brain Bank for Aging Research) Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology Tokyo Japan
- Department of Pathology Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology Tokyo Japan
- Department of Clinical Neuroscience and Therapeutics Hiroshima University Graduate School of Biomedical and Health Sciences Hiroshima Japan
| | - Tomoyasu Matsubara
- Department of Neuropathology (the Brain Bank for Aging Research) Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology Tokyo Japan
- Department of Clinical Neuroscience and Therapeutics Hiroshima University Graduate School of Biomedical and Health Sciences Hiroshima Japan
| | - Zen‐ichi Tanei
- Department of Neuropathology (the Brain Bank for Aging Research) Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology Tokyo Japan
| | - Yasuhiro Sakashita
- Department of Neuropathology (the Brain Bank for Aging Research) Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology Tokyo Japan
- Department of Pathology Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology Tokyo Japan
| | - Mikihiro Yamazaki
- Department of Neuropathology (the Brain Bank for Aging Research) Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology Tokyo Japan
| | - Ito Kawakami
- Department of Neuropathology (the Brain Bank for Aging Research) Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology Tokyo Japan
| | - Renpei Sengoku
- Department of Neuropathology (the Brain Bank for Aging Research) Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology Tokyo Japan
| | - Tomio Arai
- Department of Pathology Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology Tokyo Japan
| | - Hirofumi Maruyama
- Department of Clinical Neuroscience and Therapeutics Hiroshima University Graduate School of Biomedical and Health Sciences Hiroshima Japan
| | - Yuko Saito
- Department of Neuropathology (the Brain Bank for Aging Research) Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology Tokyo Japan
| | - Shigeo Murayama
- Department of Neuropathology (the Brain Bank for Aging Research) Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology Tokyo Japan
- The Brain Bank for Neurodevelopmental, Neurological and Psychiatric Disorders United Graduate School of Child Development, Osaka University Osaka Japan
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Choudhury S, Ramos M, Anjum H, Ali M, Surani S. Shrinking Lung Syndrome: A Rare Manifestation of Systemic Lupus Erythematosus. Cureus 2020; 12:e8216. [PMID: 32582477 PMCID: PMC7306665 DOI: 10.7759/cureus.8216] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Shrinking lung syndrome (SLS) is a pulmonary complication of systemic lupus erythematosus (SLE) characterized by dyspnea, pleuritic chest pain, and progressive decrease in lung volumes with no evidence of pleural or interstitial disease on chest CT. We present a 51-year-old female with a 14-year history of SLE with symptoms of progressive shortness of breath, pleuritic chest pains, low grade fevers, and productive cough which was unresponsive to multiple courses of antibiotics. After careful review of her course of SLE and timeline of symptoms, she was diagnosed with SLS. Even though rare, clinicians should have a high suspicion of SLS in patients with a long-term history of SLE and worsening dyspnea. Early treatment can be initiated to help reduce long-term morbidity and mortality and maintain the quality of life.
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Affiliation(s)
- Saiara Choudhury
- Internal Medicine, Corpus Christi Medical Center, Corpus Christi, USA
| | - Manuel Ramos
- Pulmonary Medicine, Corpus Christi Medical Center, Corpus Christi, USA
| | - Humayun Anjum
- Pulmonary/Critical Care Medicine, Corpus Christi Medical Center, Corpus Christi, USA
| | - Mohammed Ali
- Pulmonary/Critical Care Medicine, Corpus Christi Medical Center, Corpus Christi, USA
| | - Salim Surani
- Internal Medicine, Corpus Christi Medical Center, Corpus Christi, USA.,Internal Medicine, University of North Texas, Dallas, USA
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Oud KTM, Bresser P, ten Berge RJM, Jonkers RE. The shrinking lung syndrome in systemic lupus erythematosus: improvement with corticosteroid therapy. Lupus 2016; 14:959-63. [PMID: 16425576 DOI: 10.1191/0961203305lu2186cr] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Respiratory manifestations of systemic lupus erythematosus (SLE) are frequent. The ‘shrinking lung syndrome’ (SLS) represents a rare complication of SLE. The pathogenesis and therapy of the SLS remains controversial. We report a series of five consecutive cases with the SLS of which we provide a detailed description of the extent and dynamics of the response to corticosteroid therapy.
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Affiliation(s)
- K T M Oud
- Pulmonology Department, Division of Clinical Immunology & Rheumatology, Academic Medical Centre, Amsterdam, The Netherlands
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Colaci M, Cassone G, Manfredi A, Sebastiani M, Giuggioli D, Ferri C. Neurologic Complications Associated with Sjögren's Disease: Case Reports and Modern Pathogenic Dilemma. Case Rep Neurol Med 2014; 2014:590292. [PMID: 25161786 PMCID: PMC4139080 DOI: 10.1155/2014/590292] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Revised: 07/14/2014] [Accepted: 07/18/2014] [Indexed: 12/14/2022] Open
Abstract
Objectives. Sjögren's syndrome (SS) may be complicated by some neurological manifestations, generally sensory polyneuropathy. Furthermore, involvement of cranial nerves was described as rare complications of SS. Methods. We reported 2 cases: the first one was a 40-year-old woman who developed neuritis of the left optic nerve as presenting symptom few years before the diagnosis of SS; the second was a 54-year-old woman who presented a paralysis of the right phrenic nerve 7 years after the SS onset. An exhaustive review of the literature on patients with cranial or phrenic nerve involvements was also carried out. Results. To the best of our knowledge, our second case represents the first observation of SS-associated phrenic nerve mononeuritis, while optic neuritis represents the most frequent cranial nerve involvement detectable in this connective tissue disease. Trigeminal neuropathy is also frequently reported, whereas neuritis involving the other cranial nerves is quite rare. Conclusions. Cranial nerve injury is a harmful complication of SS, even if less commonly recorded compared to peripheral neuropathy. Neurological manifestations may precede the clinical onset of SS; therefore, in patients with apparently isolated cranial nerve involvement, a correct diagnosis of the underlying SS is often delayed or overlooked entirely; in these instances, standard clinicoserological assessment is recommendable.
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Affiliation(s)
- Michele Colaci
- Chair and Rheumatology Unit, Medical School, Azienda Ospedaliero-Universitaria, University of Modena and Reggio Emilia, Policlinico di Modena, Via del Pozzo 71, 41100 Modena, Italy
| | - Giulia Cassone
- Chair and Rheumatology Unit, Medical School, Azienda Ospedaliero-Universitaria, University of Modena and Reggio Emilia, Policlinico di Modena, Via del Pozzo 71, 41100 Modena, Italy
| | - Andreina Manfredi
- Chair and Rheumatology Unit, Medical School, Azienda Ospedaliero-Universitaria, University of Modena and Reggio Emilia, Policlinico di Modena, Via del Pozzo 71, 41100 Modena, Italy
| | - Marco Sebastiani
- Chair and Rheumatology Unit, Medical School, Azienda Ospedaliero-Universitaria, University of Modena and Reggio Emilia, Policlinico di Modena, Via del Pozzo 71, 41100 Modena, Italy
| | - Dilia Giuggioli
- Chair and Rheumatology Unit, Medical School, Azienda Ospedaliero-Universitaria, University of Modena and Reggio Emilia, Policlinico di Modena, Via del Pozzo 71, 41100 Modena, Italy
| | - Clodoveo Ferri
- Chair and Rheumatology Unit, Medical School, Azienda Ospedaliero-Universitaria, University of Modena and Reggio Emilia, Policlinico di Modena, Via del Pozzo 71, 41100 Modena, Italy
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The association between autoantibodies and peripheral neuropathy in lupus nephritis. BIOMED RESEARCH INTERNATIONAL 2014; 2014:524940. [PMID: 24864250 PMCID: PMC4017733 DOI: 10.1155/2014/524940] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Revised: 03/29/2014] [Accepted: 03/31/2014] [Indexed: 01/01/2023]
Abstract
Background and Aim. The sensitivity and specificity of biomarkers used for predicting peripheral neuropathy in patients with systemic lupus erythematosus (SLE) and nephritis (SLE-LN) remain unsatisfactory. This study aimed to determine the autoantibodies levels in SLE-LN patients with peripheral neuropathy. Methods. Data of 559 SLE-LN patients were collected retrospectively, including titers of autoantibodies, electrodiagnostic studies, and clinical manifestations. Results. The neurologic manifestations of the SLE-LN patients were diverse and nonspecific. The prevalence rate of peripheral polyneuropathy was 2.68%, of which about 73.33% was mixed sensory-motor polyneuropathy. Numbness and functional gastrointestinal problems were the most prevalent symptoms and these were noted in every subtype of peripheral neuropathy. Among all the serology markers, anti-Ro was significantly associated with neuropathy related to SLE (P = 0.009). Conclusion. Peripheral neuropathy among LN patients is rare and may be easily overlooked. This study demonstrated that positive anti-Ro antibody may imply neuropathy in LN patients. Thus, anti-Ro can be considered a biomarker that should be added to the panel of conventional autoantibodies in LN patients.
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Taverner D, Gómez-Puerta JA. Disnea en una paciente con lupus eritematoso sistémico. ACTA ACUST UNITED AC 2009; 5:88-91. [DOI: 10.1016/j.reuma.2008.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2008] [Accepted: 07/10/2008] [Indexed: 11/28/2022]
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