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Çomçali S, Topçu Yilmaz P, Çavdarli C, Coşkun Ç, Maraş Y, Aşlar Z, Alp MN. Macula and optic disc vessel density analyses in systemic lupus erythematosus with optical coherence tomography angiography. Medicine (Baltimore) 2023; 102:e35835. [PMID: 37904394 PMCID: PMC10615413 DOI: 10.1097/md.0000000000035835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 10/06/2023] [Indexed: 11/01/2023] Open
Abstract
To evaluate the optical coherence tomography angiography (OCT-A) findings in patients with systemic lupus erythematosus (SLE). Twenty-eight eyes of 28 patients with SLE and 27 eyes of 27 age and sex matched healthy controls were enrolled in this cross-sectional study. The vessel densities in the macula and optic disc were evaluated using the OCT-A (Optovue, Inc., Freemont, CA). Foveal retinal thickness, retinal vascular density in superficial capillary plexus (SCP), deep capillary plexus, and choriocapillaris, foveal avascular zone (FAZ), acircularity index, foveal vessel density (FD), and non-flow area in the superficial retina, the capillary and all-vessels density in the peripapillary area and the inside-disc area were automatically measured using Angiovue software of OCT-A and compared between the groups. The foveal, parafoveal and perifoveal retinal vessel densities in the superficial and deep capillary plexus and choriocapillaris were similar between groups. FAZ area, FAZ perimetry, acirculatory index, FD and non-flow area did not show a statistically significant difference. The vessel density in the inside disc area was significantly lower in patients with SLE (46.3 ± 3.8%) compared to the control group (49.1 ± 4.8%) (P = .02). Our results demonstrate significant decrement in vessel density in the inside-disc area in patients with SLE. The lower vessel density measurement in the inside-disc area might be associated with early neurologic vascular impairment in SLE. Further studies are required to determine the clinical relevance of this finding.
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Affiliation(s)
- Sebile Çomçali
- Department of Ophthalmology, Ankara Bilkent City Hospital, Ankara, Turkey
| | | | - Cemal Çavdarli
- Department of Ophthalmology, Ankara Bilkent City Hospital, Ankara, Turkey
| | - Çiğdem Coşkun
- Department of Ophthalmology, Ankara Bilkent City Hospital, Ankara, Turkey
| | - Yüksel Maraş
- Department of Rheumatology, Ankara Bilkent City Hospital, Ankara, Turkey
| | - Zeynep Aşlar
- Department of Rheumatology, Ankara Bilkent City Hospital, Ankara, Turkey
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Jianing W, Jingyi X, Pingting Y. Neuropsychiatric lupus erythematosus: Focusing on autoantibodies. J Autoimmun 2022; 132:102892. [PMID: 36030137 DOI: 10.1016/j.jaut.2022.102892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 08/05/2022] [Indexed: 10/15/2022]
Abstract
Patients with systemic lupus erythematosus (SLE) frequently suffer from nervous system complications, termed neuropsychiatric lupus erythematosus (NPLE). NPLE accounts for the poor prognosis of SLE. Correct attribution of NP events to SLE is the primary principle in managing NPLE. The vascular injuries and neuroinflammation are the fundamental neuropathologic changes in NPLE. Specific autoantibody-mediated central nerve system (CNS) damages distinguish NPLE from other CNS disorders. Though the central antibodies in NPLE are generally thought to be raised from the periphery immune system, they may be produced in the meninges and choroid plexus. On this basis, abnormal activation of microglia and disease-associated microglia (DAM) should be the common mechanisms of NPLE and other CNS disturbances. Improved understanding of both characteristic and sharing features of NPLE might yield further options for managing this disease.
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Affiliation(s)
- Wang Jianing
- Department of Rheumatology and Immunology, The First Hospital of China Medical University, Shenyang, 110001, People's Republic of China
| | - Xu Jingyi
- Department of Rheumatology and Immunology, The First Hospital of China Medical University, Shenyang, 110001, People's Republic of China
| | - Yang Pingting
- Department of Rheumatology and Immunology, The First Hospital of China Medical University, Shenyang, 110001, People's Republic of China.
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Liu KY, Chao HM, Lu YJ, Su YS, Lee WS. Cytomegalovirus proctitis in non-human immunodeficiency virus infected patients: A case report and literature review. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2021; 55:154-160. [PMID: 34764027 DOI: 10.1016/j.jmii.2021.10.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 10/12/2021] [Accepted: 10/16/2021] [Indexed: 02/06/2023]
Abstract
Cytomegalovirus (CMV) infection is associated with significant morbidity and mortality in both immunocompetent and immunocompromised patients. CMV is a ubiquitous Herpesviridae virus with a wide spectrum of pathologies in humans. Immunocompetent patients generally develop a benign, self-limited mononucleosis-like syndrome, whereas gastrointestinal tissue-invasive disease is more frequently seen in immunocompromised. The clinical manifestations of CMV colitis or proctitis are demarcated by bloody diarrhea, ulcerations, ulcero-infiltrative changes, and pseudomembranous formation on colonoscopy. Gastrointestinal CMV infections complicated with deep rectal ulcer and fistula formation are rare in patients with systemic lupus erythematosus. Ganciclovir is also the gold standard therapy for CMV colitis or proctitis.
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Affiliation(s)
- Kai-Yuan Liu
- Department of Surgery, Wan Fang Medical Center, Taipei Medical University, Taipei, Taiwan
| | - Hsiao-Mei Chao
- Department of Pathology, Wan Fang Medical Center, Taipei Medical University, Taipei, Taiwan
| | - Yen-Jung Lu
- Division of Colorectal Surgery, Department of Surgery, Wan Fang Medical Center, Taipei Medical University, Taipei, Taiwan
| | - Ying-Shih Su
- Division of Infectious Diseases, Department of Internal Medicine, Wan Fang Medical Center, Taipei Medical University, Taipei, Taiwan
| | - Wen-Sen Lee
- Division of Infectious Diseases, Department of Internal Medicine, Wan Fang Medical Center, Taipei Medical University, Taipei, Taiwan; Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
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Dedina L, Hassall MM, Jesudason S, Simon S. Pallid Disc Oedema in a Young Patient: Clinical and Diagnostic Challenge. Neuroophthalmology 2021; 46:95-98. [DOI: 10.1080/01658107.2020.1867873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Affiliation(s)
- Liana Dedina
- Ophthalmology Unit, Royal Adelaide Hospital, Adelaide, Australia
- Ophthalmology Unit, The Queen Elizabeth Hospital, Woodville South, Australia
| | - Mark M. Hassall
- Ophthalmology Unit, Royal Adelaide Hospital, Adelaide, Australia
- Ophthalmology Unit, The Queen Elizabeth Hospital, Woodville South, Australia
| | | | - Sumu Simon
- Ophthalmology Unit, Royal Adelaide Hospital, Adelaide, Australia
- Ophthalmology Unit, The Queen Elizabeth Hospital, Woodville South, Australia
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Carrión-Barberà I, Salman-Monte TC, Vílchez-Oya F, Monfort J. Neuropsychiatric involvement in systemic lupus erythematosus: A review. Autoimmun Rev 2021; 20:102780. [PMID: 33609799 DOI: 10.1016/j.autrev.2021.102780] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 12/31/2020] [Indexed: 02/07/2023]
Abstract
The neuropsychiatric involvement in systemic lupus erythematosus (NPSLE) is a challenge for clinicians, both at a diagnostic and therapeutic level. Although in 1999 the American College of Rheumatology (ACR) proposed a set of definitions for 19 NPSLE syndromes, with the intention of homogenizing the terminology for research purposes and clinical practice, the prevalence of NPSLE varies widely according to different series and is estimated to be between 37 and 95%. This is due to multiple factors such as the unalike definitions used, the diverse design of the studies, type of population, race, type and severity of symptoms, and follow-up of the different cohorts of patients with SLE. In recent years, some authors have tried excluding minor neuropsychiatric manifestations in order to try to reduce this wide variation in the prevalence of NPSLE since they are very prevalent in the general population; others authors have developed various models for the attribution of neuropsychiatric events to SLE that can assist clinicians in this diagnostic process, and finally, some authors developed and validated in 2014 a new algorithm based on the definitions of the ACR that includes the evaluation of the patient's lupus activity together with imaging techniques and the analysis of cerebrospinal fluid (CSF), with the aim of trying to differentiate the true neuropsychiatric manifestations attributable to SLE. In 2010, the European League Against Rheumatism (EULAR) developed recommendations for the management of NPSLE. We found abundant literature published later where, in addition to the recommendations for the management of the 19 NPSLE syndromes defined by the ACR, additional recommendations are given for other neurological and/or psychiatric syndromes, conditions, and complications that have been associated to SLE in recent years. We review below the diagnostic and therapeutic management of the different entities.
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Affiliation(s)
| | | | - F Vílchez-Oya
- Rheumatology Department, Hospital del Mar/Parc de Salut Mar-IMIM, Spain.
| | - Jordi Monfort
- Rheumatology Department, Hospital del Mar/Parc de Salut Mar-IMIM, Spain.
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Abstract
Systemic lupus erythematosus (SLE) is a chronic inflammatory disease with a wide variety of clinical presentations as a result of its effect on several organ systems. Optic nerve involvement in SLE is very uncommon, but optic neuritis can be the initial manifestation of SLE. A previously healthy 47-year-old woman developed blurring of vision in the left eye for the last three weeks and associated periorbital pain that worsened with eye movement. On a review of systems, she reported a photosensitivity rash, painless oral ulcers, and generalized arthralgia. On examination, she had relative afferent pupillary defect (RAPD) in the left eye. A visual field analysis revealed bilateral arcuate defects. Positive antinuclear antibodies (ANA), anti-beta2-glycoprotein I, and low complement levels of C4 were found consistent with the diagnosis of SLE. We present a case of optic neuropathy as the initial manifestation of SLE in a 47-year-old lady and an associated review of the literature.
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Affiliation(s)
- Salman Zahid
- Internal Medicine, Hayatabad Medical Complex, Peshawar, PAK
| | - Mustafa Iqbal
- Ophthalmology, Khyber Teaching Hospital, Peshawar, PAK
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