An unusual case of systemic lupus erythematosus with isolated hypoglossal nerve palsy, fulminant acute pneumonitis, and pulmonary amyloidosis

Swallowing disturbance due to isolated vagus nerve involvement in systemic lupus erythematosus

Neuropsychiatric lupus is a well-recognized complication of systemic lupus erythematosus (SLE) and encompasses a wide variety of neurological manifestations. Although isolated cranial nerve involvement is rare, it can cause significant morbidity and disability. This report describes a case with isolated vagus nerve involvement as the principal sign of central nervous system involvement. A 30-year-old female with SLE had one short course of lupus-associated psychosis in December 2001. In August 2002, the patient suffered from progressive swallowing difficulty, developed a transient episode of hypercapnic respiratory failure and required nasogastric tube feeding due to isolated vagus nerve involvement. Magnetic resonance imaging revealed a subtle but distinct brainstem lesion over the ponto-medullary junction, near the location of the vagus nerve nuclei. The patient completely recovered three weeks later following treatment with intravenous dexamethasone. This report also discusses the differential diagnosis of this rare condition. Lupus (2007) 16, 746—749.

Isolated partial, transient hypoglossal nerve injury following acupuncture

We report a case of isolated unilateral hypoglossal nerve injury following ipsilateral acupuncture for migraines in a 53-year-old lady. The palsy was partial, with no associated dysarthria, and transient. Further examination and imaging was negative. Cranial nerve injuries secondary to acupuncture are not reported in the literature, but are a theoretical risk given the location of the cranial nerves in the neck. Anatomical knowledge is essential in those administering the treatment, and those reviewing patients with possible complications.

Unusual diffuse pulmonary amyloidosis in systemic lupus erythematosus: computed tomography findings

Pulmonary involvement is a common feature in systemic lupus erythematosus (SLE) patients. This may include pleuritis, pneumonitis, and pulmonary hemorrhage. However, the presence of diffuse consolidation on chest radiographs is less common, and is usually interpreted as pneumonia. Moreover, consolidations with massive calcifications are a relatively rare manifestation. The association of pulmonary amyloidosis and SLE seems quite unusual, and has rarely been described. We report a patient with SLE and massive multiple calcified consolidations on radiologic images, which were confirmed as secondary amyloidosis.

Amyloid A amyloidosis and systemic lupus erythematosus

Amyloid A (AA) amyloidosis occurs secondary to long-standing inflammation and causes nephropathy and various internal manifestations, which leads to mortality. It is very rare in some rheumatic diseases, such as systemic lupus erythematosus (SLE). Therefore, there are few articles that report AA amyloidosis in SLE. This article focuses on the previously reported cases of 24 patients with SLE that are complicated by AA amyloidosis, and on the underlying mechanisms.

Cryptococcal meningitis presenting with isolated sixth cranial nerve palsy in a patient with systemic lupus erythematosus

Cryptococcal meningitis is a rare complication of systemic lupus erythematosus (SLE). The nonspecific neurologic findings associated with this infection delays accurate diagnosis because initial neuropsychiatric manifestations of SLE are in instances indistinguishable from that of crytococcal meningitis. We report a case of cryptococcal meningitis presenting with unilateral sixth cranial nerve palsy in a male patient with SLE, which was successfully treated with antifungal agents.

AA amyloidosis associated with systemic lupus erythematosus: impact on clinical course and outcome

Secondary amyloidosis (AA amyloidosis) has rarely been described in patients with systemic lupus erythematosus (SLE). We, herein, present a 56-year-old female patient, who developed AA amyloidosis following a 22-year history of SLE. She developed severe mitral regurgitation complicated with chordae tendinea rupture that led to acute congestive heart failure and went on a mitral valve replacement, where no flare symptoms of SLE were present. Three months after the operation, she presented with a nephrotic-range proteinuria, acute renal failure, and severe sepsis. She was found to have new vegetations on replaced valve and multi-organ failure caused her death. Re-evaluation of the excised mitral valve revealed AA amyloid deposition. Post-mortem biopsies from the kidney and bone marrow also revealed secondary amyloidosis.

Oral manifestations and differential diagnosis of isolated hypoglossal nerve palsy: report of two cases

Isolated hypoglossal nerve palsy is rare, but occasionally it appears as the initial or solitary sign of an intracranial or extracranial space-occupying lesion, a head and neck injury, or a vascular abnormality of the internal carotid artery. Therefore it should be considered in differential diagnosis. We report two cases of isolated unilateral hypoglossal nerve palsy. In Case 1 the cause of the palsy appeared to be hypoglossal nerve neurilemmoma within the hypoglossal canal, whereas in Case 2 the cause could not be identified. Neither patient complained of any disability other than slight dysarthria. The tongue deviated toward the healthy side at rest and toward the affected side on protrusion. Hemiatrophy of the tongue with fatty displacement was demonstrated by means of T1-weighted magnetic resonance imaging. Dentists who might at times see patients with isolated hypoglossal nerve palsy should be aware of the significance of its oral manifestation, and they should be able to perform differential diagnosis of patients with the condition who appear for treatment.

When does amyloidosis complicate systemic lupus erythematosus?

Secondary amyloidosis is a well recognised complication of rheumatic diseases, but the association with systemic lupus erythematosus is very unusual. We report the case of a patient with systemic lupus erythematosus who developed proteinuria due to renal amyloidosis. We also review the cases previously reported and the hypothesis on the pathogenic mechanisms.

Hepatic amyloidosis associated with systemic lupus erythematosus

The association between amyloidosis and systemic lupus erythematosus has rarely been described. We report a case of a 37-year-old man with a long-standing SLE who developed clinical and laboratory signs of hepatic dysfunction. A liver biopsy revealed secondary amyloidosis.

Pulmonary amyloidosis and unusual lung involvement in SLE

The association of systemic lupus erythematosus (SLE) with amyloidosis is exceptional. We present a 37-year-old patient who was diagnosed five months earlier for SLE. She developed an acute episode of chest pain, cough and dyspnoea. Hypoxemia and obstructive changes in respiratory tests were present. The chest X-ray was repeatedly normal. Open lung biopsy revealed lupus pneumonitis with positive stain for immunoglobulins and complement, bronchiolitis obliterans, and pulmonary amyloidosis.

Bilateral hypoglossal nerve palsies following head injury

Bilateral hypoglossal nerve palsies following head injury are very rare, with only two cases previously being reported. We present the case of an 11-year-old boy who developed this disorder after being struck by a car, and discuss the mechanism of injury, which is most likely traction on the hypoglossal nerve.

Systemic lupus erythematosus

Systemic lupus erythematosus (SLE) is the most common of the connective tissue disorders and can involve virtually any organ in the body. It is associated with pleuropulmonary manifestations in well over 50% of cases. Pleuritis with or without pleural effusion is the most common manifestation and can be particularly troublesome to manage but is rarely life-threatening. More serious manifestations in the lung include acute lupus pneumonitis with or without alveolar haemorrhage, chronic lupus pneumonitis and pulmonary hypertension. These all contribute significantly to overall mortality in SLE. The association between SLE and the antiphospholipid syndrome, leading to venous thrombosis and pulmonary embolism, is well recognized. Up to 20% of all cases of SLE present in childhood and many of these have pulmonary features at presentation or during the course of their illness. Sepsis is one of the main causes of death in SLE and pulmonary sepsis in these often immunocompromised patients contributes a significant proportion. Several drugs can produce a clinical syndrome that has many of the clinical and immunological features of SLE. Pleuritis may be seen in up to half of these cases of drug induced SLE. The development of SLE and conditions such as sarcoidosis or asbestosis in the same patient may represent a simple coincidence but there is some evidence for a closer association between these disorders.