A Fatal Case of Systemic Lupus Erythematosus Complicated with Diffuse Alveolar Hemorrhage
Parackrama Karunathilake,
Ruwanthi Jayasinghe,
Thilak Jayalath,
Shamali Abeyagunawardena,
Udaya Ralapanawa
Issue:
Volume 9, Issue 4, December 2021
Pages:
68-72
Received:
22 September 2021
Accepted:
12 October 2021
Published:
28 October 2021
Abstract: Introduction: SLE is a multisystem autoimmune disease with variable clinical presentation. DAH is a rare but catastrophic manifestation of SLE with high mortality, requiring early, intensive therapy. Case Presentation: A 31-year-old female presented with low-grade fever and joint pains for six weeks associated with alopecia, anorexia, and weight loss. She had pale and had cervical lymphadenopathy, moderate hepatomegaly, and splenomegaly. Hb level was 9.2mg/dL, with a platelet count of 144 × 103/µL. The ESR was 65mm/hour, and the CRP level was 36 mg/L with a UPCR of 332mg/g. She had low C3, C4 levels, positive ANA, and dsDNA titer. A renal biopsy revealed class 3 lupus nephritis. Twenty days after, she was readmitted with acute onset of pleuritic chest pain, cough, and dyspnea, where she was hemodynamically unstable with SpO2 of 85% on air. The Hb level was 8.6 g/dL with a platelet count of 106 × 103/µL. Her condition deteriorated despite standard medical care, where the Hb level and SpO2 dropped to 5.6 d/dL and 65%, respectively, even after blood transfusions, intubation, and artificial ventilation. The chest X-ray revealed bilateral large whitish hazy shadows, and the HRCT scan revealed diffuse bilateral pulmonary hemorrhages. Then she was transferred to the ICU, and there she was started with broad-spectrum antibiotics, methylprednisolone, and plasmapheresis. However, after one week of ICU stay, her renal functions worsened, and she was initiated on CRRT. However, despite all the resuscitation efforts, she succumbed following a cardiac arrest. Conclusion: DAH is a rare catastrophic complication of SLE, which usually presents in patients with an established diagnosis of SLE, even on medical therapy. The diagnosis of DAH is problematic because it mimics a severe pulmonary infection. Early detection and aggressive management are warranted to improve affected patients' outcomes and quality of life.
Abstract: Introduction: SLE is a multisystem autoimmune disease with variable clinical presentation. DAH is a rare but catastrophic manifestation of SLE with high mortality, requiring early, intensive therapy. Case Presentation: A 31-year-old female presented with low-grade fever and joint pains for six weeks associated with alopecia, anorexia, and weight lo...
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CD3+ T Cell Lineage Specific Maternal Engraftment in Pediatric Patient with Severe Combined Immunodeficiency Disorder
Gansuvd Balgansuren,
Nakita Shelton,
Lois Regen,
Dana McLendon,
Susan Russell,
Paula Peterson,
Ada Ng,
Dylan Smith,
Debra Cordell,
Chris McFarland
Issue:
Volume 9, Issue 4, December 2021
Pages:
73-78
Received:
23 November 2021
Accepted:
15 December 2021
Published:
24 December 2021
Abstract: Background: Transplacental Maternal Engraftment (TME) is common in patients with Severe Combined Immunodeficiency Disorder (SCID), however only a few are complicated by Graft Versus Host Disease (GVHD) prior to Hematopoietic Cell Transplantation (HCT). Objective: We will discuss a rare case of a SCID patient with complete TME at birth who later developed pre-HCT GVHD secondary to TME. Materials and Methods: Peripheral blood mononuclear cells or sorted cell populations are used for TME monitoring. Chimerism testing/engraftment analysis was performed by PCR based capillary electrophoresis to detect genetic polymorphisms in short tandem repeat loci. Results: SCID was diagnosed on newborn screen and the patient was prematurely born at 33 weeks of gestation. The patient had GVHD secondary to TME, which involved skin, liver, gut and bone marrow along with other clinical symptoms of SCID and treated with tacrolimus and methylprednisolone. The patient was transplanted three months after birth with an HLA identical sibling donor. Partial donor engraftment was seen in myeloid cells followed by B and T cell lineages from day +42 post transplantation. Testing sorted CD4+ and CD8+ T cells at day +42 revealed that the engrafted maternal CD3+ cells were exclusively of CD4+ phenotype, which represented 15% of circulating CD4+ T cells. Conclusion: Based on our findings, we suggest that CD3+ lineage specific T cells, presumably CD4+, might be the main contributor for pre-HCT GVHD secondary to TME.
Abstract: Background: Transplacental Maternal Engraftment (TME) is common in patients with Severe Combined Immunodeficiency Disorder (SCID), however only a few are complicated by Graft Versus Host Disease (GVHD) prior to Hematopoietic Cell Transplantation (HCT). Objective: We will discuss a rare case of a SCID patient with complete TME at birth who later dev...
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The Virology, Re-emergence of COVID-19, and Resurgence of Ebola
Aigbogun Ighodaro Edwin,
Bakare-Akpata Osarobo
Issue:
Volume 9, Issue 4, December 2021
Pages:
79-82
Received:
21 February 2021
Accepted:
10 September 2021
Published:
31 December 2021
Abstract: Severe Acute Respiratory Syndrome-Corona virus 2 (SARS-COV-2) is a viral agent capable of causing Corona Virus Disease-2019 (COVID-19) infection. The viral strain was first reported in Wuhan city, China, in 2019 hence the suffix'-19', before it's spread into major parts of the world due to its high risk of transmission via air; this has resulted in the death of over 2.4 Million persons globally. The emergence of infectious diseases is no longer news, as the Ebola virus, which caused another saga of the pandemic, has resurged again in the Democratic Republic of Congo and Guinea. This review article aims to summarize the epidemiology, virology and pathogenesis, treatment, and recommendations to contain and prevent any future pandemic. Ninety percent of the articles used for this short review are within the last 3 years (2019-2021) and from the data correlated it is evident that the factors responsible for this emergence and resurgence are mutation of the etiologic agent, geographical locations, resistance to drugs, lack of adequate post surveillance of infectious diseases, and lifestyle of people in a given locality. Finally, there is a need to implement emergency protocols in all parts of the continent as a nation and no arm of government, be it local, State or federal, is insignificant in the event of an outbreak, a joint force is required to curb and arrest future epidemics as the emergence of COVID-19 and resurgence of the Ebola virus as shown that the current protocols put in place is not full proof.
Abstract: Severe Acute Respiratory Syndrome-Corona virus 2 (SARS-COV-2) is a viral agent capable of causing Corona Virus Disease-2019 (COVID-19) infection. The viral strain was first reported in Wuhan city, China, in 2019 hence the suffix'-19', before it's spread into major parts of the world due to its high risk of transmission via air; this has resulted in...
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