Purpose: Systemic Lupus Erythematosus (SLE) in males is rare. Clinical and biological features, as well as, the outcome may differ comparatively to female patients. The purpose of our study is to define these clinical and biological features in Tunisian male patients presenting SLE. Methods: A mono-centric, retrospective and descriptive study of 96 patients followed for SLE out of which 21 are males. A comparative study was then performed between male and female patients groups. Results: Sex-ratio female/male was 3.6/1, the average age at diagnosis of SLE was 37.8±14 years. The most frequently noted clinical manifestations were: skin involvement (81%), renal involvement (71.4%) and joint damage (66.7). We observed a significant difference in clinical features between male and female patients (21 males and 76 females): renal failure (52% vs. 71.4%), serositis (23.8% vs. 2.7%), peripheral neuropathy (19% vs. 4%) and lung interstitial disease (14.3% vs. 1.3%). No significant difference was found in the positivity of serum antibodies between the two groups. Fifteen male patients (71.4%) had a SLEDAI score greater than or equal to 11, referring to high/very high disease activity. Out of the 32 patients who developed infectious complications during the course of the disease, 11 were male (52.4% of males). Concerning the male group, complete remission was observed in 10 patients (47.6%), while 10 others presented persistent sequella. We observed one death in the male group secondary to infective acute respiratory failure. Conclusion: SLE in male patients is rare and associated with poor prognosis. Disparity was observed in clinical and biological features as well as outcome in the different studies. In our study, we concluded that male lupus is more severe.
RésuméLa toxocarose humaine est une zoonose parasitaire cosmopolite causée par Toxocara canis et Toxocara catisqui sont des ascarides des chiens et des chats. C’est une affection le plus souvent bénigne. Nous rapportons un cas de pancréatite aigue dans le décours une toxocarose.
Cardiac manifestations develop in the majority of patients with systemic lupus erythematosus (SLE) at some time during the course of their disease. This study was designed to assess cardiac abnormalities in patients with SLE by echocardiography and to compare the 2 groups of patients with and without cardiac manifestations. It was a transversal, descriptive study, conducted in the Internal Medicine Department at the Military Hospital of Tunis from January 2016 to June 2018. Eighty lupus patients, diagnosed on the basis of ACR (American college of rheumatology) criteria, were enrolled in the study and were evaluated by standard echocardiography with color Doppler. Out of 80 patients 42 (52%) had abnormal echocardiographic findings. Pericardial effusion was found in 55%, valvular abnormalities in 52% and 38% had pulmonary hypertension. Patients with pleural effusion (45 vs 15%) were more vulnerable to cardiac involvement as well as renal impairment (57 vs 44%). The difference, however, were not statistically significant (p>0.05) in the renal involvement. Active disease with low complement (80%) was associated with higher frequency of cardiac involvement than disease in remission (64%) but the result was not statistically significant (p=0.11). Cardiac abnormalities are very common in lupus patients even when clinically asymptomatic form. Echocardiography is an excellent non-invasive tool for cardiac evaluation. Their research must be systematic with echocardiography in order to reduce subsequent cardiac morbidity and mortality among the lupus patients.
Background:Systemic lupus erythematosus (SLE) is an autoimmune disease that primarily affects young women. It is characterized by the production of autoantibodies and immune complexes. Vascular pulmonary involvement has long been considered rare, a consequence of thromboembolic events. It is in fact a proper entity, often of multifactorial mechanism, with spontaneous evolution to pulmonary arterial hypertension (PAH), which makes its gravityObjectives:The objective of our study is to determine the particuliarities of PAH during SLE.Methods:We conducted a mono-centric, retrospective and descriptive study of the follow up of patients in the internal medicine department of the Military Hospital of Tunis for LES (diagnosis according to the ARA criteria) between January 2010 and December 2015.All patients underwent external echocardiography or during their stay in the departmentResults:We collected 87 patients diagnosed with SLE. PAH was recorded in 16 patients (38%) including 6 men and 10 women with a F/M sex ratio of 1.66. The average age was 37.23 years with extremes ranging from 16 to 70 years old. Clinically, we observed dyspnea in 10 patients (62%), chest pain in 7 cases (43%), dry cough in 2 cases (12%), palpitations in 1 case (6%),%) and right heart failure in 1 case (6%). At cardiac auscultation, 5 patients were tachycardic (31%), 5 had a tricuspid systolic murmur and 1 had an irregular rhythm. A burst of B2 in the pulmonary focus was noted in 3 patients (18%). Nine of the 16 patients with PAH had electrical signs: five had sinus tachycardia (31%), two had signs of right ventricular hypertrophy. A complete arrhythmia with atrial fibrillation was noted in one patient. The chest X-ray showed cardiomegaly in 6 patients (37%). Among the 16 patients, there was a tricuspid valve insufficiency associated with PAH in 7 patients (43%), 2 had mitral valve insufficiency (12%), 6 patients had pericarditis, one patient had endocarditis (6%) and myocarditis was found in another one (6%). PAH was isolated in 12% of cases. In Immunological tests, NAAs were positive in all patients. Three quarters of the patients (12) had native anti-DNA positive (75%) and ¼ of the patients (4) had anti-Sm positive and anti-RNP positive antibodies (25%). The complement was consumed in 5 cases (31.2%). Anti-phospholipid antibodies were noted in 4 cases (25%). Added to non-specific measures (smoking cessation, elimination of intense physical effort ...) adopted for all patients, oxygen therapy was indicated in four patients. Diltiazem 180 mg/day vasodilator therapy was prescribed in 3 patients. Effective anti-vitamin K anticoagulation was prescribed in a patient with severe PAH at 80 mmHg.Conclusion:Pulmonary arterial hypertension (PAH) is a rare complication of systemic lupus erythematosus, its prevalence varies from 0.5 to 17.5% depending on the series. SLE is the second leading cause of PAH in connective tissue disease after systemic sclerosis. This vascular involvement is essential for the prognosis and is an important evolutionary step in t...
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