Background: Systemic lupus erythematosus (SLE) is an autoimmune condition with a wide spectrum of clinical manifestations encompassing most organs and systems. Its treatment approach includes different immunomodulatory treatments, of which B-cell targeted therapies are part of. Rituximab (an anti-CD20 antibody) had encouraging results in observational studies but failed when tested in clinical trials. It is theorized that this could have been partially due to BAFF upregulation, leading to rituximab failure. Therefore, targeting BAFF with belimumab after rituximab therapy, may have a synergic effect in SLE. Objective: We review the available observational data regarding sequential rituximab/belimumab therapy in SLE patients. Results: Twenty-four patients from 6 studies were included. The results suggest a benefit with this combined therapy, with reduction of the mean SLEDAI. However, there was significant drug regimen and patient selection heterogeneity. Conclusion: Further randomized clinical trials are needed to examine this drug sequencing protocol in SLE patients.
Lemierre's syndrome is a rare and a life-threatening disease characterized by anaerobic bacteraemia associated with thrombosis of the internal jugular vein. Odynophagia, otalgia, odontalgia, dyspnoea, cough and fever are the most frequent manifestations. We describe a case of a 37-year-old woman who was admitted to the emergency room due to fever, odynophagia, dyspnoea, myalgia, and pleuritic chest pain. She had hypoxaemia and increased systemic inflammatory markers. The chest CT showed parenchymal densification compatible with severe acute respiratory syndrome coronavirus infection, although all three polymerase chain reaction testing were negative. The neck CT showed occlusion of the left cervical internal jugular vein. She was treated with antibiotics and was discharged. With the reported clinical case the authors intend to clarify the importance of differential diagnosis and the diagnosis of other infectious respiratory conditions at the time of a global pandemic.
FIGURE. A, Chest computed tomography (bone window) showing a calcified mass (arrow). B, Patient reveals an enlarged left arm (arrow). C, Left arm x-ray film showing multiple soft tissue calcifications; some of them evoke fluid levels (arrows). D, Ultrasonography of the left arm showing a cyst-like mass with disperse calcifications (arrow).
A artéria de Percheron (AOP) é uma variante normal que irriga o tálamo. Os enfartes da AOP podem originar um espectro alargado de apresentações clínicas invulgares. O seu diagnóstico é dificultado pela conjunção de dois factores: falta de sensibilidade da tomografia computadorizada e falta de conhecimento desta entidade motivada pela sua raridade. Descrevemos o caso de uma doente com coma por enfarte da AOP. Pretendemos salientar a importância de considerar esta entidade no diagnóstico diferencial de doentes com défices neurológicos vagos de origem indeterminada. Reforçamos ainda a necessidade de baixar o limiar para a realização de ressonância magnética com o objetivo de facilitar o diagnóstico e diminuir a morbilidade associada
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.