The current report presents a case of late-onset systemic lupus erythematosus (SLE). A 75-year-old Caucasian woman was admitted to the clinical hospital because of dyspnea, dry cough, low-grade fever, wrist pain. There were no oral and skin lesions or lymphadenopathy observed. Laboratory tests revealed hypochromic microcytic anemia with hemoglobin 111 g/l, lymphopenia 0,54 x 10/l, the erythrocyte sedimentation rate (ESR) elevation up to 47 mm/h and the C-reactive protein level up to 10,7 mg/l. Tumor markers (CA-125, CA-19.9, СА-15,3, α-fetoprotein) concentration, hepatic and renal function were within the reference ranges. Of note, urinalysis didn’t reveal proteinuria or microscopic hematuria and was considered normal. Computed tomography revealed bilateral pulmonary consolidation in S10, sacculated pleuritis, solitary lymphadenopathy, and pericardial effusions. Diagnosis of SLE was confirmed based on three clinical signs (synovitis of proximal interphalangeal joints, serositis including pleuritis, hematological disorders: anemia, lymphocytopenia) and positive findings of three immunological tests (anti-double-stranded DNA antibodies [Anti-dsDNA], antinuclear antibodies [ANA], and anti-nucleosome antibodies [ANuA]). This case demonstrates that late-onset SLE may be one of the reasons for the accumulation of pleural fluid in elderly patients.
The article presents a rare case of thrombosis of the pulmonary arteries branches, which developed in a patient two months after infection with the SARS-CoV-2 virus, that caused bilateral polysegmental pneumonia. The thrombosis was suspected because of a high plasma D-dimer level. Contrast-enhanced chest CT was performed to make a definitive diagnosis. The absence of blood clots in the veins of the lower extremities and pelvis allowed us to conclude that the patient did not have thromboembolism, but rather a pulmonary thrombosis in situ. Such possible causes of venousthromboembolic complications as tumors, systemic diseases of the connective tissue, and antiphospholipid syndrome were excluded based on negative tests for tumor and autoimmune diseases markers. The long-stay in the hospital was associated with the inability of the patient to maintain the normal level of blood oxygen saturation independently due to the large area of the lung damage associated with COVID-19 pneumonia and ischemia caused by thrombosis of the branches of the pulmonary arteries.
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