Digital gangrene as the initial presentation of systemic lupus erythematosus

Adelowo, Olufemi; Ajani, Wahab; Omosebi, DT

doi:10.1136/bcr-2012-006259

Cited by 10 publications

(11 citation statements)

References 17 publications

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“…Vascular injury is an important characteristic of SLE. Digital gangrene in SLE is a rare form of vascular injury and considered to be a severe complication of SLE that generally leads to digital amputation (1,2). The mechanisms include vasculitis, premature atherosclerosis, vasospasm, and hypercoagulability related to antiphospholipid antibodies.…”

Section: Introductionmentioning

confidence: 99%

Digital Gangrene as the Initial Presentation of Systemic Lupus Erythematosus Without Secondary Antiphospholipid Syndrome: Case Report

Alghamdi

2015

Zagazig University Medical Journal

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This is a case of a 28-year-old female presented with an extensive cutaneous gangrene of her fingers and toes with history of a livedo reticularis rash in both lower limbs. Her work-up showed positive serology for Systemic Lupus Erythematosus (SLE). There were no other symptoms suggestive of SLE. Interestingly, the patient adequately responded to rituximab therapy. Such a case of digital gangrene as the initial presentation of SLE without secondary antiphospholipid syndrome has rarely been reported in the literature.

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Section: Introductionmentioning

confidence: 99%

Digital Gangrene as the Initial Presentation of Systemic Lupus Erythematosus Without Secondary Antiphospholipid Syndrome: Case Report

Alghamdi

2015

Zagazig University Medical Journal

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“…Complications of lupus have also been reported such as lupus nephritis [32,33] and neuropsychiatric lupus [34]. Rare complications have also been reported such as an associated digital gangrene [35]. Juvenile SLE has also been reported in 14 black patients out of 36 cases of lupus nephritis from a study in South Africa [36].…”

Section: Systemic Lupus Erythematosusmentioning

confidence: 88%

Systemic Autoimmune Diseases: Not So Rare in Black Africans

Adelowo¹

2014

Rheumatol Curr Res

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Conventional beliefs and some publications, had in the past, asserted that systemic auto -immune diseases such as inflammatory arthritis, connective tissue diseases and vasculitis are rare. Many of such reports had been hospital based and were not based on the ACR criteria. Rheumatoid arthritis was reported as being rare, especially among West Africans; so also Systemic Lupus Erythematosus, Scleroderma and Inflammatory myopathies. Even rarer are the Vasculitis. However, increasing reportage of these conditions may indicate that these conditions do occur, although under reported. As efforts are being made to overcome acute and chronic infections such as Malaria, Tuberculosis, chronic debilitating diseases such as arthritis and cancers may rear their head.

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“…8 However, some cases of digital gangrene as a primary event in SLE have been reported. 3,6,[9][10][11] The majority of cases reported in the literature have proved that digital gangrene occurs in young SLE patients and that the occurrence of this complication in older adult patients is extremely rare. 2,6,9,10 To the best of the authors' knowledge, only three cases of digital gangrene have been reported in patients with SLE at an older age (after 50 years old).…”

Section: Discussionmentioning

confidence: 99%

“…It is the initial manifestation of the disease in only 0.2% of cases. 2,3 It was initially identified by Dubois 4 and Alarcon-Segovia. 5 Mechanisms, such as vasculitis, thromboembolism, premature atherosclerosis, vasospasm, and coagulability can contribute to the development of gangrene.…”

Section: Introductionmentioning

confidence: 99%

Case Report: Extensive digital gangrene as a primary manifestation of late-onset systemic lupus erythematosus

et al. 2022

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Background: Digital gangrene is a rare but serious complication of systemic lupus erythematosus (SLE). It occurs usually in middle-aged patients with longer disease duration. Case: Herein we report the case of a 56-year-old man (with no history suggestive of Raynaud’s phenomenon, diabetes mellitus, smoking, trauma, infection, or chemical exposure), who presented with SLE and digital gangrene was among the first signs. He presented with a one-month history of joint pain, hair loss, photosensitivity, mouth ulcers, malar rash, dyspnea, and digital pain. Physical examination revealed painful and diffuse erythematous skin lesions in the extremities and back, as well as cyanosis in the fingers. We noted lymphocytopenia (600 cells/mm3), and an elevated C-reactive protein (15.1 mg/l) on laboratory tests. Immunological tests were positive for antinuclear antibodies (ANA) with Title 1:400. Pulmonary computed tomography revealed pulmonary fibrosis, and pulmonary function tests revealed the restrictive pulmonary disease. Diagnosis of SLE with lung involvement was retained. The immunological assessment in search of elements in favor of a vascular origin of the patient's skin lesions was negative. Treatment was initiated with 200 mg/day hydroxychloroquine. For dermal and pulmonary involvement, intravenous (IV) pulse therapy was used with methylprednisolone (1,000 mg/d for three consecutive days monthly) and cyclophosphamide (1 g/month). Calcium blocking agents were also prescribed. However, the lesions did not improve. The patient was given two infusions of rituximab (1 g) at a 14-day interval with a marked improvement of the majority of vasculitis lesions, and a partial improvement of dyspnea. Conclusions: Digital gangrene is a rare complication of late-onset SLE, especially as a primary manifestation.

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Digital gangrene as the initial presentation of systemic lupus erythematosus

Cited by 10 publications

References 17 publications

Digital Gangrene as the Initial Presentation of Systemic Lupus Erythematosus Without Secondary Antiphospholipid Syndrome: Case Report

Digital Gangrene as the Initial Presentation of Systemic Lupus Erythematosus Without Secondary Antiphospholipid Syndrome: Case Report

Systemic Autoimmune Diseases: Not So Rare in Black Africans

Case Report: Extensive digital gangrene as a primary manifestation of late-onset systemic lupus erythematosus

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