Liver Abnormalities in Systemic Lupus Erythematosus: A Prospective Observational Study

Imran, Shaik; Thabah, Molly Mary; Azharudeen, Mohamed; Ananthakrishnan, Ramesh; Bobby, Zachariah; Negi, Vir Singh

doi:10.7759/cureus.15691

Cited by 9 publications

(21 citation statements)

References 26 publications

(51 reference statements)

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“…Therefore, patients with lupus nephritis ranked the high score of disease activity among the patients, subsequently increasing their expression of IRF5. Moreover, our result indicated that the IRF5 expression levels correlated positively with ALP in SLE (I) group, and this could be explained by Imran et al (2021) who found that overall, 28 of the total 135 (20.7%) patients had liver abnormalities, including liver function tests and those detected using ultrasonography. About nine patients had raised alkaline phosphatase (ALP) or gamma-glutamyl transferase (GGT) levels are higher two-fold than the upper limit of normal values [48].…”

Section: Correlation Between Expression Of Irf5 Gene and Other Parame...mentioning

confidence: 58%

“…Moreover, our result indicated that the IRF5 expression levels correlated positively with ALP in SLE (I) group, and this could be explained by Imran et al (2021) who found that overall, 28 of the total 135 (20.7%) patients had liver abnormalities, including liver function tests and those detected using ultrasonography. About nine patients had raised alkaline phosphatase (ALP) or gamma-glutamyl transferase (GGT) levels are higher two-fold than the upper limit of normal values [48]. Takahashi et al (2013) concluded that dysfunction of the liver in the presence of SLE can be triggered by many factors, but when existing at the time of SLE onset, either SLE itself or drugs can be the reason.…”

Section: Correlation Between Expression Of Irf5 Gene and Other Parame...mentioning

confidence: 58%

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Correlation Between Gene Expression of Interferon Regulatory Factor-5 and Disease Activity Index in Systemic Lupus Erythematosus Iraqi Patients

Dahham

Haddad²

2023

Iraqi Journal of Science

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Systemic lupus erythematosus (SLE) is a heterogeneous autoimmune disease characterized by elevated levels of circulating anti-nuclear autoantibodies and interferon-alpha (INFs-α). Interferon regulatory factor-5 (IRF5) plays an important role in the induction of type I interferon and pro-inflammatory cytokines, and participates in the SLE pathogenesis. This study aimed to investigate the role of IRF5 gene expression levels in a sample of SLE Iraqi patients and its correlation with disease activity, and to identify its diagnostic ability as a biomarker reflecting disease activity. Blood samples were taken from 45 participants diagnosed with SLE cases classified according to the American College of Rheumatology (ACR) criteria. They were scored via the SLE disease activity index 2000 (SLEDAI-2K) to assess the disease activity and according to it, they were subdivided into “SLE (I) group” (SLEDAI-2k ≤5), and “SLE (II) group” (SLEDAI-2k >5), as well as age and gender matched healthy control group. RNA was isolated from whole blood samples and gene expression levels of IRF5 were determined using real-time polymerase chain reaction (PCR). Our results revealed that the expression levels of the IRF5 gene were significantly increased in SLE (I) and SLE (II) patient groups compared with the control group (p<0.05, and p<0.01) respectively, as well as higher in SLE (II) group than the SLE (I) group (p<0.01). Moreover, the expression levels of IRF5 were found to be related positively and significantly to the disease activity index in both SLE patient groups. The analysis of receiver operator curves (ROC) for gene expression levels of IRF5 in SLE (II) group showed a perfect accuracy to distinguish between SLE patients and healthy individuals (AUC=0.989, sensitivity= 95.5%, and specificity= 88.0%). However, in SLE (I) group showed a good accuracy to discriminate between SLE patients and healthy individuals. (AUC=0.769, sensitivity= 69.6%, and specificity= 80.0%). The correlation between gene expression levels of IRF5 with other parameters revealed that a significant positive correlation was found with uric acid and ALP in SLE (I) group, while in SLE (II) group with urea, creatinine, and uric acid. Our conclusion suggests that the up-regulation of IRF5 gene expression levels correlates positively with disease activity in SLE patients reflecting the possibility of using it as an immunological biomarker for diagnosis, and monitoring the disease flare.

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Section: Correlation Between Expression Of Irf5 Gene and Other Parame...mentioning

confidence: 58%

Section: Correlation Between Expression Of Irf5 Gene and Other Parame...mentioning

confidence: 58%

Correlation Between Gene Expression of Interferon Regulatory Factor-5 and Disease Activity Index in Systemic Lupus Erythematosus Iraqi Patients

Dahham

Haddad²

2023

Iraqi Journal of Science

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“…Transaminitis is one of the common laboratory abnormalities seen in patients with newly diagnosed SLE, as seen in our patient. It is important to keep in mind that other causes of liver diseases such as medications, viral hepatitis, and alcohol are more common and need to be excluded before concluding the diagnosis of lupus hepatitis [15]. Anti-ribosomal P antibody was recognized to be associated with lupus hepatitis, but the clinical usefulness is limited.…”

Section: Discussionmentioning

confidence: 99%

Lupus Cardiomyopathy and Nephritis Associated With Adalimumab and Cytomegalovirus Infection in a Patient With Seronegative Rheumatoid Arthritis: A Case of Rhupus Syndrome

Waitayangkoon¹,

Chen²,

Liu³

et al. 2023

Cureus

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Tumor necrosis factor-alpha (TNF-α) inhibitors are associated with lupus-like disease, known as anti-TNFα-induced lupus (ATIL). Cytomegalovirus (CMV) was reported to exacerbate lupus in the literature. To date, systemic lupus erythematosus (SLE) triggered by adalimumab in the setting of CMV infection has never been described. We present an unusual case of a 38-year-old female with a past medical history of seronegative rheumatoid arthritis (SnRA) who developed SLE associated with the use of adalimumab and CMV infection. She had severe SLE features including lupus nephritis and cardiomyopathy. The medication was discontinued. She was initiated on pulse steroid therapy and discharged with an aggressive regimen for SLE, including prednisone, mycophenolate mofetil, and hydroxychloroquine. She remained on the medications until a year later upon follow-up. ATIL from adalimumab usually manifests only mild symptoms of SLE such as arthralgia, myalgia, and pleurisy. Nephritis is very rare, and cardiomyopathy is unprecedented. Concomitant CMV infection might contribute to disease severity. Patients with SnRA may have an increased risk of developing SLE later when exposed to such medications and infection.

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“…1,2 Hepatocellular or cholestatic patterns in liver function tests indicate subclinical hepatic involvement in SLE. 3 SLE rarely presents with hepatic micro-abscesses. 4,5 SLE liver damage is commonly diagnosed one or more years after the initial diagnosis, indicating delayed hepatic involvement.…”

Section: Introductionmentioning

confidence: 99%

“…4,5 SLE liver damage is commonly diagnosed one or more years after the initial diagnosis, indicating delayed hepatic involvement. 3 Up to 60% of SLE patients have liver function abnormalities, and 24% have hepatitis symptoms. [1][2][3] Many patients with lupus flares have elevated liver enzymes and hepatitis symptoms.…”

Section: Introductionmentioning

confidence: 99%

Hepatic micro‐abscesses as an unusual initial presentation of systemic lupus erythematosus: A case report

Sasi,

Eltahir,

Ibrahim

et al. 2024

Clinical Case Reports

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Key Clinical MessageHepatic micro‐abscesses can be a rare initial presentation of systemic lupus erythematosus (SLE). This case highlights the importance of considering autoimmune etiologies when infectious causes are ruled out and emphasizes the need for early recognition and appropriate treatment of atypical hepatic manifestations in SLE to achieve favorable outcomes.AbstractSystemic lupus erythematosus (SLE) is an autoimmune disease that affects multiple organs, including the liver. While hepatic involvement in SLE is typically subclinical or associated with mild liver enzyme elevations, rare manifestations such as hepatic micro‐abscesses and hepatic vasculitis have been reported. We report the case of a 27‐year‐old female who presented with persistent high‐grade fever, bilateral exudative lymphocytic pleural effusion, hepatic micro‐abscesses, anemia, and lymphopenia. Despite extensive investigations and antibiotic therapy, the patient's condition continued to worsen. The diagnosis of hepatic vasculitis, a rare manifestation of SLE, was ultimately made based on clinical suspicion, positive autoimmune markers, and negative septic workup. The patient responded well to high‐dose corticosteroid therapy and intravenous immunoglobulin, with resolution of liver lesions and clinical improvement. Hepatic involvement in SLE is diverse, and atypical presentations can pose diagnostic challenges. Hepatic vasculitis, although rare, should be considered in SLE patients presenting with liver lesions. The management involves immunosuppressive therapy, and prompt diagnosis is crucial to prevent further vascular damage. Hepatic micro‐abscesses, another rare manifestation of SLE, are thought to result from immune complex deposition. The exact pathogenesis remains unclear. Hepatic micro‐abscesses can have both infectious and non‐infectious causes, and it is very important to rule out common microbial pathogens. Treatment focuses on managing the underlying SLE activity with immunosuppressive agents. This case highlights the diagnostic challenges and management considerations in atypical hepatic manifestations of SLE. Awareness of rare presentations and collaboration among multiple specialties are essential for accurate diagnosis and appropriate treatment.

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Liver Abnormalities in Systemic Lupus Erythematosus: A Prospective Observational Study

Cited by 9 publications

References 26 publications

Correlation Between Gene Expression of Interferon Regulatory Factor-5 and Disease Activity Index in Systemic Lupus Erythematosus Iraqi Patients

Correlation Between Gene Expression of Interferon Regulatory Factor-5 and Disease Activity Index in Systemic Lupus Erythematosus Iraqi Patients

Lupus Cardiomyopathy and Nephritis Associated With Adalimumab and Cytomegalovirus Infection in a Patient With Seronegative Rheumatoid Arthritis: A Case of Rhupus Syndrome

Hepatic micro‐abscesses as an unusual initial presentation of systemic lupus erythematosus: A case report

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