Bullous systemic lupus erythematosus associated with lupus nephritis: report of two cases

Bullous systemic lupus erythematosus is recognized as a distinct entity related to autoimmunity to type VII collagen. In some cases, the flare of bullous disease coincides with the exacerbation of systemic lupus erythematosus, and especially lupus nephritis. Two cases of young female patients with vesiculobullous eruption on sun-exposed and non-exposed areas associated to lupus nephritis are described. Diagnosis was proved by characteristic histopathology and direct immunofluorescence. Corticosteroids and dapsone therapy may be effective.O lúpus eritematoso sistêmico bolhoso é reconhecido como entidade distinta relacionada à auto-imunidade contra colágeno VII. Em alguns casos, a presença de doença bolhosa coincide com a exacerbação do lúpus eritematoso sistêmico, especialmente da nefrite lúpica. São descritos dois casos de mulheres jovens com erupção vésico-bolhosa em áreas expostas e não expostas ao sol associada à nefrite lúpica. O diagnóstico foi comprovado pela histopatologia e imunofluorescência direta características. O tratamento com corticosteróide e dapsona costuma ser eficiente.Sociedade Brasileira de DermatologiaComplexo Hospitalar Heliópolis Serviço de ReumatologiaUNIFESPComplexo Hospitalar Heliópolis Serviço de DermatologiaUNIFESPSciEL

Iron Behaving Badly: Inappropriate Iron Chelation as a Major Contributor to the Aetiology of Vascular and Other Progressive Inflammatory and Degenerative Diseases

The production of peroxide and superoxide is an inevitable consequence of aerobic metabolism, and while these particular "reactive oxygen species" (ROSs) can exhibit a number of biological effects, they are not of themselves excessively reactive and thus they are not especially damaging at physiological concentrations. However, their reactions with poorly liganded iron species can lead to the catalytic production of the very reactive and dangerous hydroxyl radical, which is exceptionally damaging, and a major cause of chronic inflammation. We review the considerable and wide-ranging evidence for the involvement of this combination of (su)peroxide and poorly liganded iron in a large number of physiological and indeed pathological processes and inflammatory disorders, especially those involving the progressive degradation of cellular and organismal performance. These diseases share a great many similarities and thus might be considered to have a common cause (i.e. iron-catalysed free radical and especially hydroxyl radical generation). The studies reviewed include those focused on a series of cardiovascular, metabolic and neurological diseases, where iron can be found at the sites of plaques and lesions, as well as studies showing the significance of iron to aging and longevity. The effective chelation of iron by natural or synthetic ligands is thus of major physiological (and potentially therapeutic) importance. As systems properties, we need to recognise that physiological observables have multiple molecular causes, and studying them in isolation leads to inconsistent patterns of apparent causality when it is the simultaneous combination of multiple factors that is responsible. This explains, for instance, the decidedly mixed effects of antioxidants that have been observed, etc...Comment: 159 pages, including 9 Figs and 2184 reference