Fatal gastrointestinal manifestations of SLE: case reports

Background: SLE- related gastrointestinal involvement such as gastrointestinal vasculitis and thrombosis are clinically important, as it could progress to life- threatening outcome if not treated promptly. We describe 2 patients who were admitted to our hospital with fatal gastrointestinal manifestations of SLE. Method: Case Report. Results: Case 1: The patient was a 24- year- old Asian woman who was diagnosed with SLE in 2014 and class IV lupus nephritis in 2018. She presented with hypovolemic shock secondary to massive hematochezia. CT abdomen and angiography revealed multiple bleeding sites in jejunum and mesenteric vasculitis changes of the bowels. Gastroduodenoscopy and CT angioembolization of the mesenteric arteries were performed to stop the bleeding, and IV Methylprednisolone, IV Cyclophosphamide, IV Rituximab were administered. Eventually she succumbed to Transfusion- Related Acute Lung Injury (TRALI) from multiple blood transfusions. Case 2: The patient was a 61- year- old male smoker who was diagnosed with SLE with lupus nephritis in April 2020. He however refused renal biopsy or cyclophosphamide. He presented a few months later with fever and colicky abdominal pain for 2 days. A diagnosis of Superior Mesenteric Artery (SMA) Thrombosis with Bowel Ischemia was made, which was likely due to Catastrophic Anti- Phospholipid Syndrome (CAPS) with SLE, based on CT abdomen findings of SMA thrombosis, bilateral common femoral vein thrombosis and multiple splenic infarcts. Heparin infusion was initiated, and he was administered IV Methylprednisolone and Intravenous Immunoglobulin (IVIg). He developed Disseminated Intravascular Coagulation (DIVC) subsequently and succumbed to his illness at day 2 of admission. Conclusion: In summary, early diagnosis with prompt and adequate treatment of gastrointestinal manifestation of SLE is essential to avoid serious complications like haemorrhage or perforation with a high mortality rate

Gender differences in osteoporotic hip fractures in Sarawak General Hospital

ABSTRACT Introduction: Osteoporosis and osteoporotic fracture pose a major public health problem in our ageing population, and particularly concerning is the increased morbidity and mortality associated with osteoporotic hip fractures. While overall diagnosis and treatment for osteoporosis have improved, osteoporosis in men remains underdiagnosed and undertreated. We aim to describe the difference in clinical characteristics between elderly men and women with osteoporotic hip fractures in Sarawak General Hospital. Materials and Methods: All patients diagnosed with osteoporotic hip fracture admitted to Sarawak General Hospital from June 2019 to March 2021 were recruited, and demographic data and clinical features were obtained. Results: There were 140 patients with osteoporotic hip fracture, and 40 were men (28.6%). The mean age for males was 74.1 ± 9.5 years, while the mean age for females was 77.4 ± 9.1 years (p=0.06). The types of fracture consisted of neck of femur=78, intertrochanteric=61 and subtrochanteric=1. More men were active smokers (15% vs 1%, p<0.001). There were 20 men with secondary osteoporosis (50%), while 13 women (13%) had secondary osteoporosis (p<0.001). The causes of secondary osteoporosis among the men were hypogonadism, COPD, glucocorticoid-induced osteoporosis, renal disease, androgen deprivation therapy, thyroid disorder, prostate cancer and previous gastrectomy. There were two deaths among the men and four deaths among the women during the inpatient and 3 months follow-up period. There was no statistical significance between the mortality rates between male patients (5%) and female patients (4%) (p=0.55). Conclusion: There were more females with osteoporotic hip fractures, and there were significantly more males with secondary osteoporotic hip fractures