Serologic features of cohorts with variable genetic risk for systemic lupus erythematosus

Abstract Background Systemic lupus erythematosus (SLE) is an autoimmune disease with genetic, hormonal, and environmental influences. In Western Europe and North America, individuals of West African descent have a 3–4 fold greater incidence of SLE than Caucasians. Paradoxically, West Africans in sub-Saharan Africa appear to have a low incidence of SLE, and some studies suggest a milder disease with less nephritis. In this study, we analyzed sera from African American female SLE patients and four other cohorts, one with SLE and others with varying degrees of risk for SLE in order to identify serologic factors that might correlate with risk of or protection against SLE. Methods Our cohorts included West African women with previous malaria infection assumed to be protected from development of SLE, clinically unaffected sisters of SLE patients with high risk of developing SLE, healthy African American women with intermediate risk, healthy Caucasian women with low risk of developing SLE, and women with a diagnosis of SLE. We developed a lupus risk index (LRI) based on titers of IgM and IgG anti-double stranded DNA antibodies and levels of C1q. Results The risk index was highest in SLE patients; second highest in unaffected sisters of SLE patients; third highest in healthy African-American women and lowest in healthy Caucasian women and malaria-exposed West African women. Conclusion This risk index may be useful in early interventions to prevent SLE. In addition, it suggests new therapeutic approaches for the treatment of SLE.https://deepblue.lib.umich.edu/bitstream/2027.42/143866/1/10020_2018_Article_19.pd

OLANZAPİN TEDAVİSİ İLE ORTAYA ÇIKAN BİLATERAL AYAK BİLEĞİ ÖDEMİ: BİR OLGU SUNUMU

Peripheric edema could be caused by various medical conditions as well as pharmacologic agents such as antihypertensives, nonsteroidal antiinflamatory drugs, endocrine agents and immunotherapies. Olanzapine is an atypical antipsychotic that is widely prescribed for the treatment of schizophrenia and bipolar affective disorder. Most common adverse reactions of olanzapine are weight gain, postural hypotension, constipation, dizziness, akathisia, sedation. Peripheral edema was reported as an infrequent side effect, which affected 3% of the olanzapine treated patients. In this report, we aim to draw attention of psychiatrists on this rare adverse effect by presenting a 56-year-old case, who applied to our hospital with severe depressive and obsessive-compulsive symptoms and hospitalized because of suicide risk. Before psychiatric admission, he wasn’t taking any medication. He was diagnosed as major depression with psychotic features and obsessive-compulsive disorder. He was started on olanzapine 10 mg/day, quetiapine 300 mg/day and fluoxetine 40 mg/day. Two weeks after initiation of olanzapine, he was found to have bilateral pedal edema without ulceration and temperature change but minimal redness was observed. He had no history suggestive of cardiac, renal and liver dysfunction or allergic reaction against to any drug that could explain his existing edema. Possible medical conditions which may cause edema were ruled out by laboratory tests and physical examination. Olanzapine was stopped immediately and the therapy was modified to risperidone 1 mg/day. After discontinuation of olanzapine, edema was gradually resolved within two weeks. Because olanzapine associated edema has been seen rarely, it could be overlooked by psychiatrists in comparison to its more common side effects. Although it shows self-limited and benign course, patients may feel discomfort and their compliance to treatment may decrease. Also, it may interfere with differential diagnosis of other medical conditions which may cause edema. In conclusion, we suggest that patients should be observed carefully for edema during olanzapine treatment

Primary Burkitt’s Lymphoma Presenting as a Rapidly Growing Thyroid Mass

A 31-year-old male patient presented with a rapidly growing neck mass with normal thyroid function tests. Ultrasonography showed thyroidal expansion, a hypoechoic nodule that completely filled the right lobe, and 2 hypoechoic lymphadenopathies in the right jugulodigastric chain. The patient underwent right total and left subtotal thyroidectomy, following the diagnosis of nodular goiter; however, postoperative histopathological evaluation demonstrated primary Burkitt’s lymphoma of the thyroid gland. The tumor was staged as stage 1, and R-hyper-CVAD protocol (rituximab, hyperfractionated cyclophosphamide, vincristine, doxorubicin and dexamethasone) was administered. The protocol was changed to R-CHOP after 4 cycles due to recurrent grade III/IV cytopenias and febrile neutropenia. The PET-CT scans performed after chemotherapy and at the 6-month follow-up were normal. In summary, we reported a case with a diagnosis of Burkitt’s lymphoma, which is a rare type of primary thyroid lymphoma