title: Fatal evolution of systemic lupus erythematosus associated with Crohn's disease.
abstract: The authors describe the case of a young Brazilian woman who was treated of ileocolonic Crohn's disease sparing rectum, as confirmed by colonoscopy and histopathological examination. After a 4-year course of sulfasalazine treatment, she presented with skin facial lesions in vespertilio, fever, arthralgias and high titers of anti-ANA and LE cells. A sulfasalazine-induced lupus syndrome was diagnosed, because after sulfasalazine withdrawal and a short course of prednisone, the clinical symptoms disappeared and the laboratory tests returned to normal. Mesalazine 3 g/day was started and the patient remained well for the next 3 years, when she was again admitted with fever, weakness, arthralgias, diplopy, strabismus and hypoaesthesia in both hands and feet, microhematuria, haematic casts, hypocomplementemia and high titers of autoimmune antibodies. A diagnosis of associated systemic lupus erythematosus was made. Although a pulsotherapy with methylprednisolone was started, no improvement was noticed. A cyclophosphamide trial was tried and again no positive results occurred. The patient evolved to severe clinical manifestations of general vasculitis affecting the central and peripheral nervous system and lungs, having a fatal evolution after 2 weeks. Although uncommon, the association of both disease may occur, and the authors call attention to this possibility, making a brief review of literature.
authors.affiliation: Division of Gastroenterology, Department of Medicine, Juiz de Fora University, School of Medicine, Juiz de Fora, MG, Brazil.
authors.forename: J M
authors.initials: JM
authors.lastname: Chebli
authors.forename: P D
authors.initials: PD
authors.lastname: Gaburri
authors.forename: A F
authors.initials: AF
authors.lastname: de Souza
authors.forename: K V
authors.initials: KV
authors.lastname: Dias
authors.forename: K O
authors.initials: KO
authors.lastname: Cimino
authors.forename: R J
authors.initials: RJ
authors.lastname: de Carvalho-Filho
authors.forename: F A
authors.initials: FA
authors.lastname: Lucca
mesh_terms: D000328:Adult; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects* / Q000627:therapeutic use; D003424:Crohn Disease / Q000188:drug therapy*; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D008180:Lupus Erythematosus, Systemic / Q000139:chemically induced*; D019804:Mesalamine / Q000009:adverse effects* / Q000627:therapeutic use; D012460:Sulfasalazine / Q000009:adverse effects* / Q000627:therapeutic use
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D012460:Sulfasalazine; D019804:Mesalamine