title: Fulminant systemic vasculitis in systemic lupus erythematosus. Case report and review of the literature.
abstract: Vasculitis in systemic lupus erythematosus (SLE) has a broad spectrum of clinical manifestations from cutaneous to visceral involvement and its prognosis ranges from mild to life-threatening. We report the case of a previously healthy 17-year-old woman with eight months' history of arthralgias and myalgias. Subsequently, she developed facial and lower limbs edema, and hair loss. Two weeks before admission to a secondary level hospital, she developed fever up to 40°C followed by abdominal pain, rectal bleeding, hematemesis and blisters on both legs, reason for which she was hospitalized. With active bullous SLE with rapidly progressive glomerulonephritis suspected, she was treated with methylprednisolone pulses without response. After one week of treatment, she was transferred to a tertiary level hospital. On admission she presented acute arterial insufficiency of the lower extremities, respiratory failure with apnea, metabolic acidosis and shock; six hours later she died. Autopsy findings showed active diffuse lupus nephritis and diffuse systemic vasculitis that involved vessels from the skin, brain, myocardium, spleen, iliac and renal arteries. In addition, serositis of the small intestine and colon, acute and chronic pericarditis, pericardial effusion and myocarditis were found. Immunologic tests confirmed SLE diagnosis. In this case the fulminant course was the result of SLE high disease activity, visceral vasculitis of several organs and late diagnosis, referral and treatment. Early diagnosis, and opportune referral to the rheumatologist for intensive treatment can improve the outlook in these patients.
authors.affiliation: Clinical Research Unit, Hospital de Especialidades Centro Médico La Raza IMSS, Mexico City, Mexico Universidad Nacional Autónoma de México, Mexico City, Mexico.
authors.forename: G
authors.initials: G
authors.lastname: Medina
authors.affiliation: Rheumatology Department, Hospital de Especialidades Centro Médico La Raza IMSS, Mexico City, Mexico.
authors.forename: D
authors.initials: D
authors.lastname: González-Pérez
authors.affiliation: Direction of Education and Research, Hospital de Especialidades Centro Médico La Raza IMSS, Mexico City, Mexico.
authors.forename: C
authors.initials: C
authors.lastname: Vázquez-Juárez
authors.affiliation: Pathology Department, Hospital de Especialidades Centro Médico La Raza IMSS, Mexico City, Mexico.
authors.forename: M
authors.initials: M
authors.lastname: Sánchez-Uribe
authors.affiliation: Rheumatology Department, Hospital de Especialidades Centro Médico La Raza IMSS, Mexico City, Mexico Universidad Nacional Autónoma de México, Mexico City, Mexico.
authors.forename: M A
authors.initials: MA
authors.lastname: Saavedra
authors.affiliation: Direction of Education and Research, Hospital de Especialidades Centro Médico La Raza IMSS, Mexico City, Mexico Universidad Nacional Autónoma de México, Mexico City, Mexico luis_jara_quezada@hotmail.com.
authors.forename: L J
authors.initials: LJ
authors.lastname: Jara
mesh_terms: D000293:Adolescent; D057210:Delayed Diagnosis; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D008180:Lupus Erythematosus, Systemic / Q000150:complications / Q000175:diagnosis*; D009102:Multiple Organ Failure / Q000209:etiology; D056647:Systemic Vasculitis / Q000150:complications / Q000175:diagnosis*
keywords: Fulminant vasculitis; active SLE; systemic lupus erythematosus; visceral vasculitis