A Rare Case of Systemic Lupus Erythematosus in an Elderly Man

Abstract

A. Comparative mechanisms for contraction of cardiac and skeletal muscle. Chest 1980;78(Suppl 1):123-139. 4. Stulz PM, Scheidegger D, Drop LJ et al. Ventricular pump performance during hypocalcemia: Clinical and experimental studies. J Thorac Cardiovasc Surg 1979;78:185-194. 5. Kazmi AS, Wall BM. Reversible congestive heart failure related to profound hypocalcemia secondary to hypoparathyroidism. Am J Med Sci 2007;333:226-229. 6. Zittermann A, Schleithoff SS, Tenderich G et al. Low vitamin D status: A contributing factor in the pathogenesis of congestive heart failure? J Am Coll Cardiol 2003;41:105-112. 7. Tomar M, Radhakrishnan S, Shrivastava S. Myocardial dysfunction due to hypocalcemia. Indian Pediatr 2010;47:781-783. 8. Maiya S, Sullivan I, Allgrove J et al. Hypocalcaemia and vitamin D deficiency: An important, but preventable, cause of life-threatening infant heart failure. Heart Br Card Soc 2008;94:581-584. A RARE CASE OF SYSTEMIC LUPUS ERYTHEMATOSUS IN AN ELDERLY MAN To the Editor: Systemic lupus erythematosus (SLE) is an autoimmune disorder with multiorgan involvement that occurs mainly in young women. Late-onset SLE (LO-SLE) is mainly used to describe individuals diagnosed after that age of 50. 1 Clinically, the disease is slow and insidious. The frequency of LO-SLE is reported to be between 6% and 18% of individuals with SLE; it is extremely rare after the age of 90. 2,3 CASE REPORTA 91-year-old man presented with fatigue, weakness, and weight loss lasting for 1 year, having lost 15 kg despite treatment with oral parenteral nutrition supplementation.Before symptom onset, he was independent in activities of daily living (ADLs) and instrumental ADLs, but for the previous 3 months he had needed support. Comprehensive Geriatric Assessment (CGA) Mini Nutritional Assessment score was 5, total CGA score was 15, Katz Index of Activities of Daily Living score was 2 out of 6, and Lawton and Brody Index of Instrumental Activity of Daily Living score was 2 out of 8. There were no pathological findings on physical examination. Laboratory tests showed hemoglobin 10.7 g/dL (normal 11.7-16.1 g/dL), hematocrit 31.7% (normal 37-51%), mean corpuscular volume 89.5 fL (normal 81-103 fL), blood ferritin 171 ng/mL (normal 24-336 ng/mL), erythrocyte sedimentation rate 102 mm/h (normal 0-20 mm/h), creatinine 1.26 mg/dL (normal 0.7-1.2 mg/dL), estimated glomerular filtration rate 44 mL/ min (normal >90 mL/min), albumin 2.4 g/dL (normal 3.5-5.2 g/dL), lactate dehydrogenase 121 U/L (normal 125-220 U/L), direct coombs +, and C-reactive protein (CRP) 39.7 mg/L (normal 0-3 mg/L). Spot urinalysis showed blood was positive for erythrocytes (50/lL; normal < 5/ lL) and 40 erythrocytes per high-power field, and 24-hour urinalysis revealed proteinuria (560 mg/d, normal < 140 mg/d). Complement C4 was 56 mg/dL (normal 12-72 mg/dL), and complement C3 was 0.901 g/L (normal 0.9-1.8 g/L). Evaluating for multiple myeloma, immunoglobulin (Ig)G was 32 g/L (normal 6-15 g/L), IgA was 7.68 g/L (normal 0.9-4 g/L), and serum and urinary electrophoresis ...

Very elderly-onset systemic lupus erythematosus presented with mixed-type autoimmune hemolytic anemia

“…5,6 The incidence of SLE decreases beyond this age point, 10-20% of SLE patients having disease onset beyond the age of 50 years, 5,6,7 and only 0.5% of the patients develop SLE after 70 years of age. 14 The present case presented with and was diagnosed as SLE at the age of 86 years old and, as only four cases of SLE diagnosed above 90 years of age have been reported in the literature 17,19 and the oldest age at diagnosis of SLE in 1,000 and 342 patients was 82 and 78 years, respectively, 14,20 she may be one of the rare SLE patients diagnosed at a very advanced age.…”

“…11,12,13 SLE mainly affects women of child-bearing age with mean age of disease presentation or diagnosis around thirty years of age. 14 While the definition of elderly-onset SLE varies among studies, 14,15,16,17,18 onset after age 50-65 years appears to be a widely accepted definition. 5,6 The incidence of SLE decreases beyond this age point, 10-20% of SLE patients having disease onset beyond the age of 50 years, 5,6,7 and only 0.5% of the patients develop SLE after 70 years of age.…”