SLE presenting as demyelinative autoimmune visual loss

Schattner, Ami; Voichanski, Shilo; Uliel, Livnat

doi:10.1136/bcr-2017-222158

Cited by 3 publications

(2 citation statements)

References 47 publications

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“…5,6 We further identified four more cases in the literature where NMOSD was the first manifestation of SLE. 7–10 The salient features of these six cases where NMOSD was the first manifestation of SLE are summarized in Table 1. All these six patients were women, all fulfilled the clinical and imaging criteria for NMOSD.…”

Section: Discussionmentioning

confidence: 99%

Neuromyelitis optica spectrum disorder and systemic lupus erythematosus

Thabah

Dineshbabu

Pranov

et al. 2019

Lupus

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Neuromyelitis optica spectrum disorder is an inflammatory syndrome that is associated with many autoimmune conditions. We present the case of a patient who had longitudinally extensive transverse myelitis and antibodies to aquaporin 4 IgG (AQP4-IgG). Based on presence of lymphopenia, further workup revealed strong ANA positivity, anti-Sm antibodies, and low serum complements suggesting presence of systemic lupus erythematosus. The patient promptly responded to intravenous pulse methylprednisolone and five sessions of plasma exchange. At 1 year, she is on maintenance treatment with low dose prednisolone, azathioprine, and hydroxychloroquine, she has had no relapse and no other clinical features of lupus. This case is an illustration that neuromyelitis optica spectrum disorder can be the first manifestation of systemic lupus erythematosus.

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Section: Discussionmentioning

confidence: 99%

Neuromyelitis optica spectrum disorder and systemic lupus erythematosus

Thabah

Dineshbabu

Pranov

et al. 2019

Lupus

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“…Most cases of thyroid eye disease manifest in patients with hyperthyroidism. However, thyroid eye disease can also manifest in individuals with a thyroid status other than hyperthyroidism, although the incidence rate was found to be low (10%) (Schattner et al 2023). In a separate study conducted by Muñoz-Ortiz et al (2020), the majority of thyroid eye disease patients were found to have hyperthyroidism (86.2%).…”

Section: Correlation Between Thyroid Status and Clinical Activity Scorementioning

confidence: 98%

Significant Role of Thyroid Stimulating Hormone in the Clinical Activity Score of Thyroid Eye Disease at a Tertiary Hospital in Surabaya, Indonesia

Hasna Shahida Amatlulloh,

Delfitri Lutfi,

Soebagijo Adi Soelistijo

et al. 2024

FMI

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Highlights:1. This study, conducted at a tertiary hospital, was the first to analyze the correlation between thyroid status and clinical activity score in thyroid eye disease.2. This study offers valuable information regarding the crucial role of thyroid stimulating hormone (TSH) in determining the clinical activity score of thyroid eye disease. Abstract Thyroid eye disease is an autoimmune disorder characterized by inflammation of the orbital and periorbital tissues. This condition can lead to vision impairment, which is a notable manifestation of thyroid disease. The symptoms of thyroid disease reflected the level of inflammatory activity, whereas the clinical activity score was indicative of active and inactive phases. This retrospective analysis explored the intricate association between thyroid status and clinical activity score in thyroid eye disease patients, with the hope of providing a foundation for further research on the association between thyroid status and the occurrence of TED. This study utilized medical records from the years 2019 to 2022 from the Outpatient Department of Ophthalmic Oncology of Dr. Soetomo General Academic Hospital, Surabaya, Indonesia. The variables examined in this study were thyroid status and the clinical activity score of thyroid eye disease. The statistical analysis was performed using Phi and Cramer’s V as well as Spearman's correlation test (p<0.05). A total of 88 patients were diagnosed with thyroid eye disease during the study period. Thyroid eye disease primarily affected female patients (58%) and those who had a mean age of ≥41 years (58%). The Phi and Cramer’s V analyses indicated no significant association (p > 0.05) between thyroid status and clinical activity score in thyroid eye disease patients. Intriguingly, the results exhibited the presence of euthyroidism as well as both overt and subclinical hypothyroidism and hyperthyroidism, regardless of the clinical activity score. Additionally, the Spearman test that incorporated the levels of thyroid hormones, i.e., triiodothyronine (T3), thyroxine (T4), thyroid stimulating hormone (TSH), and free thyroxine (FT4), showed a significant negative correlation (p<0.05) between TSH and clinical activity score. In conclusion, THS plays a crucial role in determining the clinical activity score of thyroid eye disease patients. This study underscores the imperative for further research to comprehensively elucidate the intricate correlation between TSH and clinical activity score.

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The Wide Spectrum of Presentations of Cytomegalovirus Infection in Immunocompetent Hosts: An Exhaustive Narrative Review

Schattner

2024

Pathogens

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CMV is a ubiquitous DNA virus that establishes infection and results in 40–100% seropositivity. Viral replication occurs following an acquired primary infection (or reinfection) or by the reactivation of life-long latency. In immunocompetent patients, CMV infection is mostly asymptomatic or mild and self-limited. However, an extensive review of the literature published up to April 2024 reveals that despite immunocompetence, CMV can cause a very large variety of clinical syndromes in any part of the gastrointestinal tract (the most common pattern), the central or peripheral nervous system, and the eyes, as well as hematological, pulmonary, cardiac, and cutaneous disease. Not uncommonly, more than one system is involved, and though the disease is often self-limited, treatment with intravenous ganciclovir or oral valganciclovir may be required, and in isolated cases, fatalities may occur. Thus, a potential CMV infection should be considered in the differential of myriad syndromes in non-immunocompromised patients. Associated systemic symptoms (fever, sweats, and weight loss), lymphocytosis, and hepatitis are not uncommon and can be a useful clue. Some populations, such as critically ill patients in intensive care, pregnant women, elderly patients, and those with inflammatory bowel disease, may be more susceptible. Moreover, the potential of past, latent CMV infection (i.e., CMV seropositivity) to be associated with significant cardiovascular morbidity and all-cause mortality years later is intriguing and requires further study. All these data indicate the outstanding importance of developing a vaccine against CMV, which hopefully will become available in the foreseeable future. Meanwhile, a solid diagnosis of active CMV infection can be quickly established (or ruled out) by widely available serology tests and PCR amplification, and clinicians in all disciplines need to be more aware of the diverse guises of CMV infection and remember to consider it in any host, including an immunocompetent one.

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SLE presenting as demyelinative autoimmune visual loss

Cited by 3 publications

References 47 publications

Neuromyelitis optica spectrum disorder and systemic lupus erythematosus

Neuromyelitis optica spectrum disorder and systemic lupus erythematosus

Significant Role of Thyroid Stimulating Hormone in the Clinical Activity Score of Thyroid Eye Disease at a Tertiary Hospital in Surabaya, Indonesia

The Wide Spectrum of Presentations of Cytomegalovirus Infection in Immunocompetent Hosts: An Exhaustive Narrative Review

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