Tendon ruptures in patients with systemic lupus erythematosus treated with corticosteroids

Abstract

There have been only 5 case reports in English of tendon rupture in SLE since 1958 (Table 1). Two additional cases involving three patellar tendons and four extensor digitorum tendons are reported here. CASE REPORTSCP is a 33-year-old white woman who developed a telangiectactic skin rash and a positive lupus erythematous (LE) cell preparation in 1965. Forty milligrams of prednisone were taken daily through 1973. In 1970 a repeat LE cell preparation was positive and antinuclear antibody by immunofluorescence (ANIF) was reactive at 1 to 32 with a mixed pattern. Twenty-four-hour urine collections revealed 400 mg of protein and a normal creatinine clearance. A renal biopsy showed a focal proliferative glomerulonephritis with 3+ diffuse granular staining for IgG and complement. Hemoglobin was 13.1 g, with a white blood count of 3200 and a normal differential. A skin biopsy revealed positive IgM and IgC at the dermal-epidermal junction and perivascularly in the papillary dermis. From 1971 to the summer of 1973, the patient developed boutonniere deformities of both hands and generalized erythematous telangiectactic scaly dermatitis due to On July 4, 1973, while leaving a bus, she felt a sudden severe pain in her right knee, and fell from the bus on her outstretched hands. A right infrapatellar tendon rupture was diagnosed a t a local hospital atid her right leg was casted for 3 weeks at which time she was transferred to the University of Chicago Hospitals.Examination on admission revealed an anxious woman with marked alopecia and a generalized erythematous scaly dermatitis, most prominent over the back and malar areas. Her blood pressure was 120/80 mmHg, pulse 95, respiration 16, temperature 37.2 Celsius. Examination also revealed: a) acromioclavicular separation of the right shoulder; b) marked \casting of the right quadriceps muscles with a defect in the right infrapatellar tendon and inability to extend the knee; c) rupture of the extensor digitorum communis of the right hand; and d) generalized proximal muscle weakness.Electrolytes, urea nitrogen, creatinine, liver function studies, uric acid, urinalysis, hemoglobin and platelet count were normal. T h e white blood cell count was 1900 with 557, polys, 57, bands, 30/, metamyelocytes, 307, lymphocytes, 67, monocytes, and 1% eosinophils. A chest film showed increased basillar interstitial markings. Hand films revealed diffuse osteoporosis with no juxta-articular erosions. A Westergren erythrocyte sedimentation rate was 34 mm/hr; hemolytic complement 125 units (normal 180-330 p); and creatiniiie clearance 115 ml/ min. ANIF was positive at 1 to 40 in a rim pattern and DNA antibodies (Farr test) was 4O0& (normal < 251z). Bone marrow aspirate revealed an increase in the myeloid/erythroid in an otherwise hypocellular marrow.6-Mercaptopurine, 75 mg daily was given, and over a 4-week period, the steroid dose was decreased from 40 to 5 mg daily. Initially a hinged knee brace was applied and she was able to walk using platform crutches.A repair of the right infrapatellar tendo...

Spontaneous bilateral patellar tendon rupture: a case report and review of the literature

“…To the best of our knowledge, bilateral and simultaneous ruptures of the patellar tendons are infrequently reported. Usually this kind of injury has been associated with systemic diseases such as SLE [7], rheumatoid arthritis [8], chronic renal failure [9] and prolonged corticosteroid treatments [11].…”

“…Jarvinen indicated that spontaneous tendon rupture represents the end stage of tissue degeneration, resulting from a cumulated effect of repetitive microtrauma to the collagen fibres, connective matrix and the vessels of the tendons [17]. Systemic disorders such as chronic renal failure [9], SLE [7], rheumatoid arthritis [8] and hyperparathyroidism [10] may also predispose to tendon rupture. In the literature there are reports of spontaneous rupture of patellar tendon in adolescents affected by Sinding-Larsen-Johannson disease [18] and in adults affected by jumper's knee [19], however in the majority of the cases a chronic intra-or peri-injury degeneration was reported.…”

Patellar Tendon Rupture with Underlying Systemic Lupus Erythematosus: A Case Report

“…Atraumatic patellar tendon ruptures in patients with SLE, though extremely rare, have been described in the literature (5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18). One study attempted to characterize the clinical features that might predict rupture (15).…”

Spontaneous bilateral rupture of the Achilles tendon: a case report

“…-maladies infectieuses (tuberculose, syphilis) [14] ; -maladies métaboliques (goutte, maladie de Cushing) [15,16].…”