Shanthi 20/F admitted with C/O breathlessness since 1 month.
-no chest pain/syncope/palpitations
-cough with minimal expectoration +
-associated with systemic symptoms like low grade fever , myalgia , arthalgia ,loss of appetite & weight×3 months.
-one episode of GTCS.
Conscious , oriented , afebrile
Thin & ill-nourished
Dry scaly skin
Hyper pigmented rash around both elbows
Pedal edema +
BP -100/70 mmhg
RS - B/L basal crepitations +
P/A- palpable liver
CNS- generalized muscle tenderness+
ECG-low voltage complexes
USG ABDOMEN- hepatomegaly , minimal free fluid in the abdomen , significant pericardial effusion.
CT BRAIN-normal study
TO R/O TUBERCULOSIS
DC-P60 , L40
24 hr URINARY PROTEIN-170 mg/day
APTT-31.2 sec(T),30.2 sec(C)
large pericardial effusion
-cells :30(90% lymphocytes)
-ADA :15 U/L
SYSTEMIC LUPUS ERYTHEMATOSES
SUB CLINICAL HYPOTHYROIDISM
ASSOCIATED PULMONARY ARTERIAL HYPERTENSION
-Low dose diuretics
- Thyroxin replacement
Patient was taken over by rheumatology GH.
PERICARDIAL EFFUSION IN SLE
Most common cardiac abnormality- pericardial involvement
Clinically evident pericarditis 20 – 40 %
PE is an infrequent presenting manifestation
Diagnosis rests on other signs and positive ANA
Pericardial fluid is typically an exudate
Symptomatic PE often accompanied by pleural effusion
Pericardial tamponade is rare
Treatment ; NSAID for pericarditis
Corticosteroids for large effusions
Immunosuppressant for resistant effusions
PHT ASSOCIATED WITH SLE
Rare but potentially life threatening complication of SLE
Incidence 0.5 – 14 %
Mortality 25 – 50 % in two years after diagnosis
ECHO may show RVH even before onset of symptoms
Vasoconstriction, vasculitis and thrombosis are implicated
Endothelial dysfunction is evident with high endothelin levels
Rt heart cath with assessment of vascular reactivity should be done.
Treatment – Ca channel blockers, Prostacyclin ,endothelin receptor antagonists.
Prevalence of thyroid dysfunction in SLE
Appenzeller, Simone MD, PhD; Pallone, Ana T. MD; Natalin, Ricardo A. MD; Costallat, Lilian T. L. MD, PhD
Our patients with SLE had a high prevalence of symptomatic (6.1%) and significantly more subclinical hypothyroidism(11.5%) and positive thyroid auto antibodies (17%). Thyroid auto antibodies may precede the appearance of clinical autoimmune disease. Sjögren syndrome and positive rheumatoid factors were more frequently observed in SLE patients with autoimmune thyroid disease. We believe that, since symptoms of SLE and thyroid disease can be similar, that SLE patients should routinely been investigated for autoimmune thyroid disease.
Chronic active hepatitis
HYPOTHYROIDISM AND AUTO IMMUNE DISORDERS
Fathima 45/F not a known DM , HT ,CAD , PULM KOCHS.
H/O abdominal distension ×2 weaks
-no associated symptoms
-No other significant history.
I0 C0 E0 LN0
-umbilicus flushed with surface
- no dilated veins
- no organomegaly
- free fluid ++
ASCITES FOR EVALUATION
G/T -B +ve
P/S -normocytic normochromic
USG abdomen :
no significant abnormality in solid abdominal& pelvic organs