PC1. Lupus hematologic - o entitate nosologica invecinata cu LES; comentariu pe marginea unui caz clinic
Pacienta C. S. in varsta de 24 de ani aflata in observatie cu diagnosticul de LES predominant hematologic seronegativ si care intrerupe corticoterapia de aproximativ o luna se prezinta cu epistaxis, gingivoragii, bule hemoragice pe mucoasa bucala, eritem in fluture cu tenta purpurica in regiunea fetei, eruptie purpurica nereliefata la nivelul membrelor inferioare, poliatralgii.
Anamnestic se retin trei avorturi spontane.
Obiectiv: starea generala este medie, prezinta micropoliadenopatie laterocervicala si submandibulara, splenomegalie moderata.
Imunobiologic se constata un VSH crescut (40/50), anemie (8g%), leucopenie (4 500/mm3), trombopenie severa
(30 000/mm3), Coombs pozitiv, complement seric scazut, anticorpi anticardiolipina prezenti si, de aceasta data, anticorpi antinucleari la titru inalt.
Concluzii. Asocierea anemiei hemolitice autoimune, a trombopeniei periferice, a trombozelor arteriale si/sau venoase, a avorturilor repetate si a antifosfolipidelor, asociere definita „lupus hematologic" trebuie considerata ca o entitate nosologica foarte apropiata LES. Pentru aceasta pledeaza posibilitatea evolutiei spre un LES autentic.
PC1. Hematological lupus - an entity similar to lupus erythematosus - comment on clinical case
Patient CS, 24 years old, known with lupus erythematosus predominant hematological, with negative serology stops corticosteroids therapy. After one month she solicits medical help for epistaxis, bleeding gums, hemorrhagic bulla on oral mucous, raised malar ("butterfly") rush, flat purpura along the legs, arthralgias. She also has three abortions in the last years.
On clinical examination, she presents cervical and submandibular lymphadenopathy, mild splenomegaly with mild systemic symptoms.
Laboratory findings: anemia (8 g%), leukocytopenia with lymphopenia, severe thrombocytopenia (30,000/mm3), and a positive Coombs' test, elevate Westergreen erythrocyte sedimentation rate, antinuclear antibodies and anticardiolipin antibody positive.
Conclusion: hematological lupus is a disease characterize by hematological abnormalities like hemolytic anemia, thrombocytopenia, presence of antinuclear antibodies and anticardiolipin antibody. It is an entity similar with systemic lupus erythematosus and can evolve in SLE.