Kosugi Shotaro, Yoshida Tadashi, Yoshimoto Norifumi, Itoh Hiroshi, Oya Mototsugu
Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan.
Apheresis and Dialysis Center, Keio University School of Medicine, Tokyo, Japan.
Clin Med Insights Case Rep. 2021 Oct 27;14:11795476211056172. doi: 10.1177/11795476211056172. eCollection 2021.
A 61-year-old woman with a 4-year history of maintenance hemodialysis due to end-stage renal disease of unknown cause was admitted because of a recurrent fever and abdominal pain lasting for 3 months. She had rheumatoid arthritis as a complication and had taken sulfasalazine for over 4 years. Laboratory data revealed thrombocytopenia, hypocomplementemia, a high C-reactive protein level, and positivity for antinuclear antibody and anti-double strand DNA antibody. Gallium scintigraphy showed pericarditis, pleuritis, and peritonitis. Nonscarring alopecia was also noted. She was diagnosed as having systemic lupus erythematosus (SLE). Drug-induced lupus elicited by sulfasalazine was ruled out because the symptoms did not improve even after the discontinuation of the drug upon admission. Oral prednisolone treatment markedly improved her symptoms and laboratory data. However, she later died of sepsis arising from proctitis on day 71 of admission. This report underscores the necessity of considering new-onset SLE in patients with unexplained fever and serositis, including pleuritis, peritonitis, or pericarditis, even if they are receiving maintenance dialysis.
一名61岁女性，因不明原因的终末期肾病接受维持性血液透析4年，因反复发热和腹痛持续3个月入院。她有类风湿关节炎并发症，服用柳氮磺胺吡啶超过4年。实验室检查显示血小板减少、补体降低、C反应蛋白水平升高，抗核抗体和抗双链DNA抗体阳性。镓扫描显示心包炎、胸膜炎和腹膜炎。还发现非瘢痕性脱发。她被诊断为系统性红斑狼疮（SLE）。因入院停药后症状仍未改善，排除了柳氮磺胺吡啶引起的药物性狼疮。口服泼尼松龙治疗使她的症状和实验室检查结果明显改善。然而，她后来在入院第71天死于直肠炎引起的败血症。本报告强调，即使是正在接受维持性透析的患者，对于原因不明的发热和浆膜炎（包括胸膜炎、腹膜炎或心包炎）患者，也有必要考虑新发SLE。
