Systemic lupus erythematosus and antineutrophilic cytoplasmic antibody-associated vasculitis overlap syndrome complicated by subarachnoid hemorrhage: case-based review
Khorolsky, Ciril; Castellano, Andrew; Comstock, David; Brinster, Nooshin K; See, Sein Y; Garner, Bruce F
Systemic lupus erythematosus (SLE) and antineutrophil cytoplasmic antibody-associated vasculitis (AAV) overlap syndrome is an inflammatory disorder with a mixed presentation that is characterized by clinical features of both SLE and AAV. Although renal disease predominates, any organ system in the body may be affected. Neurologic manifestation in patients with SLE-AAV overlap syndrome is rare and has only been previously documented as cerebral ischemia. We report a patient with SLE-AAV overlap syndrome diagnosed based on clinical, serologic and biopsy-proven histologic findings who presented with subarachnoid hemorrhage (SAH) secondary to ruptured right anterior cerebral artery aneurysm. To the authors' knowledge, this is the first reported case of SLE-AAV overlap syndrome diagnosed in a patient with a SAH due to an intracranial aneurysm. Neurologic involvement in patients with SLE-AAV overlap syndrome is uncommon and has not been well-studied. Clinicians who encounter patients with neurologic signs that present with symptoms and a serologic profile that correspond to both SLE and AAV criteria, should consider the association between SLE-AAV overlap syndrome and a hemorrhagic stroke, specifically SAH.
Isolated end-stage renal disease in Sjogren's syndrome due to immune complex mediated glomerulonephritis
Agarwal, Shashank; Eapen, Jaishvi; Wu, Ming; Garner, Bruce; Alhaddad, Adib
Renal involvement is an uncommon extra-glandular manifestation in Sjogren's syndrome (SS). We present the case of a young male who presented with nephrotic range proteinuria and advanced irreversible renal disease, with positive anti-Ro antibody (Ab) and antineutrophil cytoplasmic antibody (ANCA) with myeloperoxidase (MPO) specificity. He was initially treated with steroids for suspected ANCA vasculitis but treatment was discontinued as there was no response and renal biopsy revealed interstitial lymphocytic infiltrates, advanced glomerular disease with immune complex mediated glomerulonephritis more suspicious for SS. SS usually affects exocrine glands and patients rarely have renal involvement in which cases it is commonly tubulo-interstitial nephritis. This report describes a rare case of anti-Ro Ab and MPO-ANCA positive patient with advanced irreversible renal disease due to immune-complex mediated glomerulonephritis felt to be due to SS and without any classic sicca symptoms.
Long-term survival of an AIDS patient with a tuberculous cerebral abscess [Case Report]
Gettler, J F; Garner, B F
Unlike other forms of tuberculosis, tuberculous cerebral abscess is a rare complication of human immunodeficiency virus (HIV) infection and usually presents at a late stage of the disease. This article describes a case of tuberculous cerebral abscess in an HIV-infected patient that was effectively treated with surgery and chemotherapy. The patient has survived more than 5 1/2 years since being diagnosed and remains in good health.
Acute blood pressure elevation can mimic arteriographic appearance of cerebral vasculitis--(a postpartum case with relative hypertension) [Case Report]
Garner, B F; Burns, P; Bunning, R D; Laureno, R
A 35-year-old woman presented 9 days postpartum with severe headache, arterial hypertension, and left parietal symptoms. A cerebral angiogram revealed widespread irregular areas of narrowing and dilatation, highly suggestive of vasculitis. The hypertension was treated successfully. A repeat angiogram 9 days later was almost completely normal. As this course is inconsistent with isolated cerebral vasculitis, and because the angiogram normalized with antihypertensive therapy, it is likely that the angiographic findings were secondary to hypertension. Experimental data in fact show that acute hypertension can produce areas of cerebrovascular spasm and dilatation. Recognition that angiographic findings suggestive of cerebral vasculitis are nonspecific and may be due to hypertension should prevent unnecessary treatment for vasculitis in such patients.