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*For reference only for medical professionals, I didn't expect it to be ~ Aortic dissection, this name makes doctors shudder, after a successful "demolition", did not expect that there is another mystery in the cause? An elderly female patient who received a very timely emergency operation.
She was in good health and had abdominal pain and bloating for more than one month.
Her symptoms did not alleviate after self-administering the "Stomach Protector".
Go to the outside hospital for treatment.
Routine blood test showed: hemoglobin 85g/L, C-reactive protein 61.
7mg/L; blood biochemistry: ALT 51U/L, AST 65U/L.
Chest CT enhancement: thoracic aortic aneurysm, extensive exudation and exudation around retroperitoneal vessels, bilateral pleural effusion with atelectasis of the left lower lobe, and a small amount of pericardial effusion.
Transferred to the emergency department of our hospital, thoracic and abdominal aorta CTA: 1.
Descending aortic dissection (Stanford type B) aneurysm; 2.
Two pneumonias, bilateral pleural effusion, with partial atrophy of the lower lobes of both lungs; 3.
Longitudinal There are multiple enlarged lymph nodes in the diaphragm and the left axillary; 4.
A large amount of fluid in the abdominal and pelvic cavity; 5.
The soft tissue edema of the bilateral abdominal and pelvic walls.
"Descending aorta replacement" was performed in the emergency department of cardiothoracic surgery.
The course of the operation went smoothly.
After the operation, he was treated with anti-infection, albumin supplementation, blood transfusion, and drainage of pleural effusion, but the patient continued anemia, and the pleural and pericardial effusion did not decrease.
When the patient was admitted to the hospital, he was complicated by moderate anemia, a large amount of fluid in the serous cavity, and soft tissue edema of the abdominal and pelvic wall.
Aortic dissecting aneurysms could not explain these multi-system involvement phenomena.
After postoperative symptomatic treatments such as albumin supplementation and blood transfusion, the above symptoms were not improved.
So, are there any potential reasons? To further improve the inspection, autoantibody: ANA-T>1:1000, anti-dsDNA 1:100, A-U1RNP 3+, A-Sm 3+, A-SSA 3+, A-Ro52 3+, A-SSB 1 +, A-Jo1 is weakly positive, A-CenpB is weakly positive, anti-nucleosome antibody 1+, anti-histone antibody 3+.
Humoral immunity showed complement C3 0.
357g/L (normal value 0.
9-1.
8g/L), complement C4 0.
097g/L (normal value 0.
1-0.
4g/L), urine routine: protein 3+, red blood cell 2+, urine protein Quantitative 6.
92g/24h (normal value <0.
4g/24h).
Definitely diagnosed as "systemic lupus erythematosus", the disease involved blood, circulatory system, kidney, liver, serous cavity, SLEDAI score 12 points.
After administration of prednisone, mycophenolate mofetil, and hydroxychloroquine sulfate, the patient's symptoms were significantly relieved.
One month later, the chest cavity, abdominal cavity, and pericardial effusion were rechecked for obvious absorption, and the oral medication was continued.
Discussion Aortic dissection is not common, but most of the onset is sudden and extremely dangerous.
Early and accurate diagnosis and timely treatment are the keys to patient survival.
The etiology is mostly related to heredity and trauma, and sporadic cases have also been reported.
However, in this patient, in addition to aortic dissection at the time of diagnosis, multiple system involvements were also complicated.
Tracing the root cause, the final diagnosis was systemic lupus erythematosus.
The existing reports of systemic lupus erythematosus complicated with aortic dissecting aneurysm are more common in cardiovascular diseases caused by long-term oral glucocorticoids.
Systemic lupus erythematosus with aortic dissecting aneurysm as the first manifestation is extremely rare.
After timely diagnosis and treatment, the patient was lucky enough to escape the disaster and restore the usual quality of life.
But this case also warns us to pay attention to elderly lupus patients with atypical disease.
The cardiovascular system of systemic lupus erythematosus involves a variety of heart and vascular diseases.
Heart disease includes valvular disease, myocardial dysfunction, pericardial disease, and coronary artery involvement.
Vascular involvement is mostly manifested as vasculitis, which can involve large, medium and small blood vessels.
Small vessel disease is the most common, which can be manifested as purpura, reticularis, panniculitis, and visceral vasculitis.
Moderate and large vasculitis can also be seen in a small number of reports, and its performance is similar to polyarteritis.
Systemic lupus erythematosus with aortic dissecting aneurysm as the first manifestation has not been reported.
Combined with the patient’s medical history, no previous history of hypertension, no obvious history of trauma before the onset, no genetic history in the family, and multiple system involvement at the onset of the disease, both of which occurred at the same time.
Comprehensive consideration, systemic lupus erythematosus complicated with macrovascular disease The possibility is great.
Senile-onset systemic lupus erythematosus Senile-onset systemic lupus erythematosus is relatively rare.
According to many literature reports, the onset of senile lupus erythematosus is more insidious and clinical non-specific manifestations are more obvious.
The common light sensitivity, facial rash, and arthritis in women of childbearing age are relatively rare, while serositis and pulmonary involvement are more common, which increases the difficulty of early identification of the disease.
But at the same time, the patient has relatively few organs involved, the disease activity is relatively low, and the prognosis is relatively good.
In our case, the patient's first symptoms were extremely atypical, and the clinical manifestations were in line with the literature description.
Therefore, for the onset of multiple system lesions in elderly female patients, even if there is no typical clinical symptoms, the possibility of systemic lupus erythematosus should be considered.
Treatment of senile-onset systemic lupus erythematosus The disease activity of senile-onset systemic lupus erythematosus is relatively lower, and treatment needs to take into account the disease activity, the involvement of organs and the combined underlying diseases.
Possible drug interactions and adverse reactions caused by drugs should always be considered.
It is also important to pay attention to changes in the pharmacokinetics of the elderly (increasing the risk of side effects).
For serous effusion and arthritis, non-steroidal anti-inflammatory drugs and low-dose glucocorticoids are the first choice for treatment.
For patients with important organ involvement, such as blood system involvement and kidney involvement, treatment with immunosuppressive agents such as mycophenolate mofetil and cyclophosphamide is necessary.
However, relevant adverse reactions should be closely monitored during treatment.
References: [1]Barile-Fabris L, Hernandez-Cavrera MF, Barragan-Garfias JA.
Vasculitis in systemic lupus erythematosus.
Curr Rheumatol Rep.
2014;16(9):440.
[2]Sokalski DG,Copsey Spring TR, Roberts WN.
Large artery inflammation in systemic lupus erythematosus.
Lupus.
2013;22(9):953.
[3]J.
Rovenský, A.
Tuchyňová.
Systemic lupus erythematosus in the elderly.
Autoimmunity Reviews.
2008;(7):235 –239.
She was in good health and had abdominal pain and bloating for more than one month.
Her symptoms did not alleviate after self-administering the "Stomach Protector".
Go to the outside hospital for treatment.
Routine blood test showed: hemoglobin 85g/L, C-reactive protein 61.
7mg/L; blood biochemistry: ALT 51U/L, AST 65U/L.
Chest CT enhancement: thoracic aortic aneurysm, extensive exudation and exudation around retroperitoneal vessels, bilateral pleural effusion with atelectasis of the left lower lobe, and a small amount of pericardial effusion.
Transferred to the emergency department of our hospital, thoracic and abdominal aorta CTA: 1.
Descending aortic dissection (Stanford type B) aneurysm; 2.
Two pneumonias, bilateral pleural effusion, with partial atrophy of the lower lobes of both lungs; 3.
Longitudinal There are multiple enlarged lymph nodes in the diaphragm and the left axillary; 4.
A large amount of fluid in the abdominal and pelvic cavity; 5.
The soft tissue edema of the bilateral abdominal and pelvic walls.
"Descending aorta replacement" was performed in the emergency department of cardiothoracic surgery.
The course of the operation went smoothly.
After the operation, he was treated with anti-infection, albumin supplementation, blood transfusion, and drainage of pleural effusion, but the patient continued anemia, and the pleural and pericardial effusion did not decrease.
When the patient was admitted to the hospital, he was complicated by moderate anemia, a large amount of fluid in the serous cavity, and soft tissue edema of the abdominal and pelvic wall.
Aortic dissecting aneurysms could not explain these multi-system involvement phenomena.
After postoperative symptomatic treatments such as albumin supplementation and blood transfusion, the above symptoms were not improved.
So, are there any potential reasons? To further improve the inspection, autoantibody: ANA-T>1:1000, anti-dsDNA 1:100, A-U1RNP 3+, A-Sm 3+, A-SSA 3+, A-Ro52 3+, A-SSB 1 +, A-Jo1 is weakly positive, A-CenpB is weakly positive, anti-nucleosome antibody 1+, anti-histone antibody 3+.
Humoral immunity showed complement C3 0.
357g/L (normal value 0.
9-1.
8g/L), complement C4 0.
097g/L (normal value 0.
1-0.
4g/L), urine routine: protein 3+, red blood cell 2+, urine protein Quantitative 6.
92g/24h (normal value <0.
4g/24h).
Definitely diagnosed as "systemic lupus erythematosus", the disease involved blood, circulatory system, kidney, liver, serous cavity, SLEDAI score 12 points.
After administration of prednisone, mycophenolate mofetil, and hydroxychloroquine sulfate, the patient's symptoms were significantly relieved.
One month later, the chest cavity, abdominal cavity, and pericardial effusion were rechecked for obvious absorption, and the oral medication was continued.
Discussion Aortic dissection is not common, but most of the onset is sudden and extremely dangerous.
Early and accurate diagnosis and timely treatment are the keys to patient survival.
The etiology is mostly related to heredity and trauma, and sporadic cases have also been reported.
However, in this patient, in addition to aortic dissection at the time of diagnosis, multiple system involvements were also complicated.
Tracing the root cause, the final diagnosis was systemic lupus erythematosus.
The existing reports of systemic lupus erythematosus complicated with aortic dissecting aneurysm are more common in cardiovascular diseases caused by long-term oral glucocorticoids.
Systemic lupus erythematosus with aortic dissecting aneurysm as the first manifestation is extremely rare.
After timely diagnosis and treatment, the patient was lucky enough to escape the disaster and restore the usual quality of life.
But this case also warns us to pay attention to elderly lupus patients with atypical disease.
The cardiovascular system of systemic lupus erythematosus involves a variety of heart and vascular diseases.
Heart disease includes valvular disease, myocardial dysfunction, pericardial disease, and coronary artery involvement.
Vascular involvement is mostly manifested as vasculitis, which can involve large, medium and small blood vessels.
Small vessel disease is the most common, which can be manifested as purpura, reticularis, panniculitis, and visceral vasculitis.
Moderate and large vasculitis can also be seen in a small number of reports, and its performance is similar to polyarteritis.
Systemic lupus erythematosus with aortic dissecting aneurysm as the first manifestation has not been reported.
Combined with the patient’s medical history, no previous history of hypertension, no obvious history of trauma before the onset, no genetic history in the family, and multiple system involvement at the onset of the disease, both of which occurred at the same time.
Comprehensive consideration, systemic lupus erythematosus complicated with macrovascular disease The possibility is great.
Senile-onset systemic lupus erythematosus Senile-onset systemic lupus erythematosus is relatively rare.
According to many literature reports, the onset of senile lupus erythematosus is more insidious and clinical non-specific manifestations are more obvious.
The common light sensitivity, facial rash, and arthritis in women of childbearing age are relatively rare, while serositis and pulmonary involvement are more common, which increases the difficulty of early identification of the disease.
But at the same time, the patient has relatively few organs involved, the disease activity is relatively low, and the prognosis is relatively good.
In our case, the patient's first symptoms were extremely atypical, and the clinical manifestations were in line with the literature description.
Therefore, for the onset of multiple system lesions in elderly female patients, even if there is no typical clinical symptoms, the possibility of systemic lupus erythematosus should be considered.
Treatment of senile-onset systemic lupus erythematosus The disease activity of senile-onset systemic lupus erythematosus is relatively lower, and treatment needs to take into account the disease activity, the involvement of organs and the combined underlying diseases.
Possible drug interactions and adverse reactions caused by drugs should always be considered.
It is also important to pay attention to changes in the pharmacokinetics of the elderly (increasing the risk of side effects).
For serous effusion and arthritis, non-steroidal anti-inflammatory drugs and low-dose glucocorticoids are the first choice for treatment.
For patients with important organ involvement, such as blood system involvement and kidney involvement, treatment with immunosuppressive agents such as mycophenolate mofetil and cyclophosphamide is necessary.
However, relevant adverse reactions should be closely monitored during treatment.
References: [1]Barile-Fabris L, Hernandez-Cavrera MF, Barragan-Garfias JA.
Vasculitis in systemic lupus erythematosus.
Curr Rheumatol Rep.
2014;16(9):440.
[2]Sokalski DG,Copsey Spring TR, Roberts WN.
Large artery inflammation in systemic lupus erythematosus.
Lupus.
2013;22(9):953.
[3]J.
Rovenský, A.
Tuchyňová.
Systemic lupus erythematosus in the elderly.
Autoimmunity Reviews.
2008;(7):235 –239.