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Systemic lupus erythematosus presenting as hyponatremia-associated rhabdomyolysis: A case report
RATIONALE: Systemic lupus erythematosus (SLE) is an autoimmune disease that involves multiple organs and causes various clinical manifestations. Cases of rhabdomyolysis as the initial presentation of SLE are rare, and there are no reported cases of SLE presenting hyponatremia-associated rhabdomyolys...
Autores principales: | , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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Lippincott Williams & Wilkins
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8483824/ https://www.ncbi.nlm.nih.gov/pubmed/34596163 http://dx.doi.org/10.1097/MD.0000000000027390 |
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author | Lee, In Hee Cho, Seong Ahn, Dong Jik Kim, Min-Kyung |
author_facet | Lee, In Hee Cho, Seong Ahn, Dong Jik Kim, Min-Kyung |
author_sort | Lee, In Hee |
collection | PubMed |
description | RATIONALE: Systemic lupus erythematosus (SLE) is an autoimmune disease that involves multiple organs and causes various clinical manifestations. Cases of rhabdomyolysis as the initial presentation of SLE are rare, and there are no reported cases of SLE presenting hyponatremia-associated rhabdomyolysis as the first manifestation. Herein, we report a case of SLE with lupus nephritis in a patient with acute hyponatremia-associated rhabdomyolysis. PATIENT CONCERNS: A 44-year-old woman was admitted with complaints of altered consciousness, myalgia, and red-brownish urine that first appeared three days prior. Peripheral blood tests revealed elevated creatine kinase (19,013 IU/L) and myoglobin (5099 U/L) levels and severe hyponatremia (111 mEq/L) with no azotemia. Urinalysis showed nephritic sediments. DIAGNOSIS: Whole-body bone scintigraphy showed increased uptake of radiotracer in the both upper and lower extremities. Serological evaluation revealed the presence of anti-nuclear (speckled pattern, 1:640), anti-double stranded DNA, and anti-Smith antibodies and absence of anti-Jo-1 antibody. A kidney biopsy demonstrated mesangial proliferative (class II) lupus nephritis. INTERVENTIONS: Fluid therapy, including intravenous administration of 3% NaCl, was initiated. After three consecutive days of intravenous methylprednisolone (1 g/d), oral prednisolone (1 mg/kg/d), mycophenolate mofetil, and hydroxychloroquine were administered. OUTCOMES: On day 28, the patient was discharged with marked resolution of SLE-associated symptoms and laboratory findings. Lupus reactivation was not present during the subsequent six-month follow-up. LESSONS: Hyponatremia-associated rhabdomyolysis can be the first manifestation of SLE. Moreover, prompt fluid therapy and timely administration of immunosuppressive agents in SLE patients presenting with hyponatremia and rhabdomyolysis can significantly help alleviate disease activity and improve clinical outcomes. |
format | Online Article Text |
id | pubmed-8483824 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Lippincott Williams & Wilkins |
record_format | MEDLINE/PubMed |
spelling | pubmed-84838242021-10-04 Systemic lupus erythematosus presenting as hyponatremia-associated rhabdomyolysis: A case report Lee, In Hee Cho, Seong Ahn, Dong Jik Kim, Min-Kyung Medicine (Baltimore) 6900 RATIONALE: Systemic lupus erythematosus (SLE) is an autoimmune disease that involves multiple organs and causes various clinical manifestations. Cases of rhabdomyolysis as the initial presentation of SLE are rare, and there are no reported cases of SLE presenting hyponatremia-associated rhabdomyolysis as the first manifestation. Herein, we report a case of SLE with lupus nephritis in a patient with acute hyponatremia-associated rhabdomyolysis. PATIENT CONCERNS: A 44-year-old woman was admitted with complaints of altered consciousness, myalgia, and red-brownish urine that first appeared three days prior. Peripheral blood tests revealed elevated creatine kinase (19,013 IU/L) and myoglobin (5099 U/L) levels and severe hyponatremia (111 mEq/L) with no azotemia. Urinalysis showed nephritic sediments. DIAGNOSIS: Whole-body bone scintigraphy showed increased uptake of radiotracer in the both upper and lower extremities. Serological evaluation revealed the presence of anti-nuclear (speckled pattern, 1:640), anti-double stranded DNA, and anti-Smith antibodies and absence of anti-Jo-1 antibody. A kidney biopsy demonstrated mesangial proliferative (class II) lupus nephritis. INTERVENTIONS: Fluid therapy, including intravenous administration of 3% NaCl, was initiated. After three consecutive days of intravenous methylprednisolone (1 g/d), oral prednisolone (1 mg/kg/d), mycophenolate mofetil, and hydroxychloroquine were administered. OUTCOMES: On day 28, the patient was discharged with marked resolution of SLE-associated symptoms and laboratory findings. Lupus reactivation was not present during the subsequent six-month follow-up. LESSONS: Hyponatremia-associated rhabdomyolysis can be the first manifestation of SLE. Moreover, prompt fluid therapy and timely administration of immunosuppressive agents in SLE patients presenting with hyponatremia and rhabdomyolysis can significantly help alleviate disease activity and improve clinical outcomes. Lippincott Williams & Wilkins 2021-10-01 /pmc/articles/PMC8483824/ /pubmed/34596163 http://dx.doi.org/10.1097/MD.0000000000027390 Text en Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc. https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. http://creativecommons.org/licenses/by/4.0 (https://creativecommons.org/licenses/by/4.0/) |
spellingShingle | 6900 Lee, In Hee Cho, Seong Ahn, Dong Jik Kim, Min-Kyung Systemic lupus erythematosus presenting as hyponatremia-associated rhabdomyolysis: A case report |
title | Systemic lupus erythematosus presenting as hyponatremia-associated rhabdomyolysis: A case report |
title_full | Systemic lupus erythematosus presenting as hyponatremia-associated rhabdomyolysis: A case report |
title_fullStr | Systemic lupus erythematosus presenting as hyponatremia-associated rhabdomyolysis: A case report |
title_full_unstemmed | Systemic lupus erythematosus presenting as hyponatremia-associated rhabdomyolysis: A case report |
title_short | Systemic lupus erythematosus presenting as hyponatremia-associated rhabdomyolysis: A case report |
title_sort | systemic lupus erythematosus presenting as hyponatremia-associated rhabdomyolysis: a case report |
topic | 6900 |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8483824/ https://www.ncbi.nlm.nih.gov/pubmed/34596163 http://dx.doi.org/10.1097/MD.0000000000027390 |
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