Ewha Med J.  2015 Oct;38(3):121-125. 10.12771/emj.2015.38.3.121.

Late-onset Systemic Lupus Erythematosus with Protein-losing Enteropathy, Vitiligo, and Diffuse Alveolar Hemorrhage

• Ohe M
• Kudoh R
• Seki M
• Endo M
• Shiki M

• KMID: 2171349
• DOI: http://doi.org/10.12771/emj.2015.38.3.121

Abstract

A 60-year-old man who had been diagnosed with protein-losing enteropathy (PLE) and vitiligo at age 51 years was admitted with dyspnea, hemoptysis, and lower-limb edema. On the basis of computed tomography findings, the cause of respiratory symptoms was thought to be diffuse alveolar hemorrhage (DAH). The final diagnosis of late-onset systemic lupus erythematosus (SLE) was established on the basis of renal biopsy examinations that revealed evidence of active SLE with lupus nephritis (World Health Organization, class V) and positive results for antinuclear antibody. DAH, as well as PLE and vitiligo were attributed to SLE. The patient was successfully treated with methylprednisolone and then prednisolone in combination with cyclosporin A. Because late-onset SLE is rare and patients tend to show atypical symptoms, close attention should be paid to the preceding symptoms.

Keyword

Systemic lupus erythematosus; Late-onset; Steroid therapy

MeSH Terms

Antibodies, Antinuclear
Biopsy
Cyclosporine
Diagnosis
Dyspnea
Edema
Hemoptysis
Hemorrhage*
Humans
Lupus Erythematosus, Systemic*
Lupus Nephritis
Methylprednisolone
Middle Aged
Prednisolone
Protein-Losing Enteropathies*
Vitiligo*
Antibodies, Antinuclear
Cyclosporine
Methylprednisolone
Prednisolone

Figure

• 

  Fig. 1 Vitiligo. Depigmented patches are shown on the neck and upper back (A) and on the arm (B).

• 

  Fig. 2 Radiologic findings at initial presentation (A, B) and after treatment (C, D).(A) A chest radiograph shows bilateral, slightly reticular opacities predominantly in the middle and lower lung fields. (B) A high-resolution chest computed tomography (CT) shows bilateral ground-glass opacities, with relative sparing of the peripheral lung parenchyma. (C) A chest radiograph shows no abnormal findings. (D) A high-resolution chest CT shows no abnormal findings.

• 

  Fig. 3 Histologic findings. (A) Light microscopy of a renal biopsy specimen shows no significant glomerular findings (H&E, ×400). (B) Periodic acid methenamine silver staining shows spike formation in the basement membrane (×400). (C) Immunofluorescence microscopy shows diffuse granular deposits of IgG in the basement membrane (×400). (D) Immunofluorescence microscopy shows diffuse granular deposits of C3 in the basement membrane (×400).

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