Angioedema in Systemic Lupus Erythematosus (SLE) in Emergency Setting: A Case Report

Nur Mujaddidah Mochtar, Ricky Indra Alfaray, Detty Irawaty, Yelvi Levani

Abstract


Abstract

Systemic Lupus Erythematosus (SLE) is an autoimmune disease which causes chronic inflammation with its characteristics of the formation of autoantibody that attacks nuclear antigen. This disease may damage multisystem organs, and its diagnoses are barely implemented in the Emergency Department. However, cases of angioedema on SLE patient are quite uncommon not only in Indonesia but also globally. This article report an interesting case of 20 years old woman who came to the Emergency Department of Siti Khodijah Sepanjang Hospital with a complaint of swollen lips for three days. The complaint and examination led to the diagnosis of SLE. However, because the incidence rate of angioedema on SLE is low, doctors tend to unconsider the appropriate diagnosis management and administration on this breathing problem caused by SLE.

Keywords: Systemic Lupus Erythematosus, angioedema, emergency

 

Abstrak

Sistemic Lupus Eritematosus (SLE) adalah penyakit autoimun yang menyebabkan peradangan kronis dengan karakteristik pembentukan autoantibodi yang menyerang antigen. Penyakit ini dapat merusak organ multisistem, dan diagnosisnya hampir tidak diterapkan di Unit Gawat Darurat. Namun, kasus angioedema pada pasien SLE sangat jarang tidak hanya di Indonesia tetapi juga secara global. Artikel ini melaporkan kasus menarik dari wanita berusia 20 tahun yang datang ke Unit Gawat Darurat Rumah Sakit Siti Khodijah Sepanjang dengan keluhan bibir bengkak selama tiga hari. Keluhan dan pemeriksaan mengarah pada diagnosis SLE. Namun, karena tingkat kejadian angioedema pada SLE rendah, dokter cenderung tidak mempertimbangkan manajemen diagnosis yang tepat dan administrasi pada masalah pernapasan yang disebabkan oleh SLE ini.

Kata kunci: Sistemik Lupus Eritematosus, angioedema, gawat darurat


Keywords


Systemic Lupus Erythematosus, angioedema, emergency

Full Text:

PDF

References


Manson JJ, Rahman A. Systemic lupus erythematosus. Orphanet J Rare Dis. 2006 Dec 27;1(1):6.

Rosenbaum E, Krebs E, Cohen M, Tiliakos A, Derk C. The spectrum of clinical manifestations, outcome and treatment of pericardial tamponade in patients with systemic lupus erythematosus: a retrospective study and literature review. Lupus. 2009 Jun 11;18(7):608–12.

Jakes RW, Bae S-C, Louthrenoo W, Mok C-C, Navarra S V., Kwon N. Systematic review of the epidemiology of systemic lupus erythematosus in the Asia-Pacific region: Prevalence, incidence, clinical features, and mortality. Arthritis Care Res (Hoboken). 2012 Feb;64(2):159–68.

Indonesia KKR. Lupus. Infodatin. 2017;

Urowitz MB, Gladman D, Ibañez D, Bae SC, Sanchez-Guerrero J, Gordon C, et al. Atherosclerotic vascular events in a multinational inception cohort of systemic lupus erythematosus. Arthritis Care Res (Hoboken). 2010 Jun;62(6):881–7.

Fernandes N, Gomes G, Capela C. Presentation of systemic lupus erythematosus (SLE) in emergency department: a case report. BMC Res Notes. 2013;6(1):181.

Garris C, Shah M, Farrelly E. The prevalence and burden of systemic lupus erythematosus in a medicare population: retrospective analysis of medicare claims. Cost Eff Resour Alloc. 2015 Dec 6;13(1):9.

Jacobsen, J Petersen, S Ullman, P J S. Mortality and Causes of Death of 513 Danish Patients with Systemic Lupus Erythematosus. Scand J Rheumatol. 1999 Jan 12;28(2):75–80.

Association of Indonesian Rheumatology. Rekomendasi Perhimpunan Reumatologi Indonesia Untuk Diagnosis Dan Pengelolaan Lupus Eritematosus Sistemik. Jakarta: Perhimpunan Rheumatologi Indonesia; 2011.

Rink C, Khanna S. Significance of Brain Tissue Oxygenation and the Arachidonic Acid Cascade in Stroke. Antioxid Redox Signal. 2011 May 15;14(10):1889–903.

Tselios K, Urowitz MB. Cardiovascular and Pulmonary Manifestations of Systemic Lupus Erythematosus. Curr Rheumatol Rev. 2017 Dec 26;13(3).

Thong BY, Thumboo J, Howe HS, Feng PH. Life-threatening angioedema in systemic lupus erythematosus. Lupus. 2001 Apr 2;10(4):304–8.

Habibagahi Z, Ruzbeh J, Yarmohammadi V, Kamali M, Rastegar MH. Refractory Angioedema in a Patient with Systemic Lupus Erythematosus. Iran J Med Sci. 2015 Jul;40(4):372–5.

Tekin ZE, Yener GO, Yüksel S. Acquired angioedema in juvenile systemic lupus erythematosus: case-based review. Rheumatol Int. 2018 Aug 27;38(8):1577–84.

LoVerde D, Files DC, Krishnaswamy G. Angioedema. Crit Care Med. 2017 Apr;45(4):725–35.

Keane MP. Rare diseases bullet 7: Pleuropulmonary manifestations of systemic lupus erythematosus. Thorax. 2000 Feb 1;55(2):159–66.

Cicardi M, Zanichelli A. Acquired angioedema. Allergy Asthma Clin Immunol. 2010 Jul 28;6(1):14.

Wong BN, Vadas P. Angioedema suppressed by a combination of anti-histamine and leukotriene modifier. Allergy, Asthma Clin Immunol. 2017 Dec 13;13(1):28.

Lahiri M, Lim AYN. Angioedema and systemic lupus erythematosus--a complementary association? Ann Acad Med Singapore. 2007 Feb;36(2):142–5.

Longhurst H, Zinser E. Prophylactic Therapy for Hereditary Angioedema. Immunol Allergy Clin North Am. 2017;37(3):557–70.

Tarzi MD, Hickey A, Förster T, Mohammadi M, Longhurst HJ. An evaluation of tests used for the diagnosis and monitoring of C1 inhibitor deficiency: normal serum C4 does not exclude hereditary angio-oedema. Clin Exp Immunol. 2007 Jul 5;149(3):513–6.

Longhurst HJ. Emergency treatment of acute attacks in hereditary angioedema due to C1 inhibitor deficiency: what is the evidence? Int J Clin Pract. 2005 May;59(5):594–9.

Longhurst H, Cicardi M, Craig T, Bork K, Grattan C, Baker J, et al. Prevention of Hereditary Angioedema Attacks with a Subcutaneous C1 Inhibitor. N Engl J Med. 2017;376(12):1131–40.




DOI: https://doi.org/10.18196/mm.200252

Refbacks

  • There are currently no refbacks.


Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.


      

Editorial Office:
Journal Room, G1 (Biomedic) Building, Ground Floor, Faculty of Medicine and Health Science Universitas Muhammadiyah Yogyakarta, 
Jalan Lingkar Selatan (Brawijaya), Tamantirto, Kasihan, Bantul, Daerah Istimewa Yogyakarta, Indonesia
Phone: +62 274 387 656 (ext: 231)
WA : +62 811-2650-303
Website: http://journal.umy.ac.id/index.php/mm 
E-mail: mmjkk@umy.university

Creative Commons License
Mutiara Medika: Jurnal Kedokteran dan Kesehatan is licensed under a Creative Commons Attribution 4.0 International License. View My Stats