RESPIRATORY FEATURES OF A SYSTEMIC LUPUS ERYTHEMATOSUS IN A SMOKING PATIENT. CASE REPORT
There is increasingly mentioned in literature a respiratory onset of the systemic lupus erythematous (SLE). A 61-year-old female (active smoker, with myocardial infarction history) was admitted in the hospital for respiratory failure, fatigue, nose rash, alopecia, photosensitivity, polyarthralgia, weight loss. Computed Tomography (CT) scan of the chest noticed a pattern of an obliterative bronchiolitis (“tree-in-bud”, interstitial fibrosis, and bronchiectasis), kyphosis and advanced atherosclerosis. Immunological investigation revealed antinuclear antibodies that sustained SLE diagnosis. Lung function impairment showed severe mixed ventilatory dysfunction with decreased oxygen saturation (SaO2) below 90% during a minimal effort. Bronchoscopy, chest CT and biomarkers excluded sarcoidosis or lung tumor. Skin biopsy confirmed SLE vasculitis. The patient received immunosuppressive medication, oxygen, bronchodilators, vasoactive agents, platelet aggregation inhibitors, statins. Clinical status improved after 2 weeks and stabilized after 1 year under treatment. SLE may have a long less symptomatic evolution and could evolve apparently subacute with respiratory features. The previous myocardial infarction and the advanced atherosclerosis may be considered early manifestations of SLE vasculitis in a smoker. Early education for smoking cessation in patients with ischemic condition has to be part from the rehabilitation program for respiratory and cardiovascular complication prevention.
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