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Systemic lupus erythematosus mimics heart failure
International Journal of Cardiology 78 (2001) 95–96 www.elsevier.com / locate / ijcard
Letter to the Editor
Systemic lupus erythematosus mimics heart failure a ¨ ´ ´ ´ b , Oben Doven ¨ ˘ a Tamer Sayin a , *, Gulay Kynykly , Remzi Karaoguz a
Ankara University, Department of Cardiology, Heart Center Hospital (A.U. Kalp Merkezi Hastanesi), 06590 Cebeci, Ankara, Turkey b Ankara University, Department of Immunology (A.U. Kalp Merkezi Hastanesi), 06590 Cebeci, Ankara, Turkey Received 2 November 2000; accepted 6 December 2000
Abstract Systemic Lupus Erythematosus (SLE) predominantly affects young women in their 20’s. In the elderly, the disease may have a more insidious onset and the time interval between the onset and diagnosis of the disease may be prolonged with respect to younger patients. We present a male patient aged 82, clinically mimicking heart failure diagnosed SLE. 2001 Elsevier Science Ireland Ltd. All rights reserved. Keywords: Lupus; Elderly; Heart failure
1. Introduction SLE is an autoimmune disease, mainly affecting female sex, in which tissues and cells are damaged by cellular cytotoxicity and immune complexes. The prevalence of the inflammatory disorders of connective tissue in the older age group is quite likely underestimated and the disease in the elderly may have a different clinical and serologic course from that in young patients [1,2]
2. Patient history Eighty two year old male, with symptoms of exertional dyspnea, fatique polyarthralgia, intermittent fever, and weight loss was examined first by an orthopedist and later was hospitalized and treated with sefiriaxone for 2 weeks with the diagnosis of *Corresponding author. Tel.: 190-312-362-3030; fax: 190-312-3632289. E-mail address: [email protected] (T. Sayin).
pneumonia in infectious disease department. Because his symptoms did not improve and his shortness of breath increased, he was admitted to Ankara University Heart Center Hospital. He had a history of hypertension for four years, smoked a package of cigarettes for 60 years. His physical examination at the Heart Center revealed; a pale physical appearance, blood pressure of 160 / 80 mmHg, pulse was 80 / mm and rhythmic, an apical systolic murmur but no S3 and no respiratory sounds at the base of the right lung. His functional status was assessed as class 3–4 in New York Heart Association Classification. In his laboratory examinations we found normochrome normocytic anemia and leukopenia, mild renal impairment with creatinine 1.4 mg / dl, and moderate proteinuria of 0.9 g / day. His Erythrocyte sedimentation rate (ESR) was 86 mm / h, serum albumin was 2.9 gr / dl. His chest X-ray showed cardiomegaly, pleural effusion, echocardiography demonstrated a dilated left ventricle an ejection fraction around % 35–40. The patient had heart failure treatment but the clinical status didn’t improve. His immunological markers revealed polyclon-
0167-5273 / 01 / $ – see front matter 2001 Elsevier Science Ireland Ltd. All rights reserved. PII: S0167-5273( 00 )00466-6
T. Sayin et al. / International Journal of Cardiology 78 (2001) 95 – 96
96
al gammapathy, CRP of 260 mg / lt (normal range 0–5), romatoid factor was negative, ANA was 111 1, Anti ds DNA was 14.1 IU / l (normal range: 0–7). With the presented clinical and laboratory data the patient was consultated with the immunology department and was diagnosed to have SLE. We initiated prednisolone 1 mg / kg and tapered the dosage gradually. After 6 weeks his dyspnea, fatigue, polyartralgia, intermittent fever all improved, his functional status improved to grade 1 from 3 to 4. CRP levels and ESR returned to normal and pleural effusion disapeared.
3. Conclusion We think that the patient’s medical course was
instructive since at first sight the patient’s problem seemed to be heart failure. Though SLE is usually a disease of women in their childbearing ages it is possible to diagnose SLE in the elderly. It would be prudent to keep collagenous diseases in mind for patients with an elevated ESR and diverse symptomatology.
References [1] Stevens MB. Connective tissue disease in the elderly. Clin Rheum Dis 1986;12(1):11–32. [2] Mishra N, Kammer GM. Clinical expression of autoimmune diseases in older adults. Clin Geriatr Med 1998;14(3):515–42.
Letter to the Editor
Systemic lupus erythematosus mimics heart failure a ¨ ´ ´ ´ b , Oben Doven ¨ ˘ a Tamer Sayin a , *, Gulay Kynykly , Remzi Karaoguz a
Ankara University, Department of Cardiology, Heart Center Hospital (A.U. Kalp Merkezi Hastanesi), 06590 Cebeci, Ankara, Turkey b Ankara University, Department of Immunology (A.U. Kalp Merkezi Hastanesi), 06590 Cebeci, Ankara, Turkey Received 2 November 2000; accepted 6 December 2000
Abstract Systemic Lupus Erythematosus (SLE) predominantly affects young women in their 20’s. In the elderly, the disease may have a more insidious onset and the time interval between the onset and diagnosis of the disease may be prolonged with respect to younger patients. We present a male patient aged 82, clinically mimicking heart failure diagnosed SLE. 2001 Elsevier Science Ireland Ltd. All rights reserved. Keywords: Lupus; Elderly; Heart failure
1. Introduction SLE is an autoimmune disease, mainly affecting female sex, in which tissues and cells are damaged by cellular cytotoxicity and immune complexes. The prevalence of the inflammatory disorders of connective tissue in the older age group is quite likely underestimated and the disease in the elderly may have a different clinical and serologic course from that in young patients [1,2]
2. Patient history Eighty two year old male, with symptoms of exertional dyspnea, fatique polyarthralgia, intermittent fever, and weight loss was examined first by an orthopedist and later was hospitalized and treated with sefiriaxone for 2 weeks with the diagnosis of *Corresponding author. Tel.: 190-312-362-3030; fax: 190-312-3632289. E-mail address: [email protected] (T. Sayin).
pneumonia in infectious disease department. Because his symptoms did not improve and his shortness of breath increased, he was admitted to Ankara University Heart Center Hospital. He had a history of hypertension for four years, smoked a package of cigarettes for 60 years. His physical examination at the Heart Center revealed; a pale physical appearance, blood pressure of 160 / 80 mmHg, pulse was 80 / mm and rhythmic, an apical systolic murmur but no S3 and no respiratory sounds at the base of the right lung. His functional status was assessed as class 3–4 in New York Heart Association Classification. In his laboratory examinations we found normochrome normocytic anemia and leukopenia, mild renal impairment with creatinine 1.4 mg / dl, and moderate proteinuria of 0.9 g / day. His Erythrocyte sedimentation rate (ESR) was 86 mm / h, serum albumin was 2.9 gr / dl. His chest X-ray showed cardiomegaly, pleural effusion, echocardiography demonstrated a dilated left ventricle an ejection fraction around % 35–40. The patient had heart failure treatment but the clinical status didn’t improve. His immunological markers revealed polyclon-
0167-5273 / 01 / $ – see front matter 2001 Elsevier Science Ireland Ltd. All rights reserved. PII: S0167-5273( 00 )00466-6
T. Sayin et al. / International Journal of Cardiology 78 (2001) 95 – 96
96
al gammapathy, CRP of 260 mg / lt (normal range 0–5), romatoid factor was negative, ANA was 111 1, Anti ds DNA was 14.1 IU / l (normal range: 0–7). With the presented clinical and laboratory data the patient was consultated with the immunology department and was diagnosed to have SLE. We initiated prednisolone 1 mg / kg and tapered the dosage gradually. After 6 weeks his dyspnea, fatigue, polyartralgia, intermittent fever all improved, his functional status improved to grade 1 from 3 to 4. CRP levels and ESR returned to normal and pleural effusion disapeared.
3. Conclusion We think that the patient’s medical course was
instructive since at first sight the patient’s problem seemed to be heart failure. Though SLE is usually a disease of women in their childbearing ages it is possible to diagnose SLE in the elderly. It would be prudent to keep collagenous diseases in mind for patients with an elevated ESR and diverse symptomatology.
References [1] Stevens MB. Connective tissue disease in the elderly. Clin Rheum Dis 1986;12(1):11–32. [2] Mishra N, Kammer GM. Clinical expression of autoimmune diseases in older adults. Clin Geriatr Med 1998;14(3):515–42.