Lymphocytic interstitial pneumonitis (LIP) is characterized by diffuse bilateral pulmonary infiltrations in both lower lobes. Pleomorphic lymphohistiocytes including mature lymphocytes, variable admixture of plasma cells and other mononuclear cells infiltrate within the pulmonary interstitium, ranging from widened septa to confluent masses. We report a case of LIP associated with Epstein-Barr virus in a patient with SLE and Sj gren's syndrome. A 50-year-old woman was admitted with insidious onset of progressive dyspnea for 20 days. She suffered from arthritis 10 years earlier without specific diagnosis. A radiography of chest has showed bilateral consolidative infiltrations with pleural effusion in both lower lung fields. Open lung biopsy documented lymphocytic interstitial pneumonitis which expressed Epstein-Barr virus genome in situ hybridization study. Following corticosteroid and cyclophosphamide therapy, clinical symptoms and radiologic infiltrations gradually remitted.
Case Report ; Cyclophosphamide/therapeutic use ; Female ; Glucocorticoids, Synthetic/therapeutic use ; Herpesviridae Infections/*complications ; *Herpesvirus 4, Human ; Human ; Immunosuppressive Agents/therapeutic use ; Lung Diseases, Interstitial/*complications/drug therapy ; Lupus Erythematosus, Systemic/*complications ; Middle Age ; Prednisone/therapeutic use ; Sjogren's Syndrome/*complications

Retroperitoneal fibrosis is a rare disease characterized by the formation of dense plaque of fibrous tissue covering the retroperitoneal structures. This disease is commonly presented as ureteral obstruction, but the involvement of duodenum is rare. We report a case of retroperitoneal fibrosis which was complicated with duodenal stenosis and was successfully treated with corticosteroids. A 58-yr-old man, who had history of aorto-iliac bypass graft due to arteriosclerosis obliterans with infrarenal aortic occlusion was admitted to the hospital with abdominal pain and a mass. Abdominal CT scan revealed the periaortic soft tissue mass encircling grafted aorta and stenosis of duodenal third portion. Retroperitoneal fibrosis with duodenal stenosis was diagnosed and prednisolone therapy was initiated. Follow-up CT scan showed that the patient responded to prednisolone therapy with eased pain, shrinking periaortic mass, and reduced duodenal stenosis.
Anti-Inflammatory Agents, Steroidal/therapeutic use ; Case Report ; Duodenal Obstruction/*complications/drug therapy/physiopathology/radiography ; Glucocorticoids, Synthetic/therapeutic use ; Human ; Male ; Middle Age ; Prednisolone/therapeutic use ; Retroperitoneal Fibrosis/*complications/drug therapy/physiopathology/radiography ; Tomography, X-Ray Computed/methods ; Treatment Outcome

A rare manifestation of systemic lupus erythematosus (SLE) is cerebral venous sinus thrombosis (CVST), in which early diagnosis and aggressive therapy are of prime importance for favorable outcome. The pathogenesis of CVST is largely unknown, but it is thought to be caused by cerebral vasculitis, antiphospholipid antibodies or other conditions associated with enhanced coagulability. We describe two cases of SLE with CVST which were not associated with antiphospholipid antibodies. Both cases were treated with immunosuppressants (intravenous methylprednisolone and cyclophosphamide pulse therapy) and anticoagulant drugs (heparin and subsequent maintenance therapy with warfarin). There was a marked improvement of neurologic symptoms with the disappearance of thrombus in a follow-up MRI. The possibility of CVST should be considered in any patients with SLE who show neuropsychiatric manifestations.
Adult ; Anti-Inflammatory Agents, Steroidal/therapeutic use ; Anticoagulants/therapeutic use ; Brain/radiography ; Cyclophosphamide/therapeutic use ; Female ; Glucocorticoids, Synthetic/therapeutic use ; Heparin/therapeutic use ; Human ; Immunosuppressive Agents/therapeutic use ; Lupus Erythematosus, Systemic/*complications ; Magnetic Resonance Imaging ; Methylprednisolone/therapeutic use ; Middle Age ; Sinus Thrombosis, Intracranial/*complications/drug therapy/physiopathology/radiography ; Treatment Outcome ; Warfarin/therapeutic use

Interleukin-15 (IL-15) has multiple biological properties, including the induction of other cytokine production and the inhibition of T cell apoptosis. Recently, IL-15 was reported to have a major role in synovial inflammation of rheumatoid arthritis, and that it provokes and amplifies the inflammatory process through the activation of TNF-alpha production. In systemic lupus erythematosus (SLE), the dysregulation of apoptosis and various cytokine production were observed and have been implicated in the pathogenesis of SLE. Thus, we tried to determine serum IL-15 levels in SLE patients and to assess the relationship among IL-15 levels, TNF-alpha levels and disease activity of SLE. Twenty SLE patients and 10 controls were studied. Paired serum samples were collected from all SLE patients at the time of presentation with active disease and at 4 weeks after institution of treatment. IL-15 levels were determined by ELISA and compared with the disease activity indices in SLE. The disease activity of SLE was measured using the SLE Disease Activity Index (SLEDAI) and laboratory parameters such as circulating immune complex (CIC), C3, C4, anti-DNA antibody, IgG, IgM, and IgA. The IL-15 levels in SLE patients were significantly higher than those of controls (5.38 +/- 4.89 vs. 1.04 +/- 1.26 pg/ml). However, elevated IL-15 levels did not correlate with the SLEDAI, nor did they correlate with other laboratory activity indices. The changes in serum IL-15 levels did not correlate with the changes in serum TNF-alpha in the disease course of SLE patients, whereas TNF-alpha reflected the changes in disease activity of SLE. Serum levels of IL-15 are elevated in SLE patients, but IL-15 did not correlate with the disease activity of SLE. TNF-alpha production in SLE patients was unlikely to be related with IL-15.
Adolescence ; Adult ; Female ; Glucocorticoids, Synthetic/therapeutic use ; Human ; Interleukin-15/blood* ; Lupus Erythematosus, Systemic/physiopathology ; Lupus Erythematosus, Systemic/drug therapy ; Lupus Erythematosus, Systemic/blood* ; Male ; Prednisolone/therapeutic use ; Tumor Necrosis Factor/analysis

The purpose of this study is to determine the characteristic clinical features, radiologic findings, and precipitating and prognostic factors in the patients with breast cancer and with 5-Fluorouracil (5-FU)-induced leukoencephalopathy. We reviewed the medical records of six breast cancer patients who developed leukoencephalopathy after chemotherapy which included 5-FU and also evaluated thorough neurological examinations including mini-mental status examination, cerebrospinal fluid studies, brain images and brain biopsies. Six patients exhibited slowly progressing neurologic symptoms characterized by the impairment of cognitive function, abulia, ataxic gait, and/or akinetic mutism. None of the patients had any specific causes or etiologic factors for leukoencephalopathy. Brain MRI in all patients showed diffuse periventricular white matter changes in the T2-weighted MR image. Brain biopsy in Patient 1 showed fragmented axonal fiber and minimally deprived myelination with many scattered macrophages. Five patients who treated with steroids at the onset of neurological symptoms showed clinical improvement, regardless of their age, sex, the pathology and stage of breast cancer, or the total dosage of chemotherapeutic agents. We conclude that leukoencephalopathy in these cases could be attributable to 5-FU neurotoxicity and suggest that the administration of steroids might be the treatment of choice.
Adenocarcinoma, Mucinous/complications/drug therapy ; Adult ; Anti-Inflammatory Agents, Steroidal/therapeutic use ; Antineoplastic Agents/adverse effects/therapeutic use ; Brain/*drug effects/metabolism/radiography ; Breast Neoplasms/*complications/drug therapy ; Carcinoma, Infiltrating Duct/*complications/drug therapy ; Cyclophosphamide/adverse effects/therapeutic use ; Epirubicin/adverse effects/therapeutic use ; Female ; Fluorouracil/*adverse effects/analogs & derivatives/therapeutic use ; Glucocorticoids, Synthetic/therapeutic use ; Human ; Magnetic Resonance Imaging ; Methylprednisolone/therapeutic use ; Middle Age ; Nervous System Diseases/chemically induced/drug therapy/metabolism/radiography ; Prednisolone/therapeutic use