Saturday, October 22, 2016

SLE complications

emDocs - October 13, 2016 - Authors: Kaufman R and Reed K
Edited by: Koyfman A and Long B
..."SLE Pearls and Pitfalls
  • Consider MRI for patients with lupus and severe hip pain with a negative x-ray as they are more susceptible to avascular necrosis that may be early, reversible, and not seen on plain radiographs.
  • Patient with fevers, evidence of immune-compromise (such a herpes zoster), and neutropenia warrant admission.
  • Otherwise low-risk chest pain in patients with SLE is never to be considered low risk. These patients have a much higher rate of CAD and an earlier age onset of CAD.
  • Be cautious about holding back on imaging for patients with SLE with headaches as well as for vague neurologic complaints. See neurologic complications above.
  • GI vasculitis is devastating and a patient must appear extremely well so as not to require some form of imaging when complaining about vague abdominal distress.
  • Patients with SLE on chronic steroids and sepsis or shock require stress-dose steroids (hydrocortisone 100 mg IV) and broad-spectrum antibiotics. Adrenal insufficiency from abrupt discontinuation of steroids should be highly considered, especially in the patient whose blood pressure is not fluid responsive."