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[Lupus erythematosus in old age]
1Medizinische Abteilung, Spital Schweizerische Pflegerinnenschule, Zürich.
Deutsche Medizinische Wochenschrift (1946)
|June 3, 1994
Summary
An 88-year-old man with symptoms mimicking pneumonia was diagnosed with older-onset systemic lupus erythematosus. Prompt prednisone treatment led to significant symptom improvement and disease marker reduction.
Area of Science:
- Rheumatology
- Internal Medicine
- Geriatrics
Background:
- Older-onset systemic lupus erythematosus (SLE) can present with diverse and potentially severe symptoms.
- Diagnosis can be challenging due to overlapping symptoms with other conditions like infections.
Observation:
- An 88-year-old male presented with pleuritic chest pain, fatigue, fever, and disorientation over two months.
- Initial investigations revealed elevated inflammatory markers, pleural effusion, and signs of hepatitis, leading to a suspicion of bacterial pneumonia.
- Immunological testing showed markedly elevated antinuclear antibodies (ANA) and moderately elevated anti-double-stranded DNA (anti-dsDNA) antibodies.
Findings:
- The patient was diagnosed with older-onset SLE based on clinical presentation and positive autoantibodies.
- Treatment with prednisone (50 mg daily) resulted in rapid improvement of pleuritic pain, fever, disorientation, and depressive mood.
- Disease markers, including anti-dsDNA titre, significantly decreased with continued prednisone therapy.
Implications:
- This case highlights the importance of considering autoimmune diseases, particularly SLE, in elderly patients presenting with atypical symptoms and elevated inflammatory markers.
- Early diagnosis and immunosuppressive therapy, such as with corticosteroids, can effectively manage older-onset SLE and prevent severe complications.
- Prompt recognition and treatment can significantly improve quality of life and functional status in geriatric patients with SLE.