Fatal Disseminated Aspergillosis in a Patient with Systemic Lupus Erythematosus
Identifieur interne : 000143 ( Pmc/Checkpoint ); précédent : 000142; suivant : 000144Fatal Disseminated Aspergillosis in a Patient with Systemic Lupus Erythematosus
Auteurs : Rochelle Hardie [États-Unis] ; Tracian James-Goulbourne [États-Unis] ; Monsoon Rashid [États-Unis] ; Jeremy Sullivan [États-Unis] ; Yamen Homsi [États-Unis]Source :
- Case Reports in Infectious Diseases [ 2090-6625 ] ; 2020.
Abstract
Patients with systemic lupus erythematosus (SLE) are at increased risk for infection including opportunistic infections. Fungal infection in particular can be difficult to diagnose and treat and often can be life-threatening in the immunocompromised patient. We present a case in which a patient with SLE presented to the hospital with shortness of breath and cough. Throughout the hospital course, the patient's condition continued to decline leading to acute respiratory failure, and eventually, the patient expired. Postmortem autopsy revealed invasive fungal aspergillosis infection involving the heart, lungs, and brain. Earlier diagnosis and treatment with empiric antifungals may improve survival in these patients.
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DOI: 10.1155/2020/9623198
PubMed: 32181030
PubMed Central: 7066410
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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Fatal Disseminated Aspergillosis in a Patient with Systemic Lupus Erythematosus</title><author><name sortKey="Hardie, Rochelle" sort="Hardie, Rochelle" uniqKey="Hardie R" first="Rochelle" last="Hardie">Rochelle Hardie</name><affiliation wicri:level="1"><nlm:aff id="I1">Division of Infection Disease, SUNY Downstate Medical Center, 450 Clarkson Avenue, Brooklyn, NY 11203, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Division of Infection Disease, SUNY Downstate Medical Center, 450 Clarkson Avenue, Brooklyn, NY 11203</wicri:regionArea><wicri:noRegion>NY 11203</wicri:noRegion></affiliation></author><author><name sortKey="James Goulbourne, Tracian" sort="James Goulbourne, Tracian" uniqKey="James Goulbourne T" first="Tracian" last="James-Goulbourne">Tracian James-Goulbourne</name><affiliation wicri:level="1"><nlm:aff id="I2">Division of Internal Medicine, SUNY Downstate Medical Center, 450 Clarkson Avenue, Brooklyn, NY 11203, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Division of Internal Medicine, SUNY Downstate Medical Center, 450 Clarkson Avenue, Brooklyn, NY 11203</wicri:regionArea><wicri:noRegion>NY 11203</wicri:noRegion></affiliation></author><author><name sortKey="Rashid, Monsoon" sort="Rashid, Monsoon" uniqKey="Rashid M" first="Monsoon" last="Rashid">Monsoon Rashid</name><affiliation wicri:level="1"><nlm:aff id="I2">Division of Internal Medicine, SUNY Downstate Medical Center, 450 Clarkson Avenue, Brooklyn, NY 11203, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Division of Internal Medicine, SUNY Downstate Medical Center, 450 Clarkson Avenue, Brooklyn, NY 11203</wicri:regionArea><wicri:noRegion>NY 11203</wicri:noRegion></affiliation></author><author><name sortKey="Sullivan, Jeremy" sort="Sullivan, Jeremy" uniqKey="Sullivan J" first="Jeremy" last="Sullivan">Jeremy Sullivan</name><affiliation wicri:level="1"><nlm:aff id="I3">Division of Internal Medicine, NYU Langone Hospital-Brooklyn, 150 55th St, Brooklyn, NY 11220, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Division of Internal Medicine, NYU Langone Hospital-Brooklyn, 150 55th St, Brooklyn, NY 11220</wicri:regionArea><wicri:noRegion>NY 11220</wicri:noRegion></affiliation></author><author><name sortKey="Homsi, Yamen" sort="Homsi, Yamen" uniqKey="Homsi Y" first="Yamen" last="Homsi">Yamen Homsi</name><affiliation wicri:level="1"><nlm:aff id="I4">Division of Rheumatology, NYU Langone Hospital-Brooklyn, 150 55th St, Brooklyn, NY 11220, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Division of Rheumatology, NYU Langone Hospital-Brooklyn, 150 55th St, Brooklyn, NY 11220</wicri:regionArea><wicri:noRegion>NY 11220</wicri:noRegion></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">32181030</idno><idno 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of Infection Disease, SUNY Downstate Medical Center, 450 Clarkson Avenue, Brooklyn, NY 11203, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Division of Infection Disease, SUNY Downstate Medical Center, 450 Clarkson Avenue, Brooklyn, NY 11203</wicri:regionArea><wicri:noRegion>NY 11203</wicri:noRegion></affiliation></author><author><name sortKey="James Goulbourne, Tracian" sort="James Goulbourne, Tracian" uniqKey="James Goulbourne T" first="Tracian" last="James-Goulbourne">Tracian James-Goulbourne</name><affiliation wicri:level="1"><nlm:aff id="I2">Division of Internal Medicine, SUNY Downstate Medical Center, 450 Clarkson Avenue, Brooklyn, NY 11203, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Division of Internal Medicine, SUNY Downstate Medical Center, 450 Clarkson Avenue, Brooklyn, NY 11203</wicri:regionArea><wicri:noRegion>NY 11203</wicri:noRegion></affiliation></author><author><name sortKey="Rashid, Monsoon" sort="Rashid, Monsoon" uniqKey="Rashid M" first="Monsoon" last="Rashid">Monsoon Rashid</name><affiliation wicri:level="1"><nlm:aff id="I2">Division of Internal Medicine, SUNY Downstate Medical Center, 450 Clarkson Avenue, Brooklyn, NY 11203, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Division of Internal Medicine, SUNY Downstate Medical Center, 450 Clarkson Avenue, Brooklyn, NY 11203</wicri:regionArea><wicri:noRegion>NY 11203</wicri:noRegion></affiliation></author><author><name sortKey="Sullivan, Jeremy" sort="Sullivan, Jeremy" uniqKey="Sullivan J" first="Jeremy" last="Sullivan">Jeremy Sullivan</name><affiliation wicri:level="1"><nlm:aff id="I3">Division of Internal Medicine, NYU Langone Hospital-Brooklyn, 150 55th St, Brooklyn, NY 11220, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Division of Internal Medicine, NYU Langone Hospital-Brooklyn, 150 55th St, Brooklyn, NY 11220</wicri:regionArea><wicri:noRegion>NY 11220</wicri:noRegion></affiliation></author><author><name sortKey="Homsi, Yamen" sort="Homsi, Yamen" uniqKey="Homsi Y" first="Yamen" last="Homsi">Yamen Homsi</name><affiliation wicri:level="1"><nlm:aff id="I4">Division of Rheumatology, NYU Langone Hospital-Brooklyn, 150 55th St, Brooklyn, NY 11220, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Division of Rheumatology, NYU Langone Hospital-Brooklyn, 150 55th St, Brooklyn, NY 11220</wicri:regionArea><wicri:noRegion>NY 11220</wicri:noRegion></affiliation></author></analytic><series><title level="j">Case Reports in Infectious Diseases</title><idno type="ISSN">2090-6625</idno><idno type="eISSN">2090-6633</idno><imprint><date when="2020">2020</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p>Patients with systemic lupus erythematosus (SLE) are at increased risk for infection including opportunistic infections. Fungal infection in particular can be difficult to diagnose and treat and often can be life-threatening in the immunocompromised patient. We present a case in which a patient with SLE presented to the hospital with shortness of breath and cough. Throughout the hospital course, the patient's condition continued to decline leading to acute respiratory failure, and eventually, the patient expired. Postmortem autopsy revealed invasive fungal aspergillosis infection involving the heart, lungs, and brain. Earlier diagnosis and treatment with empiric antifungals may improve survival in these patients.</p></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Barber, C" uniqKey="Barber C">C. Barber</name></author><author><name sortKey="Gold, W L" uniqKey="Gold W">W. L. Gold</name></author><author><name sortKey="Fortin, P R" uniqKey="Fortin P">P. R. 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<front><journal-meta><journal-id journal-id-type="nlm-ta">Case Rep Infect Dis</journal-id><journal-id journal-id-type="iso-abbrev">Case Rep Infect Dis</journal-id><journal-id journal-id-type="publisher-id">CRIID</journal-id><journal-title-group><journal-title>Case Reports in Infectious Diseases</journal-title></journal-title-group><issn pub-type="ppub">2090-6625</issn><issn pub-type="epub">2090-6633</issn><publisher><publisher-name>Hindawi</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">32181030</article-id><article-id pub-id-type="pmc">7066410</article-id><article-id pub-id-type="doi">10.1155/2020/9623198</article-id><article-categories><subj-group subj-group-type="heading"><subject>Case Report</subject></subj-group></article-categories><title-group><article-title>Fatal Disseminated Aspergillosis in a Patient with Systemic Lupus Erythematosus</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Hardie</surname><given-names>Rochelle</given-names></name><xref ref-type="aff" rid="I1"><sup>1</sup></xref></contrib><contrib contrib-type="author"><name><surname>James-Goulbourne</surname><given-names>Tracian</given-names></name><xref ref-type="aff" rid="I2"><sup>2</sup></xref></contrib><contrib contrib-type="author"><name><surname>Rashid</surname><given-names>Monsoon</given-names></name><xref ref-type="aff" rid="I2"><sup>2</sup></xref></contrib><contrib contrib-type="author"><name><surname>Sullivan</surname><given-names>Jeremy</given-names></name><xref ref-type="aff" rid="I3"><sup>3</sup></xref></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid" authenticated="false">https://orcid.org/0000-0002-4195-2281</contrib-id><name><surname>Homsi</surname><given-names>Yamen</given-names></name><email>yamenhomsi@yahoo.com</email><xref ref-type="aff" rid="I4"><sup>4</sup></xref></contrib></contrib-group><aff id="I1"><sup>1</sup>Division of Infection Disease, SUNY Downstate Medical Center, 450 Clarkson Avenue, Brooklyn, NY 11203, USA</aff><aff id="I2"><sup>2</sup>Division of Internal Medicine, SUNY Downstate Medical Center, 450 Clarkson Avenue, Brooklyn, NY 11203, USA</aff><aff id="I3"><sup>3</sup>Division of Internal Medicine, NYU Langone Hospital-Brooklyn, 150 55th St, Brooklyn, NY 11220, USA</aff><aff id="I4"><sup>4</sup>Division of Rheumatology, NYU Langone Hospital-Brooklyn, 150 55th St, Brooklyn, NY 11220, USA</aff><author-notes><fn fn-type="other"><p>Academic Editor: Larry M. Bush</p></fn></author-notes><pub-date pub-type="collection"><year>2020</year></pub-date><pub-date pub-type="epub"><day>29</day><month>2</month><year>2020</year></pub-date><volume>2020</volume><elocation-id>9623198</elocation-id><history><date date-type="received"><day>6</day><month>10</month><year>2019</year></date><date date-type="rev-recd"><day>20</day><month>1</month><year>2020</year></date><date date-type="accepted"><day>5</day><month>2</month><year>2020</year></date></history><permissions><copyright-statement>Copyright © 2020 Rochelle Hardie et al.</copyright-statement><copyright-year>2020</copyright-year><license xlink:href="http://creativecommons.org/licenses/by/4.0/"><license-p>This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.</license-p></license></permissions><abstract><p>Patients with systemic lupus erythematosus (SLE) are at increased risk for infection including opportunistic infections. Fungal infection in particular can be difficult to diagnose and treat and often can be life-threatening in the immunocompromised patient. We present a case in which a patient with SLE presented to the hospital with shortness of breath and cough. Throughout the hospital course, the patient's condition continued to decline leading to acute respiratory failure, and eventually, the patient expired. Postmortem autopsy revealed invasive fungal aspergillosis infection involving the heart, lungs, and brain. Earlier diagnosis and treatment with empiric antifungals may improve survival in these patients.</p></abstract></article-meta></front><floats-group><fig id="fig1" orientation="portrait" position="float"><label>Figure 1</label><caption><p>CT chest without contrast showed multifocal consolidations bilaterally with bibasilar predominance.</p></caption><graphic xlink:href="CRIID2020-9623198.001"></graphic></fig><fig id="fig2" orientation="portrait" position="float"><label>Figure 2</label><caption><p>Image of MRI brain showing multifocal areas of diffusion restriction suggestive of vasculitis versus acute infarcts.</p></caption><graphic xlink:href="CRIID2020-9623198.002"></graphic></fig><fig id="fig3" orientation="portrait" position="float"><label>Figure 3</label><caption><p>Histopathological slide showing a section from the Heart.</p></caption><graphic xlink:href="CRIID2020-9623198.003"></graphic></fig><fig id="fig4" orientation="portrait" position="float"><label>Figure 4</label><caption><p>Histopathological slide showing a section from the Lung.</p></caption><graphic xlink:href="CRIID2020-9623198.004"></graphic></fig><fig id="fig5" orientation="portrait" position="float"><label>Figure 5</label><caption><p>Histopathological slide showing a section from the Brain.</p></caption><graphic xlink:href="CRIID2020-9623198.005"></graphic></fig><table-wrap id="tab1" orientation="portrait" position="float"><label>Table 1</label><caption><p>Blood and urine studies.</p></caption><table frame="hsides" rules="groups"><thead><tr><th align="left" rowspan="1" colspan="1">Complete blood count</th><th align="center" rowspan="1" colspan="1">Current visit</th><th align="center" rowspan="1" colspan="1">Four months prior</th><th align="center" rowspan="1" colspan="1">Reference range</th></tr></thead><tbody><tr><td align="left" rowspan="1" colspan="1">White blood cells</td><td align="center" rowspan="1" colspan="1">11.07</td><td align="center" rowspan="1" colspan="1">4.75</td><td align="center" rowspan="1" colspan="1">(4.5–10.9) K/uL</td></tr><tr><td align="left" rowspan="1" colspan="1">Neutrophils</td><td align="center" rowspan="1" colspan="1">84.0</td><td align="center" rowspan="1" colspan="1">59.7</td><td align="center" rowspan="1" colspan="1">(38.7–60.3) %</td></tr><tr><td align="left" rowspan="1" colspan="1">Bands</td><td align="center" rowspan="1" colspan="1">12.0</td><td align="center" rowspan="1" colspan="1">0</td><td align="center" rowspan="1" colspan="1">(0.0–10.0) %</td></tr><tr><td align="left" rowspan="1" colspan="1">Lymphocytes</td><td align="center" rowspan="1" colspan="1">2.0</td><td align="center" rowspan="1" colspan="1">26.5</td><td align="center" rowspan="1" colspan="1">(22.4–49.0) %</td></tr><tr><td align="left" rowspan="1" colspan="1">Monocytes</td><td align="center" rowspan="1" colspan="1">2.0</td><td align="center" rowspan="1" colspan="1">8.7</td><td align="center" rowspan="1" colspan="1">(2.4–9.2) %</td></tr><tr><td align="left" rowspan="1" colspan="1">Eosinophils</td><td align="center" rowspan="1" colspan="1">0</td><td align="center" rowspan="1" colspan="1">1.3</td><td align="center" rowspan="1" colspan="1">(0–8.6) %</td></tr><tr><td align="left" rowspan="1" colspan="1">Basophils</td><td align="center" rowspan="1" colspan="1">0</td><td align="center" rowspan="1" colspan="1">1.3</td><td align="center" rowspan="1" colspan="1">(0–1.0) %</td></tr><tr><td align="left" rowspan="1" colspan="1">Hgb</td><td align="center" rowspan="1" colspan="1">6.7</td><td align="center" rowspan="1" colspan="1">8.1</td><td align="center" rowspan="1" colspan="1">(12.0–16.0) g/dL</td></tr><tr><td align="left" rowspan="1" colspan="1">Hct</td><td align="center" rowspan="1" colspan="1">22.3</td><td align="center" rowspan="1" colspan="1">26.6</td><td align="center" rowspan="1" colspan="1">(37.0–47.0) %</td></tr><tr><td align="left" rowspan="1" colspan="1">RDW</td><td align="center" rowspan="1" colspan="1">19.8</td><td align="center" rowspan="1" colspan="1">19.4</td><td align="center" rowspan="1" colspan="1">(11.5–15.1) %</td></tr><tr><td align="left" rowspan="1" colspan="1">Platelets</td><td align="center" rowspan="1" colspan="1">111</td><td align="center" rowspan="1" colspan="1">210</td><td align="center" rowspan="1" colspan="1">(130–400) K/uL</td></tr><tr><td align="left" rowspan="1" colspan="1">Metabolic panel</td><td align="left" rowspan="1" colspan="1"> </td><td align="left" rowspan="1" colspan="1"> </td><td align="left" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1"> Sodium</td><td align="center" rowspan="1" colspan="1">139</td><td align="center" rowspan="1" colspan="1">141</td><td align="center" rowspan="1" colspan="1">(136–141) mmol/L</td></tr><tr><td align="left" rowspan="1" colspan="1"> Potassium</td><td align="center" rowspan="1" colspan="1">4.7</td><td align="center" rowspan="1" colspan="1">4.1</td><td align="center" rowspan="1" colspan="1">(3.5–5) mmol/L</td></tr><tr><td align="left" rowspan="1" colspan="1"> Chloride</td><td align="center" rowspan="1" colspan="1">99</td><td align="center" rowspan="1" colspan="1">105</td><td align="center" rowspan="1" colspan="1">(98–106) mmol/L</td></tr><tr><td align="left" rowspan="1" colspan="1"> CO<sub>2</sub></td><td align="center" rowspan="1" colspan="1">21</td><td align="center" rowspan="1" colspan="1">20</td><td align="center" rowspan="1" colspan="1">(24–31) mmol/L</td></tr><tr><td align="left" rowspan="1" colspan="1"> Plasma urea nitrogen (BUN)</td><td align="center" rowspan="1" colspan="1">70</td><td align="center" rowspan="1" colspan="1">43</td><td align="center" rowspan="1" colspan="1">(6–20) mg/dL</td></tr><tr><td align="left" rowspan="1" colspan="1"> Creatinine</td><td align="center" rowspan="1" colspan="1">2.88</td><td align="center" rowspan="1" colspan="1">2.35</td><td align="center" rowspan="1" colspan="1">(0.4–1.2) mg/dL</td></tr><tr><td align="left" rowspan="1" colspan="1"> Glucose</td><td align="center" rowspan="1" colspan="1">117</td><td align="center" rowspan="1" colspan="1">79</td><td align="center" rowspan="1" colspan="1">(70–99) mg/dL</td></tr><tr><td align="left" rowspan="1" colspan="1"> Calcium</td><td align="center" rowspan="1" colspan="1">8.2</td><td align="center" rowspan="1" colspan="1">8.6</td><td align="center" rowspan="1" colspan="1">(8.4–10.3) mg/dL</td></tr><tr><td align="left" rowspan="1" colspan="1"> Total protein</td><td align="center" rowspan="1" colspan="1">4.6</td><td align="center" rowspan="1" colspan="1">6.2</td><td align="center" rowspan="1" colspan="1">(6.0–8.5) g/dL</td></tr><tr><td align="left" rowspan="1" colspan="1"> Albumin</td><td align="center" rowspan="1" colspan="1">2.5</td><td align="center" rowspan="1" colspan="1">3.2</td><td align="center" rowspan="1" colspan="1">(2.8–5.7) g/dL</td></tr><tr><td align="left" rowspan="1" colspan="1"> Aspartate amino transferase</td><td align="center" rowspan="1" colspan="1">20</td><td align="center" rowspan="1" colspan="1">28</td><td align="center" rowspan="1" colspan="1">(10–35) u/l</td></tr><tr><td align="left" rowspan="1" colspan="1"> Alanine aminotransferase</td><td align="center" rowspan="1" colspan="1">29</td><td align="center" rowspan="1" colspan="1">23</td><td align="center" rowspan="1" colspan="1">(0–31) u/l</td></tr><tr><td align="left" rowspan="1" colspan="1"> Alkaline phosphatase</td><td align="center" rowspan="1" colspan="1">143</td><td align="center" rowspan="1" colspan="1">69</td><td align="center" rowspan="1" colspan="1">(25–125) u/l</td></tr><tr><td align="left" rowspan="1" colspan="1"> Total bilirubin</td><td align="center" rowspan="1" colspan="1">1.49</td><td align="center" rowspan="1" colspan="1">0.39</td><td align="center" rowspan="1" colspan="1">(0.0–1.2) mg/dL</td></tr><tr><td align="left" rowspan="1" colspan="1"> LDH</td><td align="center" rowspan="1" colspan="1">222</td><td align="center" rowspan="1" colspan="1">n/a</td><td align="center" rowspan="1" colspan="1">(140–280) u/l</td></tr><tr><td align="left" rowspan="1" colspan="1">Rheumatology workup:</td><td align="left" rowspan="1" colspan="1"> </td><td align="left" rowspan="1" colspan="1"> </td><td align="left" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1"> ANA</td><td align="center" rowspan="1" colspan="1">1 : 640 homogenous pattern</td><td align="center" rowspan="1" colspan="1">1 : 640 speckled pattern</td><td align="center" rowspan="1" colspan="1"><1 : 40</td></tr><tr><td align="left" rowspan="1" colspan="1"> Anti-SSA</td><td align="center" rowspan="1" colspan="1">Negative</td><td align="center" rowspan="1" colspan="1">Negative</td><td align="center" rowspan="1" colspan="1">Negative</td></tr><tr><td align="left" rowspan="1" colspan="1"> Anti-SSB</td><td align="center" rowspan="1" colspan="1">Negative</td><td align="center" rowspan="1" colspan="1">Negative</td><td align="center" rowspan="1" colspan="1">Negative</td></tr><tr><td align="left" rowspan="1" colspan="1"> Anti-Smith</td><td align="center" rowspan="1" colspan="1">Negative</td><td align="center" rowspan="1" colspan="1">Negative</td><td align="center" rowspan="1" colspan="1">Negative</td></tr><tr><td align="left" rowspan="1" colspan="1"> Anti-ds DNA</td><td align="center" rowspan="1" colspan="1">130</td><td align="center" rowspan="1" colspan="1">65</td><td align="center" rowspan="1" colspan="1">(<100) U/mL</td></tr><tr><td align="left" rowspan="1" colspan="1"> Rheumatoid factor</td><td align="center" rowspan="1" colspan="1"><7</td><td align="center" rowspan="1" colspan="1"><7</td><td align="center" rowspan="1" colspan="1">(<14) IU/mL</td></tr><tr><td align="left" rowspan="1" colspan="1"> Anticyclic citrullinated peptide antibodies</td><td align="center" rowspan="1" colspan="1">10</td><td align="center" rowspan="1" colspan="1">10</td><td align="center" rowspan="1" colspan="1">(0–19) units</td></tr><tr><td align="left" rowspan="1" colspan="1"> Anti-RNP</td><td align="center" rowspan="1" colspan="1">Negative</td><td align="center" rowspan="1" colspan="1">Negative</td><td align="center" rowspan="1" colspan="1">Negative</td></tr><tr><td align="left" rowspan="1" colspan="1"> Creatine Kinase</td><td align="center" rowspan="1" colspan="1">32</td><td align="center" rowspan="1" colspan="1">30</td><td align="center" rowspan="1" colspan="1">(24–195) u/l</td></tr><tr><td align="left" rowspan="1" colspan="1"> ESR</td><td align="center" rowspan="1" colspan="1">76</td><td align="center" rowspan="1" colspan="1">38</td><td align="center" rowspan="1" colspan="1">(0–20) mm/hr</td></tr><tr><td align="left" rowspan="1" colspan="1"> hsCRP</td><td align="center" rowspan="1" colspan="1">>300</td><td align="center" rowspan="1" colspan="1">38.59</td><td align="center" rowspan="1" colspan="1">(1.0–4.0) mg/L</td></tr><tr><td align="left" rowspan="1" colspan="1"> C3</td><td align="center" rowspan="1" colspan="1">87</td><td align="center" rowspan="1" colspan="1">45</td><td align="center" rowspan="1" colspan="1">(86–184) mg/dL</td></tr><tr><td align="left" rowspan="1" colspan="1"> C4</td><td align="center" rowspan="1" colspan="1">26</td><td align="center" rowspan="1" colspan="1">22</td><td align="center" rowspan="1" colspan="1">(20–58) mg/dL</td></tr><tr><td align="left" rowspan="1" colspan="1"> Total complement CH50</td><td align="center" rowspan="1" colspan="1">52</td><td align="center" rowspan="1" colspan="1">50</td><td align="center" rowspan="1" colspan="1">(42–60) U/mL</td></tr><tr><td align="left" rowspan="1" colspan="1"> c-ANCA (PR3)</td><td align="center" rowspan="1" colspan="1">5</td><td align="center" rowspan="1" colspan="1">8</td><td align="center" rowspan="1" colspan="1">AU/mL<break></break><100—neg<break></break>100–120—equivocal<break></break>>100—pos</td></tr><tr><td align="left" rowspan="1" colspan="1"> p-ANCA (MPO)</td><td align="center" rowspan="1" colspan="1">5</td><td align="center" rowspan="1" colspan="1">10</td><td align="center" rowspan="1" colspan="1">AU/mL<break></break><100—neg<break></break>100–120—equivocal<break></break>>100—pos</td></tr><tr><td align="left" rowspan="1" colspan="1">Others blood tests:</td><td align="left" rowspan="1" colspan="1"> </td><td align="left" rowspan="1" colspan="1"> </td><td align="left" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1"> Hep B Surface antibody</td><td align="center" rowspan="1" colspan="1"><3.5</td><td align="center" rowspan="1" colspan="1"><3.5</td><td align="center" rowspan="1" colspan="1"><8.499 mIU/mL</td></tr><tr><td align="left" rowspan="1" colspan="1"> Hepatitis B Surface Ag</td><td align="center" rowspan="1" colspan="1">Nonreactive</td><td align="center" rowspan="1" colspan="1">Nonreactive</td><td align="center" rowspan="1" colspan="1">Nonreactive</td></tr><tr><td align="left" rowspan="1" colspan="1"> Hep C antibody</td><td align="center" rowspan="1" colspan="1">Nonreactive</td><td align="center" rowspan="1" colspan="1">Nonreactive</td><td align="center" rowspan="1" colspan="1">Nonreactive</td></tr><tr><td align="left" rowspan="1" colspan="1"> Quantiferon</td><td align="center" rowspan="1" colspan="1">Negative</td><td align="center" rowspan="1" colspan="1">Negative</td><td align="center" rowspan="1" colspan="1">Negative</td></tr><tr><td align="left" rowspan="1" colspan="1"> Pro-BNP</td><td align="center" rowspan="1" colspan="1">>7000</td><td align="center" rowspan="1" colspan="1">110</td><td align="center" rowspan="1" colspan="1">(</td></tr><tr><td align="left" rowspan="1" colspan="1"> Urine protein/creatinine ratio</td><td align="center" rowspan="1" colspan="1">6.3</td><td align="center" rowspan="1" colspan="1">3.7</td><td align="center" rowspan="1" colspan="1">0.5 mg/g</td></tr></tbody></table></table-wrap><table-wrap id="tab2" orientation="portrait" position="float"><label>Table 2</label><caption><p>CSF analysis.</p></caption><table frame="hsides" rules="groups"><thead><tr><th align="left" rowspan="1" colspan="1">Variable</th><th align="center" rowspan="1" colspan="1">Result</th><th align="center" rowspan="1" colspan="1">Reference range</th></tr></thead><tbody><tr><td align="left" rowspan="1" colspan="1">CSF appearance</td><td align="center" rowspan="1" colspan="1">Clear-colorless</td><td align="center" rowspan="1" colspan="1">Clear-colorless</td></tr><tr><td align="left" rowspan="1" colspan="1">CSF WBC</td><td align="center" rowspan="1" colspan="1">1</td><td align="center" rowspan="1" colspan="1">0–5 ul</td></tr><tr><td align="left" rowspan="1" colspan="1">CSF RBC</td><td align="center" rowspan="1" colspan="1">6–10</td><td align="center" rowspan="1" colspan="1">0 ul</td></tr><tr><td align="left" rowspan="1" colspan="1">CSF glucose</td><td align="center" rowspan="1" colspan="1">60</td><td align="center" rowspan="1" colspan="1">40–70 mg/dl</td></tr><tr><td align="left" rowspan="1" colspan="1">CSF total protein</td><td align="center" rowspan="1" colspan="1">95</td><td align="center" rowspan="1" colspan="1">15–45 mg/dl</td></tr><tr><td align="left" rowspan="1" colspan="1">CSF cryptococcal antigen</td><td align="center" rowspan="1" colspan="1">Negative</td><td align="center" rowspan="1" colspan="1">Negative</td></tr><tr><td align="left" rowspan="1" colspan="1">CSF CMV PCR</td><td align="center" rowspan="1" colspan="1">Negative</td><td align="center" rowspan="1" colspan="1">Negative</td></tr><tr><td align="left" rowspan="1" colspan="1">CSF EBV PCR</td><td align="center" rowspan="1" colspan="1">Negative</td><td align="center" rowspan="1" colspan="1">Negative</td></tr><tr><td align="left" rowspan="1" colspan="1">CSF HSV PCR</td><td align="center" rowspan="1" colspan="1">Negative</td><td align="center" rowspan="1" colspan="1">Negative</td></tr><tr><td align="left" rowspan="1" colspan="1">CSF culture</td><td align="center" rowspan="1" colspan="1">No growth after 72 hrs</td><td align="center" rowspan="1" colspan="1">No growth</td></tr></tbody></table></table-wrap></floats-group></pmc><affiliations><list><country><li>États-Unis</li></country></list><tree><country name="États-Unis"><noRegion><name sortKey="Hardie, Rochelle" sort="Hardie, Rochelle" uniqKey="Hardie R" first="Rochelle" last="Hardie">Rochelle Hardie</name></noRegion><name sortKey="Homsi, Yamen" sort="Homsi, Yamen" uniqKey="Homsi Y" first="Yamen" last="Homsi">Yamen Homsi</name><name sortKey="James Goulbourne, Tracian" sort="James Goulbourne, Tracian" uniqKey="James Goulbourne T" first="Tracian" last="James-Goulbourne">Tracian James-Goulbourne</name><name sortKey="Rashid, Monsoon" sort="Rashid, Monsoon" uniqKey="Rashid M" first="Monsoon" last="Rashid">Monsoon Rashid</name><name sortKey="Sullivan, Jeremy" sort="Sullivan, Jeremy" uniqKey="Sullivan J" first="Jeremy" last="Sullivan">Jeremy Sullivan</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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