Internal Medicine

0521779407-19 CUNY1086/Karliner 0 521 77940 7 June 6, 2007 17:50

Syphilis Systemic Lupus Erythematosus 1399

early latent cases; may precipitate preterm delivery and fetal distress

in pregnancy

■Prognosis: PCN remains highly effective against T. pallidum; fail-

ure to respond to therapy likely due to reinfection, undiagnosed

neurosyphilis, or non-compliance with alternative treatment re-

gimen

SYSTEMIC LUPUS ERYTHEMATOSUS

JOHN B. WINFIELD, MD

history & physical

Risk Factors

■young women (M:F=1:5), but may occur at any age

■associations: complement deficiencies, MHC class II genes, Fc

receptor genes

■∼10% have affected relatives

■UV light exposure,

■Drugs: procainamide, isoniazid, hydantoins, minocycline, many

others silica dust

■flare during pregnancy or postnatally (20–60%)

Signs & Symptoms

■at onset: constitutional, arthralgia/arthritis, malar rash, alopecia,

Raynaud’s disease, pleuritis, pericarditis, mesangial glomerulone-

phritis (GN)

■established SLE: above plus other rashes (discoid, generalized ery-

thema±photosensitivity) oral/nasal ulcerations, vasculitis, neu-

rologic disease, hematological manifestations, glomerulonephritis

(mesangial, membranous, focal proliferative or diffuse), peritonitis

■less common: bullous rash, myositis, pancreatitis, myocarditis,

endocarditis, pulmonary disease (diffuse interstitial pneumonitis,

hemorrhage, pulmonary hypertension)

tests

Laboratory

■Basic blood studies:

➣CBC: anemia (usually of chronic disease, occasionally hemo-

lytic), lymphopenia, thrombocytopenia

➣ESR: increased

➣BUN/creatinine: increased in renal disease

➣Decreased complement (CH 50 or C3 & C4)