全身性エリテマトーデスの治療中, 細菌性心内膜炎による大動脈弁閉鎖不全症をきたした1例

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A 36-year old female was admitted to our hospital because of fever and discoid lupus. The patient's illness began at the age of 33 when she had facial erythema and hair loss.On admission, laboratory examination revealed proteinuria, elevated ESR, lymphopenia, a high titer of anti-DNA antibody and hypocomplementemia. She responded well to steroid therapy. Three months after admission, tooth extraction was performed, when immunosuppressant therapy was combined. One month after, she had fever, proteinuria and cardiac diastolic murmur. Laboratory data revealed elevated ESR and positive CRP. UCG and PCG showed findings of aortic regurgitaion. Enterococcus was repeatedly found in blood culture. She was diagnosed as being complicated with bacterial endocarditis. One month of high doses of antibiotics therapy resulted in negative blood culture, and other symptoms disappeared. Eleven months after admission, she had fever, proteinuria and hypocomplementemia, and enterococcus was detected in blood culture again. The titers of antienterococcus antibody were 1:50 at first time and 1:800 at second time.The pathogenesis of aortic regurgitation due to bacterial endocarditis in inactive stages of the disease was thought o be closely associated with tooth extraction and immunosuppressant therapy.Some discussions have been made concerning the pathogenesis of endocarditis in patients with SLE judging from clinical course and immunological studies of this patient.
日本臨床免疫学会の論文

全身性エリテマトーデスの治療中, 細菌性心内膜炎による大動脈弁閉鎖不全症をきたした1例

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