Vancouver IM LMR

In today’s noon report we work through a case of a young, previously healthy 32 year old woman who presented to the ICU with multiorgan dysfunction (hypoxemic respiratory failure/ ARDS requiring VV-ECMO, shock with low LVEF and elevated troponin, autoimmune hemolytic anemia, and acute GIB).

Eventually, all infectious work up is negative, and she ends up being diagnosed with first presentation of catastrophic Systemic lupus erythematosus!

See didactic slide deck here.

Key takeaway points:

• In patients presenting with multiorgan dysfunction from overwhelming inflammation, consider if the cause could be due to infection/ sepsis, autoimmune, or malignancy
• SLE can affect pretty much any organ system!
  • Constitutional symptoms
  • Arthritis and arthralgias
  • Mucocutaneous involvement (photosensitivity, malar rash, discoid lesions, oral/ nasal ulcers, alopecia)
  • Cardiac (pericarditis, pericardial effusion, myocarditis, valvular disease, Libman-Sacks endocarditis)
  • Vascular (Raynaud’s, vasculitis, VTE, antiphospholipid antibody syndrome)
  • Respiratory (pleural effusion, pneumonitis, ILD, pulmonary hypertension, diffuse alveolar hemorrhage)
  • Hematologic (anemia, leukopenia, thrombocytopenia, autoimmune hemolytic anemia, lymphadenopathy, splenomegaly)
  • Gastrointestinal (dysphagia, PUD, protein losing enteropathy, hepatitis, pancreatitis, mesenteric vasculitis, peritonitis etc)
  • Renal (lupus nephritis, which can present on spectrum of nephritic-nephrotic syndrome)
  • Neuro/psychiatric (stroke, seizures, cognition/ mood changes, cerebritis, delirium, psychosis, peripheral neuropathy)
  • Ophthalmologic (sicca symptoms, retinal vasculopathy, etc)
  • Other (immunosuppression, associated with other autoimmune diseases)