Rheumatology Research Journal
Volume:7 Issue: 4, Autumn 2022

COVID-19 and autoimmune rheumatic diseases has been an interesting issue since the beginning of the COVID-19 pandemic. This survey was designed to study COVID-19 reinfection in autoimmune rheumatic patients and to find possible risk factors for reinfection related to autoimmune rheumatic diseases or their medications. In this cross-sectional survey, autoimmune rheumatic patients attending rheumatology clinics were interviewed to find rheumatic patients who had been infected by COVID-19. A group of patients who had been infected by COVID-19 just for one time and another group who had never been infected by COVID-19, were considered as control groups. Demographic and clinical characteristics of the three groups were compared. We found 15 patients (mean age: 45.33) who had been infected by COVID-19 two times. Rheumatoid arthritis was the most common disease (33.33%) and prednisolone was the most commonly used medication among these patients (80%). The mean interval between first and second infections was 8.53 months. We detected no significant differences for age, sex, type of autoimmune rheumatic disease, medications and comorbidities between our three group. Neither the type of autoimmune rheumatic disease, nor the type of medication used to treat it, was a risk factor for COVID-19 reinfection.

Systemic lupus erythematosus, and systemic sclerosis are chronic autoimmune diseases with symptoms with different degrees of severity and mechanisms. Hence, we present a 36-year-old female with a history of systemic lupus erythematosus which was later overlapped with systemic sclerosis. She complained of vertigo over three months before developing poor gait. She was diagnosed with truncal ataxia due to her ataxic gait and abnormal point motions. Based on the magnetic resonance imaging, a final diagnosis of a cute cerebellar dysfunction in systemic lupus erythematosus was made. Cyclophosphamide was initiated with a single dose of 500 mg which continued for at least three more monthly cycles, and the methylprednisolone pulse was adjusted to 500 mg/day for three days. Due to measures taken to avert a renal crisis caused by scleroderma, the methyl prednisolone dose was deemed to be lower than the adjusted amount (1 g). A follow-up magnetic resonance imaging showed regression of the lesions after treatment, the cerebral lesion had shrunken, and corticomedullary lesion had resolved entirely. Cerebral ataxia could be developed in patients with sytemic lupus erythematosus in terms of vasculitis, diffusely infiltrating glioma, acute disseminated encephalomyelitis, and systemic lupus erythematosus itself. One of the uncommon signs of neuropsychiatric systemic lupus erythematosus is ataxia and cerebellar involvement. The prognosis is generally favorable while receiving immunosuppressive therapy.

Hemophagocytic lymphohistiocytosis (HLH), is a disorder seen more often in children and is life-threatening in terms of over- activation of macrophages, and T cells resulting in cytokine storm. HLH can be familial or secondary to infections,malignancy, immunosuppression, and autoimmune conditions, such as systemic lupus erythematosus (SLE). Here, we report a 10-year old female with previously diagnosed SLE who hospitalized because of fever and pancytopenia.

Peripheral neuropathy may be reversible or permanent. Hence, we would like to present a 38-years-old man without any previous medical history admitted to ShahidSadoughi Hospital in Yazd in terms of reduced force of all four limbs, shortness of breath, cough and hemoptysis. Electromyography and nerve conduction velocity study was performed after the para-clinical examinations and Guillain–Barré syndrome was considered first diagnosis. Regarding the pulmonary symptoms, sinusitis and bilateral alveolar opacities, and positive anti-neutrophil cytoplasmic antibodies, Wegener's granulomatosis was suggested as a potential diagnosis and more steps were performed. This patient has been verified to have concurrent increasing limb weakness, also known as Guillain-Barré syndrome.

The possibility of infection with mycobacterium tuberculosis (TB), and other infectious agents is the first option when granulomatous inflammation wasobserved in the histological examination of a tissue specimen. However, gout with manifestations of granulomatous synovitis may mimic TB tenosynovitis. An 80-year-old male with a history of hypertension, and gout presented with the swelling of the right wrist, and deformity as a result of trauma. The results of cytology for malignancy, TB polymerase chain reaction (PCR), and TB culture were negative. Histopathological examination with an electron microscope confirmed the diagnosis of tophaceous gout along with granulomatous synovitis. The current case emphasizes the significance of a correct gouty process diagnosis in patients who exhibit granulomatous tophaceous tuberculous tenosynovitis or rheumatoid arthritis. We suggested that gout should be considered in differential diagnosis of granulomatous synovitis, especially in cases with negative mycobacterium TB-PCR.