Systemic lupus erythematosus-associated catastrophic antiphospholipid syndrome occurring after typhoid fever -: A possible role of <i>Salmonella</i> lipopolysaccharide in the occurrence of diffuse vasculopathy-coagulopathy

作     者：Hayem, G Kassis, N Nicaise, P Bouvet, P Andremont, A Labarre, C Kahn, MF Meyer, O 

作者机构：CHU Bichat Serv Rhumatol F-75877 Paris 18 France Inst Pasteur Paris France 

出 版 物：《ARTHRITIS AND RHEUMATISM》 (关节炎与风湿病)

年 卷 期：1999年第42卷第5期

页      面：1056-1061页

核心收录：

学科分类：1002[医学-临床医学] 100201[医学-内科学(含：心血管病、血液病、呼吸系病、消化系病、内分泌与代谢病、肾病、风湿病、传染病)] 10[医学] 

主　　题：抗磷脂综合征/并发症 抗磷脂综合征/病因学 血液凝固障碍/病因学 脂多糖类/药理学 红斑狼疮 系统性/并发症 红斑狼疮 系统性/病因学 沙门菌 伤寒/免疫学 伤寒/并发症 血管疾病/病因学 成年人 女(雌)性 人类 

摘      要：We report a case of well-documented typhoid fever in a 30-year-old woman with inactive systemic lupus erythematosus with asymptomatic lupus anticoagulant and high-titer anticardiolipin antibody (aCL), Despite prompt eradication of the Salmonella typhi obtained,vith appropriate antibiotic therapy, multiple organ system dysfunction occurred, The central nervous system was involved, with ischemic infarcts in the occipital lobes. High-dose corticosteroid therapy failed to improve the neurologic manifestations, which responded to repeated plasmapheresis. A sharp fall in aCL and anti-beta(2)-glycoprotein I antibody titers was recorded before the start of plasmapheresis, At the same time, IgM and IgG antibodies to Salmonella group O:9 lipopolysaccharide became detectable;the IgM antibodies disappeared within 4 months, whereas the IgG antibodies remained detectable during the next 13 months, Despite treatment with high-dose corticosteroids and cyclophosphamide, rapidly progressive glomerulonephritis developed, leading to chronic renal failure, There is convincing evidence of a link between the S typhi infection and the ensuing catastrophic syndrome in this patient, probably precipitated by bacterial antigens.