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Systemic lupus erythematosus and antineutrophilic cytoplasmic antibody-associated vasculitis overlap syndrome complicated by subarachnoid hemorrhage: case-based review

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Abstract

Systemic lupus erythematosus (SLE) and antineutrophil cytoplasmic antibody-associated vasculitis (AAV) overlap syndrome is an inflammatory disorder with a mixed presentation that is characterized by clinical features of both SLE and AAV. Although renal disease predominates, any organ system in the body may be affected. Neurologic manifestation in patients with SLE–AAV overlap syndrome is rare and has only been previously documented as cerebral ischemia. We report a patient with SLE–AAV overlap syndrome diagnosed based on clinical, serologic and biopsy-proven histologic findings who presented with subarachnoid hemorrhage (SAH) secondary to ruptured right anterior cerebral artery aneurysm. To the authors’ knowledge, this is the first reported case of SLE–AAV overlap syndrome diagnosed in a patient with a SAH due to an intracranial aneurysm. Neurologic involvement in patients with SLE–AAV overlap syndrome is uncommon and has not been well-studied. Clinicians who encounter patients with neurologic signs that present with symptoms and a serologic profile that correspond to both SLE and AAV criteria, should consider the association between SLE–AAV overlap syndrome and a hemorrhagic stroke, specifically SAH.

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Funding

No funding was received for this study.

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Authors and Affiliations

  1. Department of Medicine, NYU Langone Health, 550 First Avenue, New York, NY, 10016, USA

    Ciril Khorolsky, Andrew Castellano & David Comstock

  2. Department of Pathology, NYU Langone Health, 550 First Avenue, New York, NY, 10016, USA

    Nooshin K. Brinster

  3. Department of Nephrology, NYU Langone Health, 550 First Avenue, New York, NY, 10016, USA

    Sein Y. See

  4. Department of Rheumatology, NYU Langone Health, 550 First Avenue, New York, NY, 10016, USA

    Bruce F. Garner

Authors
  1. Ciril Khorolsky
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  2. Andrew Castellano
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  3. David Comstock
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  4. Nooshin K. Brinster
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  5. Sein Y. See
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  6. Bruce F. Garner
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Contributions

All authors assisted in data extraction, data analysis and literature review, and wrote significant sections of the paper.

Corresponding author

Correspondence to Ciril Khorolsky.

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The authors declare that they have no conflict of interest.

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Written informed consent was obtained from the patient for publication of this case study.

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Khorolsky, C., Castellano, A., Comstock, D. et al. Systemic lupus erythematosus and antineutrophilic cytoplasmic antibody-associated vasculitis overlap syndrome complicated by subarachnoid hemorrhage: case-based review. Rheumatol Int 38, 2329–2335 (2018). https://doi.org/10.1007/s00296-018-4169-z

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  • DOI: https://doi.org/10.1007/s00296-018-4169-z

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