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• W2511758418 abstract "We appreciate the opportunity to respond to the comments of Dr. Marvisi regarding our case report.1Susanto I Peters JL Acute lupus pneumonitis with normal chest radiograph.Chest. 1997; 111: 1781-1783Abstract Full Text Full Text PDF PubMed Scopus (21) Google Scholar Dr. Marvisi suggested our patient may not actually have systemic lupus erythematosus (SLE). The patient had at least four of the American College of Rheumatology criteria for SLE diagnosis (serositis, leukopenia/lymphopenia, antinuclear antibody, malar rash).2Tan EM Cohen AS Fries JF et al.The 1982 revised criteria for the classification of systemic lupus erythematosus.Arthritis Rheum. 1982; 25: 1271-1277Crossref PubMed Scopus (12346) Google Scholar In addition, she also had a moderate titer of anticardiolipin antibody in lieu of a false-positive serologic test for syphilis, reflecting the presence of an immunologic disorder (antiphospholipid antibody) as the fifth criteria. Pleuritic chest pain was one of her chief presenting complaints. Lupus pleuritis may occur without pleural effusion.2Tan EM Cohen AS Fries JF et al.The 1982 revised criteria for the classification of systemic lupus erythematosus.Arthritis Rheum. 1982; 25: 1271-1277Crossref PubMed Scopus (12346) Google Scholar,3Orens JB Martinez FJ Lynch JP. Pleuropulmonary manifestations of systemic lupus erythematosus.Rheum Dis Clin North Am. 1994; 20: 159-193Abstract Full Text PDF PubMed Google Scholar She had documented normal leukocyte and lymphocyte counts on various occasions prior to and following the pneumonitis, despite a longstanding diagnosis of uncomplicated cirrhosis. Antinuclear antibody is present in 95% of patients with active and untreated SLE and is often present in high titers (1:2,560 in our patient).4Green RJ Ruoss SJ Kraft SA et al.Pulmonary capillaritis and alveolar hemorrhage.Chest. 1996; 110: 1305-1316Abstract Full Text Full Text PDF PubMed Scopus (216) Google Scholar Our patient had a history of erysipelas-like malar rash without other skin manifestations. Porphyria cutanea tarda (PCT) is often associated with facial blisters and hypertrichosis, hyperpigmentation, and sclerodermoid changes,5Grossman M Bickers DR Poh-Fitzpatrick MB et al.Porphyria cutanea tarda: clinical features and laboratory findings in 40 patients.Am J Med. 1979; 67: 277-286Abstract Full Text PDF PubMed Scopus (212) Google Scholar none of which was noted in our patient. She also had no other clinical findings compatible with PCT. Although there is an association between hepatitis C virus and mixed cryoglobulinemia (MC),6Ferry C Greco F Longombardo G et al.Association between hepatitis C virus and mixed cryoglobulinemia.Clin Exp Rheumatol. 1991; 9: 621-624PubMed Google Scholar the cutaneous findings of MC include purpura, hyperpigmentation, infarction, and hemorrhagic crusts and ulcers.7Davis MDP Su WPD. Cryoglobulinemia: recent findings in cutaneous and extracutaneous manifestations.Int J Dermatol. 1996; 35: 240-248Crossref PubMed Scopus (21) Google Scholar Our patient had none of these cutaneous findings. We are aware of possible alternative expianations for each of the SLE criteria we mentioned above. However, as a group, these criteria overwhelmingly support the diagnosis of SLE.2Tan EM Cohen AS Fries JF et al.The 1982 revised criteria for the classification of systemic lupus erythematosus.Arthritis Rheum. 1982; 25: 1271-1277Crossref PubMed Scopus (12346) Google Scholar Dr. Marvisi suggested the interstitial lung inflammation might be due to idiopathic pulmonary fibrosis (IPF) and/or hepatitis C-associated essential MC. The finding of capillaritis on our patient's transbronchial biopsy did not support IPF. Dr. Marvisi himself has kindly provided the reference refuting the association between hepatitis C and IPF.8Irving WL Day S Johnston IDA. Idiopathic pulmonary fibrosis and hepatitis C virus infection.Am Rev Respir Dis. 1993; 148: 1683-1684Crossref PubMed Google Scholar Although cryoglobulinemia may be present in patients with either hepatitis C or SLE,6Ferry C Greco F Longombardo G et al.Association between hepatitis C virus and mixed cryoglobulinemia.Clin Exp Rheumatol. 1991; 9: 621-624PubMed Google Scholar, 9Howard TW Iannini MJ Burge JJ et al.Rheumatoid factor, cryoglobulinemia, anti-DNA, and renal disease in patients with systemic lupus erythematosus.J Rheumatol. 1991; 18: 826-830PubMed Google Scholar it would not have altered the diagnosis in our patient. We found one case report of lymphocytic pulmonary vasculitis associated with hepatitis C, cryoglobulinemia, and glomerulonephritis.10Roithinger FX Allinger S Kirchgatterer A et al.A lethal course of chronic hepatitis C, glomerulitis, and pulmonary vasculitis unresponsive to interferon treatment.Am J Gastroenterol. 1995; 90: 1006-1008PubMed Google Scholar Our patient did not have lymphocytic vasculitis. In an extensive review of the histopathology of pulmonary capillaritis, Green et al reported that pulmonary capillaritis has not been described in essential MC.4Green RJ Ruoss SJ Kraft SA et al.Pulmonary capillaritis and alveolar hemorrhage.Chest. 1996; 110: 1305-1316Abstract Full Text Full Text PDF PubMed Scopus (216) Google Scholar Although hypoxemia may be associated with cirrhosis, our patient's hypoxemia and diffusion abnormality significantly improved with the administration of corticosteroids. Lupus pneumonitis often remains a diagnosis of exclusion, and as such, other explanations should always be considered. A Case of Systemic Lupus Erythematosus or Hepatitis C Virus?CHESTVol. 113Issue 4PreviewTo the Editor: Full-Text PDF" @default.
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• W2511758418 title "A Case of Systemic Lupus Erythematosus or Hepatitis C Virus?: To the Editor" @default.
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