Lupus and autoimmune shock: Use of intravenous gammaglobulin. Case report and proposal for a new designation
Shock is a state of hypotension and hypoperfusion which in turnleads to cellular dysfunction, neuroendocrine responses, inflam-matory mediator release, and alterations of the microcirculation.There are various ways of classifying tissue perfusion failure. Asimple method is dividing them into a distr...
| Autores: | , , , , |
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| Tipo de recurso: | artículo |
| Estado: | Versión publicada |
| Fecha de publicación: | 2013 |
| País: | México |
| Institución: | Instituto Nacional de Pediatría |
| Repositorio: | Redalyc-INP |
| OAI Identifier: | oai:redalyc.org:423640341008 |
| Acceso en línea: | https://www.redalyc.org/articulo.oa?id=423640341008 |
| Access Level: | acceso abierto |
| Palabra clave: | Medicina Lupus autoimmunity immunologic dissonance intravenous immunoglobulin |
| Sumario: | Shock is a state of hypotension and hypoperfusion which in turnleads to cellular dysfunction, neuroendocrine responses, inflam-matory mediator release, and alterations of the microcirculation.There are various ways of classifying tissue perfusion failure. Asimple method is dividing them into a distributive category, such asseptic or anaphylactic shock, and a non-distributive category suchas hypovolemic shock. There is extensive knowledge on septicshock; the interaction between bacteria and the antigen presentingcell receptor (TRL-2, TRL-4) releases a proinflammatory cytokinestorm, favoring the production of nitric oxide, thus perpetuating thehypotensive state. The imbalance between proinflammatory andanti-inflammatory cytokines creates an immunologic dysfunction,which favors the systemic inflammatory response syndrome andunleashes a shock state, a situation namedimmunologic disso-nanceby Dr. Roger Bone in 1996. From our perspective, this termexplains the alterations presented in one particular case, where thecornerstone is the dysfunction of the patient’s immune system and itsculmination in a distributive form of shock, which from our hypotheti-cal perspective is of autoimmune origin. We consider autoimmunityto be the platform leading to the state of immunologic dissonanceresponsible for autoimmune shock, which we believe merits anon-traditional approach. For this reason in a case in which wesuspect shock based on autoimmunity, intravenous gammaglobulinwas used in conjunction with a bolus of methylprednisolone in anattempt to counteract the immunologic dissonance; satisfactoryresults were obtained. |
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