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Clinico-Pathological Conference 2 October 6, 2009

The Patient. 52 yr old female with SLE ? scleroderma overlap Inflammatory polyarthritisSclerodermatous skin changes with RaynaudsExtensive GI dysmotility- TPNGlomerulonephritisRestrictive lung diseaseHypocomplementemiaInflammatory myositis / myocarditis. SLE-scleroderma . 2006- Polyarthritis

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Clinico-Pathological Conference 2 October 6, 2009

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    1. Clinico-Pathological Conference #2 October 6, 2009

    2. The Patient 52 yr old female with SLE scleroderma overlap Inflammatory polyarthritis Sclerodermatous skin changes with Raynauds Extensive GI dysmotility- TPN Glomerulonephritis Restrictive lung disease Hypocomplementemia Inflammatory myositis / myocarditis

    3. SLE-scleroderma 2006- Polyarthritis Weakness with myositis 2/2008 Esophageal dysmotility TPN + IV methylprednisolone (30 mg/day)

    4. HPI 1 month PTA- volume overload, cardiac dysfunction R / L cardiac cath: no pulmonary arterial hypertension or coronary artery disease Endomyocardial biopsy: inflammatory cells, scaring: mycophenolate, methylpred (60mg/dy)

    5. Medications Lasix 20 mg daily Hydrochlorquine 200 mg twice daily Lisinopril 5 mg daily Metoprolol 25 mg twice daily Prednisolone 60 mg intravenously in the morning Reglan 10 mg four times daily Myfortic 180 mg twice daily Dilaudid 2mg as needed Dapsone 100 mg every Monday-Wednesday-Friday Flagyl 500 mg every 8 hours for bacterial overgrowth Protonix 40 mg twice daily Ambien 10 mg as needed Ergocalciferol 1000 International Units daily

    6. Course 3 weeks later- OSH: SOB, fever, chills, rigors, cough Bilateral infiltrates Rapid decline with sepsis, multi-organ failure despite Vancomycin, pip/tazo, oral flagyl, caspofungin

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