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Systemic lupus erythematosus (SLE) is a systemic autoimmune disease associated with anti-nuclear antibodies (ANA), extractable nuclear antigens (ENA), and anti-double stranded DNA antibodies. Glomerulonephritis (GN) with immune complex deposition is found in 50% of cases.1 Twenty per cent of patients with SLE have antineutrophil cytoplasmic antibodies (ANCA), which in certain patients is associated with ANCA-associated vasculitis (AAV).2 The ANCA detected in such cases is reported in the literature as antimyeloperoxidase antibodies (MPO) rather than antiproteinase 3 (PR3) antibodies.3 The prevalence of dual-positive AAV is up to 9% but these cases are not associated with SLE.4 This is the first report of a case of SLE/AAV involving AAV (necrotising pauci-immune GN) with both anti-MPO and anti-PR3 antibodies. A 70-year-old woman presented with thrombocytopenia (platelets 17×109/L), renal failure (creatinine 260 µmol/L) and deep vein thrombosis. She has a 10-year history of SLE characterised by panniculitis, photosensitivity, polyarthritis, oral ulceration, sicca symptoms, relapsing polychondritis, pulmonary hypertension, interstitial lung disease and pulmonary thromboembolism due to secondary antiphospholipid syndrome. Her laboratory investigations revealed a high titre (>2560) homogeneous ANA, anti-double-stranded-DNA antibodies and persistently elevated anticardiolipin and anti-beta-2 glycoprotein 1 antibodies. Her symptoms were non-responsive to methotrexate and leflunomide. A renal biopsy performed 1 year prior to presentation for a creatinine 110 µmol/L demonstrated hypertensive changes with no features of lupus nephritis. Following the …

A female in her early 50s presented with a long-standing history of episodic urticaria and angioedema. She also reported urticarial reactions after ingestion of aspirin, prednisone and multiple antibiotics. These medications were all taken during upper respiratory tract infections. An elimination diet followed by a series of open challenges to food chemicals demonstrated an urticarial eruption following the ingestion of mints, which contain high levels of salicylates. A double-blinded placebo-controlled challenge to salicylate confirmed her sensitivity and explained her reaction to aspirin. The patient informed her treating physician of her copious ingestion of mints during upper respiratory tract infections. Drug hypersensitivity to antibiotics and prednisone was excluded on the basis of negative radioallergosorbent tests (RASTs) and/or absent skin-test responses and/or tolerance to oral challenges. This patient had a salicylate intolerance that caused her episodic urticaria and angioedema, and also masqueraded as a drug allergy due to the concurrent ingestion of mints.

A man in his 60s presented with dry eyes and progressive deterioration in vision bilaterally over a 2-year period. He was treated a number of times presumptively for conjunctivitis with topical antibiotics. Upon referral to an ophthalmologist, physical examination revealed the presence of conjunctival scarring with loss of the fornix, symblepharon (adhesion between conjunctival surfaces of the lid and globe), entropion (lid inversion due to conjunctival scarring) and …