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What Do You Suggest For Lupus With Myasthenia Gravis?

Posted on Thu, 6 Mar 2014

Question: I have Systemic Lupus along with Myasthenia Gravis, CVID and other conditions. I recently had UA because of fever. Culture didn't grow anything, but I've been referred to a urologist because results showed wbc of 2+, occult 1+, and rbc 4-10. Last UA done a year ago showed wbc 0-5, rbc 6-10, sqm epi moderate, ketones 2+ , and mucus moderate. Is this anything to be concerned about? BUN/Creatnine ratio has been high for last few blood tests. I am on IVIG 1g/kg weight every 2 wks

Answered by Dr. Shoaib Khan (42 minutes later)

Brief Answer: I do not think there is a cause for concern ma'am Detailed Answer: Hello ma'am and welcome. Thank you for writing to us. I have gone through your query with diligence ma'am. Your current UA does not raise much concern ma'am, but there is a slight doubt of this being an infection, although at times, hospital contamination of the sample can also result in such a report. For this very reason, your doctor has referred you to a urologist, just to make sure all is well. Your urologist will look into your reports with diligence, and if required prescribe mild antibiotics to treat the infection. But in my opinion, there is no infection. I would also like to ask if you had/have any of the following symptoms ma'am: -Burning sensation while urinating -Frequent urination -Increased urge to urinate, but less amount of urine passed -Chills -Fever -Lower abdominal and/or flank region pain -Itching around the genitals -Blood in urine or immediately after (not always seen) -Vaginal discharge All these symptoms need not be present, but are usually related to an infection of the urinary tract. I hope you find my response both helpful and informative. Please feel free to write back to me for any further clarifications, I would be more than happy to help. Best wishes.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Shoaib Khan (53 minutes later)

Thank you for your response. Yes, I had a fever (103) at the time of the UA which was why the test was done (along with a chest x-ray and blood cultures to rule out pneumonia or infection that might have made its way to my bloodstream--both of which were negative). But because the culture didn't grow anything and because I have had abnormal blood work (with low protein and high BUN/Creatnine ratio) and UA's (with blood, protein, ketones and wbc's) in the past, I thought perhaps it might be due to something going on with my kidneys since I have Lupus, rather than an actual infection. I frequently have edema in my hands, ankles and face, and it is not uncommon for me to run fevers intermittently due to inflammation rather than infection. Also, I know that IVIG is hard on the kidneys. Before I spend the money seeking out a specialist I wanted to see if there is a valid reason to be concerned.

Answered by Dr. Shoaib Khan (20 minutes later)

Brief Answer: I feel a nephrologists opinion would help more Detailed Answer: Hello once again ma'am. 103 is a high temperature and usually accompanies a urinary tract infection (UTI), but your culture and UA reports otherwise. Although, your suspicion could also be right ma'am. But if your suspicion is to be further investigated, I would recommend a nephrologist instead of a urologist, to make sure your renal health is not the cause for such a presentation, because with your history coupled with the normal UA and culture, I don't really see the need for a urologist, not as much as a nephrologist at least. But the intermittent fevers and the high temperature will have to be investigated ma'am. As for the requirement of a urologist, it would just be a simple 2 minute consultation to get his/her opinion. I hope I have explained this in a manner best understood by you ma'am. Please do not hesitate to write back to me for any further clarifications, I am always available to help. Best wishes.

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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar