SYSTEMIC LUPUS ERYTHEMATOUS AS A MIMICKER OF LYMPHOPROLIFERATIVE DISEASE
M Bank MD 1 , AS Ito MD 1 , SA Chaudhary MD 2 , S Sanne DO 1 1 Department of Medicine, LSU Health, New Orleans, LA 2 Department of Medicine, Section of Infectious Diseases, LSU Health, New Orleans, LA
INTRODUCTION: Systemic lupus erythematous (SLE) is a known mimicker of many other conditions because of its diverse multi-system presentation. Especially when evaluating for a lymphoproliferative disease, consider SLE as a coexisting or alternative diagnosis.
CASE: A 42-year female with no known past medical or family history presented to the hospital with three days of chest pressure, shortness of breath, fever, and five days of throat pain. The patient also reported weakness, arthralgias, myalgias, fatigue, night sweats, and a 20lb weight loss over the prior two months. Infectious workup was negative; however, patient was noted to have pancytopenia with a white blood cell count of 2.0 K/uL, hemoglobin of 7.6 gm/dL, and platelets of 120 k/uL. Imaging showed enlarged lymph nodes in both sides of neck, supraclavicular region, axilla, mediastinum, and scattered enlarged lymph nodes in periportal and peri-splenic area, retroperitoneum, pelvis, and groin. The patient had an elevated serum creatinine of 1.27 mg/dL with nephrotic range proteinuria and mild elevation in transaminases. Other relevant labs included an elevated ESR and a positive EBV IgG. Oncology was consulted due to concern for lymphoma and the patient underwent excisional lymph node and bone marrow biopsy. Lymph node biopsy revealed reactive lymphoid hyperplasia, but was negative for malignancy, as was the bone marrow biopsy. A concurrent autoimmune workup revealed a positive ANA and low complement levels. Further autoimmune workup was positive for anti-ds DNA, as well as anti-SSA, anti- SSB, anti-Sm, anti-chromatin, anti-ribosomal P, and anti-RNP. Rheumatology diagnosed the patient with SLE at that time. Nephrology was consulted for help with renal biopsy which showed lupus nephritis class IV. The patient’s symptoms improved with prednisone and she has been managed outpatient by rheumatology and nephrology on a regimen of hydroxychloroquine and mycophenolate. Follow-up labs revealed significant improvement in her anemia and renal function. DISCUSSION: This case highlights the importance of keeping a broad differential when approaching a patient to ensure a prompt and accurate diagnosis. While this patient’s B symptoms, pancytopenia and diffuse lymphadenopathy were suggestive of a hematologic malignancy such as lymphoma, she also exhibited many classic symptoms of SLE.
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