Lymphadenopathy and systemic lupus erythematosus

Area of Science:

• Rheumatology
• Immunology
• Pathology

Background:

• Lymphadenopathy is a common benign finding in Systemic Lupus Erythematosus (SLE).
• It is frequently observed in younger patients presenting with skin involvement and constitutional symptoms.
• Reactive follicular hyperplasia is the typical histopathological finding on lymph node biopsy.

Observation:

• A case report details a patient experiencing recurrent lymphadenopathy, hepatosplenomegaly, fever, and weight loss from age 13.
• The patient subsequently developed arthritis, hypertension, proteinuria, cardiomyopathy, and peripheral neuropathy.
• Extensive investigations and empirical tuberculosis treatment preceded the eventual SLE diagnosis five years later.

Findings:

• This case highlights diagnostic challenges in SLE, particularly when initial auto-antibody and complement levels are not indicative of disease.
• The patient's presentation was complex, mimicking other conditions and delaying specific SLE treatment.
• Lymphadenopathy in SLE can be a significant early sign, even without typical serological markers.

Implications:

• Emphasizes the need for considering SLE in young patients with persistent, unexplained lymphadenopathy and multi-system involvement.
• Suggests that atypical presentations of SLE require a high index of suspicion for timely diagnosis and management.
• Highlights the importance of longitudinal patient monitoring and reassessment when initial diagnostic workups are inconclusive.