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Related Experiment Video

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Analyses of Proteinuria, Renal Infiltration of Leukocytes, and Renal Deposition of Proteins in Lupus-prone MRL/lpr Mice
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Angioimmunoblastic T-cell Lymphoma: A Mimic for Lupus.

Hui Boon Tay1, Stanley Angkodjojo1, Zhi En Amos Tay2

  • 1Division of Medicine, Sengkang General Hospital, SingHealth, Singapore.

European Journal of Case Reports in Internal Medicine
|October 21, 2020
PubMed
Summary

Elderly-onset systemic lupus erythematosus (SLE) can mimic lymphoma. This case highlights the importance of considering lymphoma as an alternative diagnosis in older adults presenting with atypical SLE features, especially when lymphadenopathy is present.

Keywords:
Elderly-onset systemic lupus erythematosusangioimmunoblastic T-cell lymphomalupus nephritis

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Area of Science:

  • Rheumatology
  • Oncology
  • Pathology

Background:

  • Systemic lupus erythematosus (SLE) is rarely diagnosed in elderly patients.
  • Atypical presentations of SLE can pose diagnostic challenges, particularly in differentiating from other conditions.

Purpose of the Study:

  • To report a rare case of elderly-onset SLE concurrent with angioimmunoblastic T-cell lymphoma.
  • To emphasize the importance of considering alternative diagnoses in complex cases.

Main Methods:

  • Clinical case presentation of a 71-year-old woman with new-onset SLE.
  • Diagnostic work-up including serological tests (ANA, anti-dsDNA), renal biopsy, and lymph node biopsy.
  • Re-evaluation of lymph node biopsy to confirm concurrent lymphoma.

Main Results:

  • The patient presented with fever, alopecia, bicytopenia, hepatomegaly, lymphadenopathy, and glomerulonephritis, consistent with SLE.
  • Renal biopsy confirmed lupus nephritis.
  • Initial lymph node biopsy showed reactive hyperplasia, but subsequent review revealed angioimmunoblastic T-cell lymphoma.

Conclusions:

  • Elderly-onset lupus requires thorough investigation for secondary causes and alternative diagnoses.
  • Lupus and lymphoma can present with overlapping symptoms (cytopenias, hepatomegaly, lymphadenopathy), making differentiation difficult.
  • High clinical suspicion and pathologist consultation are crucial for diagnosing rare lymphomas, even with initially negative histology.