Diffuse splenic calcifications in systemic lupus erythematosus: a case-based review

Systemic lupus erythematosus (SLE) is a multi-organ autoimmune disease with a wide spectrum of splenic manifestations. In recent literature, splenic calcifications have increasingly been recognized as a rare manifestation of SLE. We describe a patient presenting with fever in whom abdominal imaging revealed splenomegaly with diffuse splenic microcalcifications, prompting further diagnostic evaluation that ultimately led to the diagnosis of SLE. To contextualize this finding, we performed a systematic case-based literature review and identified 29 previously reported cases, resulting in a total of 30 cases including our own. Across reported cases, no distinct serological or clinical phenotype could be identified. However, a characteristic imaging pattern emerged, predominantly consisting of diffuse, small, round-to-rod-shaped splenic calcifications. When longitudinal data were available, calcifications were usually stable, although progression was reported in association with disease flares, sometimes evolving to functional autosplenectomy. This case illustrates that splenic calcifications may represent an early or presenting manifestation of SLE and that an incidental detection should prompt consideration of autoimmune disease in the broad differential diagnosis. By synthesizing previously scattered reports, this review provides an updated overview to support clinical interpretation and awareness.