An Elderly Female Systemic Lupus Erythematosus Patient Presented with Severe Agranulocytosis as Initial Symptom

Agranulocytosis refers to a severe reduction in neutrophils (with an absolute value less than 0.5 x 109/L) in peripheral blood, and a small portion of acquired agranulocytosis is caused by systemic lupus erythematosus (SLE). SLE is a chronic autoimmune disease involving multiple systems, mainly occurring in young women. Its clinical manifestations include polyarthralgia and arthritis, Raynaud's syndrome, rashes on the cheeks and other parts, pleurisy or pericarditis, involvement of the kidneys or central nervous system, and autoimmune cytopenia.

Blood routine and bone marrow routine tests were used to detect the cell proliferation condition in peripheral blood and bone marrow. Complement, immunoglobulin, etc. were detected by biochemical instrument, and antinuclear antibody (ANA), anti-dsDNA antibody, etc. were detected by immunofluorescence method.

Blood routine indicated a WBC of 0.49 x 109/L with neutrophil count 0.09 x 109/L. Bone marrow routine showed bone marrow nucleated cells decreased, granulocyte granules increased and thickened. Biochemistry indicators: immunoglobulin G (IgG), immunoglobulin A (IgA), C-reactive protein (CRP), amylase (AMY), aspartate transaminase (AST), lactate dehydrogenase (LDH) were elevated, and complement C3, complement C4, albumin, eGFR were decreased. ANA.IgG positive (+), anti-dsDNA antibody positive (++).

This postmenopausal SLE patient presented with agranulocytosis as the initial symptom are rarely seen. Therefore, clinicians should enhance their understanding of SLE, conduct a comprehensive analysis of various clinical manifestations, and conduct relevant tests timely to reduce misdiagnosis.