Lymphadenopathy of Systemic Lupus Erythematosus: A Case Presentation
Systemic lupus erythematosus (SLE) is an autoimmune disease that might be seen at any period of life regardless of age, gender, or race, but it most frequently affects young female patients. SLE might be observed to be together with the involvement of multiple organs coursing with skin, kidney, hematologic, and musculoskeletal involvement and responds well to the corticosteroids. Several symptoms and findings during the course of the disease might be dependent on the involvement of disease and they might also develop secondarily to the therapies applied. SLE is rarely seen together with lymphadenopathy (LAP) and this situation causes difficulties in diagnosis and treatment.
The present case was a 32-year-old female patient, who has been diagnosed 13 years before, had no follow-up during the last 1.5 years, and presented to the family health center with the complaint of disease activation and swelling on the left side of neck. In medical examination, soft, mobile, and painless LAPs with approx. 2x1cm size were observed in both cervical regions. The one located on the right side was more remarkable. The patient stated that the swellings were there for 1.5 months and no reduction was observed in LAPs although she has taken various antibiotics. The patient was referred to Uşak Education and Research Hospital General Surgery Clinic with a referral note containing the necessary information with the preliminary diagnosis of SLE lymphadenopathy as a result of Anamnesis and physical examination taken by the patient who was admitted to the Family Health Center. All the procedures were followed by contacting the relevant branch physicians and patients at the hospital where the patient was admitted and treated. We had the opportunity to learn about the diagnostic procedures and treatments applied to the patient.
The histopathologic diagnosis of LAP excision specimen was lupus lymphadenitis. The early diagnosis might be very difficult in these cases since the autoantibodies and low levels of complements cannot be detected. The present case is discussed here in the literature in order to emphasize that SLE is a pathology that should be considered in the differential diagnosis for the patients presenting with LAP.
References
- Albayrak İ, Küçük A, Bağçacı S, Küçükşen S, Tunç R. Lenfadenopati ile başlayan sistemik lupus eritematozus: Olgu sunumu. FTR Bil Der 2014; 17: 38-41.
- Neto NSR, Bonfiglioli KR, Milanez FM, Macêdo PA, Levy-Neto M. Lymphadenopathy and systemic lupus erythematosus. Bras J Rheumatol 2010;50 (1) : 96-101.
- Gelincik İ. Bir Nekrotizan Lenfadenit Nedeni: Kikuchi – Fujimoto Hastalığı: Olgu Sunumu. Yeni Tıp Dergisi 2012;29(3):176-8.
- Türkbeyler İH, Pehlivan Y, Çömez G, Zengin O. Göktepe F, Onat AM. Yaygın lenfadenopati nedeni ile başvuran hastada sistemik lupus eritematozis tanısı: Olgu sunumu. ADÜ Tıp Fakültesi Dergisi 2011; 12(2): 45-7.
- Shrestha D, Dhakal AK, Shiva Raj KC et al. Systemic lupus erythematosus and granulomatous lymphadenopathy. BMC Pediatrics 2013;13:179-85.
- Naramala S, Adapa S et al. An Overlapping Case of IgG4 Related Disease and Systemic Lupus Erythematosus. Journal of Investigative Medicine High Impact Case Reports 2019;7: 1–4.
- Aktaş B, Kalyoncu U, Çağkan İA et al. Clinicopathologic case discussion: systemic lupus erythematosus. RAED Dergisi 2014;6(1):36-4.
- Çiçek D, Dağlı AF. Kikuchi – Fujimoto hastalığı ile karışan bir sistemik lupus eritematozus olgusu. Fırat Tıp Dergisi 2007;12(2): 137-9.
- Akhüseyinoğlu M, Saylam G, Han Ü et al. A Rare necrotising lymphadenitis cause in our country: Kikuchi-Fujimoto Disease. KBB ve BBC Dergisi 2009;17 (2):58-61.
- Scott GD, Kumar J, Oak JS, Boyd SD, Raess PW, Gratzinger DA. Histology-Independent Signature Distinguishes Kikuchi-Fujimoto Disease/Systemic Lupus Erythematosus-Associated Lymphadenitis From Benign and Malignant Lymphadenopathies. Am J Clin Pathol 2020;154(2):215-24. doi:10.1093/ajcp/aqaa036.
- Masab M, Surmachevska N, Farooq H. Kikuchi Disease. In: StatPearls. Treasure Island (FL), StatPearls Publishing; 2020.