A Case Report of Male Systemic Lupus Erythematous with Antinuclear Antibodies-Negative: A Challenging Diagnosis

Baharudin, Ruziana; Idris, Nur Suhaila; Muhammad, Juliawati; Abdullah, Wan Noor Hasbee Wan

doi:10.4082/kjfm.20.0211

Cited by 4 publications

(5 citation statements)

References 9 publications

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“…Diagnosing systemic lupus erythematosus (SLE) relies on clinical and laboratory assessments, yet there persists a notable delay between symptom onset and diagnosis 13 . On average, it takes around two years to diagnose SLE, despite increased awareness.…”

Section: Discussionmentioning

confidence: 99%

A Case Report of a Male with Systemic Lupus Erythematous with First Presentation of Annular Macular Itchy Rashes on his Extremities

Alouthmani,

ALakkad,

Ramli

et al. 2024

J. Drug Delivery Ther.

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Background: Systemic lupus erythematosus (SLE) is an idiopathic autoimmune disease which impacts multiple organs and has various clinical presentations. Among all the organs, the skin is the most frequently affected. Case Presentation: This case report presents a 34-year-old male who presented with severe, itchy, and painful rashes over his right arm and both legs, along with a history of pigmented skin lesions. Initially, the patient was given corticosteroid creams by a dermatologist, but the condition progressed, requiring further investigation. The patient's medical history revealed hypertension and, on review, signs of rashes, fatigue, and arthralgias were noted. Physical examination indicated mild swelling and tenderness in both knees. Additionally, an examination revealed his skin was warm, he had fast capillary refill (<2 seconds), and he had an erythematic rash on the right arm and both legs. A nodular erythema rash was seen on the left leg, along with pigmented skin lesions on the right leg, including a bigger lesion measuring approximately 2.5 cm. Laboratory results indicated increased creatinine, low white blood cell count, anemia, and abnormal protein levels, raising doubts about SLE. Further tests confirmed a raised level of autoantibodies, low complement levels, and positive lupus-related antibodies. Later, the patient was referred to a rheumatologist and an SLE diagnosis was confirmed based on laboratory results and hematological manifestations, mucocutaneous involvement, and lupus nephritis. Treatment initially started with hydroxychloroquine and prednisolone, then tests were repeated and the patient underwent a renal biopsy that revealed focal segmental glomerulosclerosis. He was again prescribed methylprednisolone and prednisolone for three days. The patient's condition resolved and he made a successful recovery. Conclusion: This case demonstrates the multiple clinical manifestations of SLE, the necessity of in-depth investigations, and the requirement for multidisciplinary care to address the intricacies of organ involvement in the disease.

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Section: Discussionmentioning

confidence: 99%

A Case Report of a Male with Systemic Lupus Erythematous with First Presentation of Annular Macular Itchy Rashes on his Extremities

Alouthmani,

ALakkad,

Ramli

et al. 2024

J. Drug Delivery Ther.

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“…Occasional cases of “ANA-negative” SLE are described, although the concept is controversial, and an ANA-negative child should be vigorously evaluated for alternative diagnoses. 8 , 9 Studies have suggested that a positive ANA may disappear in some SLE patients over time, with sensitivity dropping to 76% and positivity dropping from 98% to 71% in patients with established SLE. ANAs have a sensitivity of 33.6%, while anti-dsDNA has a sensitivity of 57.1%, indicating that a significant portion of SLE cases may be missed based on these markers alone.…”

Section: Discussionmentioning

confidence: 99%

“…Sero-negativity in lupus patients may be due to technical failure or entrapment of ANA in circulating immune complexes yet patients exemplify similar clinical presentations to their ANA-positive counterparts. 9 Additionally, autoantibodies such as anti-dsDNA and anti-Smith (anti-Sm) help to confirm the diagnosis of SLE but are not uniformly present. All these antibodies may also be found in children who do not fulfill the classification criteria for SLE.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic Dilemma of ANA-negative Pediatric Systemic Lupus Erythematosus in a South Asian Female

Khan

Abdi

et al. 2023

Clin Med Insights Case Rep

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Background: Systemic lupus erythematosus (SLE) is an autoimmune disorder affecting multiple organs with different degrees of severity. SLE is typically diagnosed based on the presence of antinuclear antibodies (ANA) in the serum. However, seronegative SLE is rare and is diagnosed by clinicians when the patient’s ANA is negative but fulfills other diagnostic criteria. Case report: We report a case of a 15-year-old South Asian female with SLE who had negative antinuclear antibodies yet displayed the typical clinical presentations of photosensitive maculopapular rash, joint pain, alopecia, anemia, and thrombocytopenia. Clinical evaluations in conjunction with lab results were used to establish a diagnosis of ANA-negative SLE. Conclusion: ANA positivity is an entry criterion for SLE; rarely, cases of ANA-negative SLE may present. A typical clinical presentation may help determine the diagnosis in such a scenario. However, still, the physician should rule out immunodeficiency and other systemic illnesses before reaching a diagnosis of ANA-negative pediatric SLE.

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“…Based on clinical and test results, SLE is diagnosed. 1 The presence of antibodies against cytoplasmic and nuclear antigens is a characteristic of SLE. Additionally, patients with SLE may also have other autoantibodies, such as anti-phospholipid, anti-cardiolipin, anti-La, anti-Ro, and anti-Scl-70 antibodies, suggesting a broad correlation between SLE and other autoimmune diseases.…”

Section: Introductionmentioning

confidence: 99%

“…The improved classification criteria used by the European League Against Rheumatism (EULAR) and the American College of Rheumatology (ACR) serve as the most advanced and precise criteria to date. 1,2 There have been reports of varying SLE prevalence and incidence rates; these variations are primarily attributable to population variances. With a 9 to 1 female-to-male ratio, women of reproductive age are primarily affected by SLE.…”

Section: Introductionmentioning

confidence: 99%

Systemic lupus erythematous in men with interstitial lung pneumonia: a rare case report

Anjani,

Saputra,

Widyaningsih

2024

Int J Adv Med

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Systemic lupus erythematosus (SLE) is a chronic autoimmune inflammatory disease with unknown etiology and very diverse clinical manifestations, disease course, and prognosis. It is most common in African-American women, the prevalence being 4 per 1000 females. SLE predominantly affects young women, most presenting between 20 and 40 years of age. Male SLE is rare, with only one male patient reported per nine females. Pulmonary involvement in SLE is various. SLE-associated interstitial lung disease (ILD), while rare, is a predictor of poor prognosis. We report a 50-year-old male patient with complaints of shortness of breath, previously diagnosed with systemic lupus erythematous by examination of the antinuclear antibody (ANA) profile. The patient underwent a computed tomography (CT) scan of the thorax and the results showed interstitial lung pneumonia. The patient was given azathioprine and methylprednisolone therapy for Systemic lupus erythematous and ceftriaxone and acetylcysteine for interstitial lung pneumonia.

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A Case Report of Male Systemic Lupus Erythematous with Antinuclear Antibodies-Negative: A Challenging Diagnosis

Cited by 4 publications

References 9 publications

A Case Report of a Male with Systemic Lupus Erythematous with First Presentation of Annular Macular Itchy Rashes on his Extremities

A Case Report of a Male with Systemic Lupus Erythematous with First Presentation of Annular Macular Itchy Rashes on his Extremities

Diagnostic Dilemma of ANA-negative Pediatric Systemic Lupus Erythematosus in a South Asian Female

Systemic lupus erythematous in men with interstitial lung pneumonia: a rare case report

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