Clinical pitfalls of leishmaniasis and Whipple’s disease hidden behind systemic lupus erythematosus: A case series

Abstract

Systemic lupus erythematosus (SLE) is a multisystemic autoimmune disease that can affect major organs possibly leading to life-threatening complications and appears with heterogeneous clinical picture. SLE could present with broad spectrum of clinical and laboratory features that can resemble those of other diseases, such as hemopoietic malignancies, infections, or immune-mediated disorders. Its complexity and protean features overlap with many other diseases, hindering the differential diagnosis. Rarely, true overlap with other diseases may occur. Herein, we report a case series of two patients affected by infectious diseases, namely visceral leishmaniasis and Whipple's disease (WD), intertwined with clinical or serological features of SLE. In both cases, several confounding factors have led to a delay in the diagnosis. Moreover, we first describe the persistent elevation of autoantibodies and a monoclonal gammopathy in a patient with WD. Awareness of unusual presentations of infections or other rare disorders, which may be encountered in clinical practice when taking care of SLE patients, is essential for timely diagnosis and treatment of potentially lethal diseases.

COVID-19 infection may trigger SLE disease: A case report

“…SLE is an inflammatory disease in which autoimmunity, triggered by genetic environmental factors, plays a role in its aetiology, seen more frequently in females (11). Smoking, alcohol use, ultraviolet radiation exposure, vaccines, silica exposure, air pollution and solvent exposure can be counted among the environmental factors triggering SLE development (11,12). Besides these, it has been reported that infectious diseases such as Epstein-Barr virus (EBV) and cytomegalovirus could trigger SLE development (11,13,14).…”

Whipple Disease Presenting as Isolated Transverse Myelitis with Permanent Neurological Damage in a Patient with Systemic Lupus Erythematosus: A Case Report of a Difficult Diagnosis with a Literature Review

“…Its main clinical features are abdominal pain, diarrhea, weight loss, and arthralgia, but cardiac, pulmonary, and neurological symptoms can also be present [ 3 ]. The central nervous system (CNS) is involved in 90% of cases of WD, but neurological manifestations are evident in only 10–43% [ 2 , 3 ], and are mainly represented by cognitive impairment, psychiatric dysfunction, sleep disturbances, oculo-masticatory myorhythmia, oculo-facio-skeletal myorhythmia, seizures, and ataxia, while medullary manifestations are rare, and few data are present in the literature [ 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 ].…”