Histoplasmosis presenting as colitis and blood dyscrasias in a patient with systemic lupus erythematosus

Butt, Dua Noor; Warraich, Muhammad Sheharyar; Balakrishna, Akshay Machanahalli; Ismayl, Mahmoud; Liaqat, Sumbul; Butt, Kanza Noor; Thirumalareddy, Joseph; Velagapudi, Manasa

doi:10.1080/08998280.2022.2035163

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“…The case presenting with dysentery is too rare. One case report by Butt et al [9] , described the women with SLE on steroid therapy presentation of dysentery, fever, and thrombocytopenia and later revealed due to histoplasmosis. The cause of dysentery may be due to either vasculitis or colitis shown in the ultrasound.…”

Section: Discussionmentioning

confidence: 99%

Dysentery and leg ulcer as an atypical presentation of systemic lupus erythematosus: A case report

et al. 2022

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Introduction: Due to heterogeneity in the organs involved and a variety of influencing factors, a wide range of clinical manifestations are possible in systemic lupus erythematosus (SLE). In our knowledge, a combination of leg ulcer and dysentery as presenting symptoms of SLE has never been reported previously. Patient concerns: A 13-year-old female child presented with a chronic wound over right medial malleolus for 6 months, and passing of watery stool, later mixed with blood, for 4 days. On examination, she had a fever of 38.5°C. Lab reports revealed anemia, thrombocytopenia, proteinuria, and features of urinary tract infection. Renal biopsy showed membranous glomerulonephropathy. She was positive for antinuclear antibodies (ANA) and antidouble stranded DNA (anti-dsDNA). Immunofluorescence revealed reduced C4 and C3 levels. Abdominal ultrasound showed symmetrical circumscribed thickening, and edematous cecum and ascending colon. Diagnosis: The patient was diagnosed with SLE based on the Systemic Lupus International Collaborating Clinics classification criteria. Interventions: The patient was treated with prednisolone, hydroxychloroquine, metronidazole, ciprofloxacin, trypsin-chymotrypsin, zinc, calcium, and calcitriol tablets. Outcomes: Fever subsided within 3 days of treatment. Gastrointestinal symptoms subsided within 1 week of treatment. On 31 day of treatment, the wound had been reduced and showed features of healing. Conclusion: Dysentery and leg ulcers can be the manifestations of SLE. Therefore, SLE should also be considered when a patient presents with such symptoms. Any suspicion of infection in SLE should be treated aggressively with antibiotics.

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Section: Discussionmentioning

confidence: 99%