Lymphadenopathy as a Prodrome for Systemic Lupus Erythematous

Abstract

: A 41-year-old woman presented to the hospital with one month of fever, chills, lymphadenopathy, abdominal pain, a bilateral upper extremity rash, and malaise. The patient had no significant prior medical history and was physically active, kickboxing twice a week and working 16-hour days. She reported increased difficulty getting out of bed over the span of one month. Physical exam was notable for tender, palpable posterior cervical lymph nodes that were mobile and about 1 cm in maximum diameter. There was mild abdominal tenderness to deep palpation without guarding or rebound tenderness. A computerized tomography (CT) scan of the abdomen and pelvis was notable for diffuse mesenteric fat stranding and prominent right retroperitoneal lymph nodes. The patient was readmitted two months later with worsening fatigue, abdominal pain, subjective fever, night sweats, and swelling and tenderness of her wrists and fingers despite ibuprofen. After extensive infectious, hematologic and autoimmune evaluations, a diagnosis of systemic lupus erythematous (SLE) was made and treatment with high-dose steroids and hydroxychloroquine, which resulted in gradual improvement in symptoms. This report highlights fevers and generalized lymphadenopathy as a subtle prodrome of SLE.

Linfadenopatías generalizadas como manifestación inicial de lupus eritematoso sistémico: a propósito de un caso clínico

“…La linfadenopatía por LES tiene una incidencia estimada del 1% al momento del diagnóstico 8 , no obstante, ocurre hasta en el 25 % de los pacientes con LES en algún momento de la enfermedad. Típicamente las adenopatías son blandas, indoloras, varían en tamaño de 0,5 cm a varios centímetros y se detectan generalmente en áreas cervical, axilar e inguinal y plantean problemas en el diagnóstico, así como la necesidad de descartar otras enfermedades que pueden manifestarse con linfadenopatías 9 .…”

Differenzialdiagnostik von benignen Lymphadenopathien in der Rheumatologie

“…Obwohl Lymphadenopathien beim SLE in 33-69 % beobachtet werden [17,21], haben sie aufgrund ihrer fehlenden Spezifität keinen Eingang in die EULAR Klassifikationskriterien gefunden. Sie können als Prodromi eines SLE vorhanden sein [22], treten aber meist generalisiert und bei jüngeren Patienten bei aktiver Erkrankung auf. Sie sind assoziiert mit einer Hautbeteiligung, Hepatosplenomegalie, hohen ds-DNA Antikörpertitern und Komplementverbrauch [21].…”

Generalized Lymphadenopathy as the First Manifestation of Systemic Lupus Erythematosus

“…In systemic lupus erythematosus (SLE), LAP represents a benign and common finding. Though it is not considered a clinical criterion in the 2019 European League Against Rheumatism/American College of Rheumatology (EULAR/ACR) classification criteria, some reports have suggested that it can be the first manifestation, with a cumulative incidence ranging from one-third to one-half of the cases [2,3,4,5]. There are some clinical and paraclinical characteristics associated with LAP in SLE, such as more constitutional symptoms (fatigue, fever, and weight loss), more cutaneous symptoms, increased anti-dsDNA antibodies, and decreased complement levels [6,7].…”