Parvovirus B19 Associated Systemic Lupus Erythematosus in a Child with Sickle Cell Disease; a Diagnostic and Therapeutic Challenge

Abstract

Although sickle cell disease (SCD) and systemic lupus erythematosus (SLE) are two distinct and relatively common chronic diseases, coexistence of these two conditions in the same patient appears to be rare. The authors report an eight-year-old child with SCD who developed a severe form of parvovirus B19-associated SLE, with secondary severe immune hemolytic anemia related to drugs, Libman-Sacks endocarditis complicated by severe aortic regurgitation, dilated left ventricle with impaired function and myocardial ischemia, with further decompensation culminating in cardiac arrest during an infectious intercurrence, which led to death. This patient displayed a broad spectrum of musculoskeletal, hematologic and cardiovascular complications, which could be associated with either SCD or SLE. Because of a substantial overlap between the clinical manifestations of these two disorders, the diagnosis of SLE in a patient with a previously known diagnosis of SCD may be difficult and is often delayed. Our report illustrates the importance of considering other disease processes, like autoimmune diseases when clinical features or its evolution are atypical of SCD and emphasizes some of the diagnostic difficulties encountered during the diagnosis and management of these patients.