Very elderly-onset systemic lupus erythematosus presented with mixed-type autoimmune hemolytic anemia

Abstract

An 86-year-old Japanese woman presented with severe anemia and was diagnosed as mixed-type autoimmune hemolytic anemia (AIHA). Subsequently, although she did not show typical manifestations of systemic lupus erythematosus (SLE), she was diagnosed as SLE complicated with Sjögren's syndrome and Greves' disease. While AIHA occurs in 5-10% of SLE patients and SLE is the most common underlying condition of mixed-type AIHA, complication of mixed-type AIHA among SLE patients has not been studied yet. SLE mainly affects women of child-bearing age and is seldom diagnosed in elderlies and the present case is the oldest SLE patient presented with mixed type-AIHA reported so far in the literature, indicating that mixed-type AIHA may complicate in elderly SLE patients and thorough evaluation of the possibility of the complication is justified. She also exemplifies the notion that elderly SLE patients often present with manifestations different from those in younger patients.