Fever of Unknown Origin in a Male Patient with Systemic Lupus Erythematosus

Overview

Journal Caspian J Intern Med

Specialty General Medicine

Date 2017 Sep 22

PMID 28932375

Authors

Duminda Bandara Basnayake

Thamara Kannangara

Laknath Welagedara

Vindhya Bandara

Janitha Herath

Affiliations

Soon will be listed here.

Abstract

Background: Systemic lupus erythematosus (SLE) is an inflammatory autoimmune disorder which is uncommon in men. It has a wide variety of clinical presentations.

Case Report: We report a 21-year-old male presented with one month history of fever, loss of appetite, weight loss and reduced hair growth with an examination revealing an oral ulcer, cervical and axillary lymphadenopathy simulating hematological malignancy. Investigations showed pancytopenia, positive anti-nuclear factor and double-stranded DNA, high erythrocyte sedimentation rate with normal C-reactive protein levels and hypocomplementemia. The diagnosis of systemic lupus erythematosus was made and treatment with oral prednisolone conferred a dramatic clinical and biochemical improvement within one week.

Conclusion: In the evaluation of fever of unknown origin, one should be guided by the presenting symptoms and signs of a patient and even though uncommon, SLE is a worthwhile diagnosis to investigate even in a male patient if the clinical picture is suggestive.

References

Hochberg M . Updating the American College of Rheumatology revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum. 1997; 40(9):1725. DOI: 10.1002/art.1780400928. View

Pons-Estel G, Alarcon G, Scofield L, Reinlib L, Cooper G . Understanding the epidemiology and progression of systemic lupus erythematosus. Semin Arthritis Rheum. 2009; 39(4):257-68. PMC: 2813992. DOI: 10.1016/j.semarthrit.2008.10.007. View

Arbuckle M, James J, Dennis G, Rubertone M, McClain M, Kim X . Rapid clinical progression to diagnosis among African-American men with systemic lupus erythematosus. Lupus. 2003; 12(2):99-106. DOI: 10.1191/0961203303lu334oa. View

Molina J, Drenkard C, Molina J, Cardiel M, Uribe O, Anaya J . Systemic lupus erythematosus in males. A study of 107 Latin American patients. Medicine (Baltimore). 1996; 75(3):124-30. DOI: 10.1097/00005792-199605000-00002. View

Bertsias G, Ioannidis J, Boletis J, Bombardieri S, Cervera R, Dostal C . EULAR recommendations for the management of systemic lupus erythematosus. Report of a Task Force of the EULAR Standing Committee for International Clinical Studies Including Therapeutics. Ann Rheum Dis. 2007; 67(2):195-205. DOI: 10.1136/ard.2007.070367. View

Arce-Salinas C, Morales-Velazquez J, Villasenor-Ovies P, Muro-Cruz D . Classical fever of unknown origin (FUO): current causes in Mexico. Rev Invest Clin. 2006; 57(6):762-9. View

Garcia M, Marcos J, Marcos A, Pons-Estel B, Wojdyla D, Arturi A . Male systemic lupus erythematosus in a Latin-American inception cohort of 1214 patients. Lupus. 2006; 14(12):938-46. DOI: 10.1191/0961203305lu2245oa. View

Knockaert D, Vanderschueren S, Blockmans D . Fever of unknown origin in adults: 40 years on. J Intern Med. 2003; 253(3):263-75. DOI: 10.1046/j.1365-2796.2003.01120.x. View

Mulders-Manders C, Simon A, Bleeker-Rovers C . Fever of unknown origin. Clin Med (Lond). 2015; 15(3):280-4. PMC: 4953114. DOI: 10.7861/clinmedicine.15-3-280. View

10.

Bertsias G, Pamfil C, Fanouriakis A, Boumpas D . Diagnostic criteria for systemic lupus erythematosus: has the time come?. Nat Rev Rheumatol. 2013; 9(11):687-94. DOI: 10.1038/nrrheum.2013.103. View

11.

Miller M, Urowitz M, Gladman D, Killinger D . Systemic lupus erythematosus in males. Medicine (Baltimore). 1983; 62(5):327-34. DOI: 10.1097/00005792-198309000-00005. View