Visceral leishmaniasis mimicking systemic lupus erythematosus: Case series and a systematic literature review.

Autor: Santana IU; Serviço de Clínica Médica do Hospital Geral Roberto Santos, Salvador, Brazil., Dias B; Serviços Especializados em Reumatologia (SER) da Bahia, Rua Conde Filho, 117, Graça, Salvador, Bahia CEP 40150-150, Brazil., Nunes EA; Serviços Especializados em Reumatologia (SER) da Bahia, Rua Conde Filho, 117, Graça, Salvador, Bahia CEP 40150-150, Brazil., Rocha FA; Serviço de Reumatologia do Hospital Universitário Walter Cantídio, Ceará, Brazil., Silva FS Jr; Serviço de Reumatologia do Hospital Universitário Walter Cantídio, Ceará, Brazil., Santiago MB; Serviços Especializados em Reumatologia (SER) da Bahia, Rua Conde Filho, 117, Graça, Salvador, Bahia CEP 40150-150, Brazil. Electronic address: mbsantiago2014@gmail.com.
Jazyk: angličtina
Zdroj: Seminars in arthritis and rheumatism [Semin Arthritis Rheum] 2015 Jun; Vol. 44 (6), pp. 658-65. Date of Electronic Publication: 2014 Dec 29.
DOI: 10.1016/j.semarthrit.2014.12.004
Abstrakt: Objective: Systemic lupus erythematosus (SLE) is an autoimmune disease that may present manifestations that resemble other diseases. Visceral leishmaniasis (VL) is a parasitic infection whose hallmarks may mimic SLE symptoms. Here, we report a case series and evaluate the published, scientific evidence of the relationship between SLE and VL infection.
Methods: To assess original studies reporting cases of VL-infected patients presenting manifestations that are capable of leading to inappropriate suspicions of SLE or mimicking an SLE flare, we performed an extensive search in several scientific databases (MEDLINE, LILACS, SciELO, and Scopus). Two authors independently screened all citations and abstracts identified by the search strategy to identify eligible studies. Secondary references were additionally obtained from the selected articles.
Results: The literature search identified 53 eligible studies, but only 17 articles met our criteria. Among these, 10 lupus patients with VL mimicking an SLE flare and 18 cases of VL leading to unappropriated suspicions of SLE were described. The most common manifestations in patients infected with VL were intermittent fever, pancytopenia, visceromegaly, and increased serum level of acute phase reactants. The most frequent autoantibodies were antinuclear antibodies, rheumatoid factor, and direct Coombs' test.
Conclusion: In endemic areas for VL, the diagnosis of SLE or its exacerbation may be a clinical dilemma. Hepatosplenomegaly or isolated splenomegaly was identified in the majority of the reported cases where VL occurred, leading to unappropriated suspicions of SLE or mimicking an SLE flare. Furthermore, the lack of response to steroids, the normal levels of complement proteins C3 and C4, and the increased level of transaminases suggest a possible infectious origin.
(Copyright © 2015 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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