J Rheum Dis.  2019 Jan;26(1):79-82. 10.4078/jrd.2019.26.1.79.

Leptospirosis as Unusual Trigger of Systemic Lupus Erythematosus

• Lee J
• Kim YR
• Yoon CH

• KMID: 2442038
• DOI: http://doi.org/10.4078/jrd.2019.26.1.79

Abstract

Systemic lupus erythematosus (SLE) is a chronic autoimmune disorder of an unknown origin. The role of leptospirosis as a triggering factor for SLE is unknown. This paper reports an uncommon case of SLE following a leptospira infection. A 29-year-old female was referred due to fevers, myalgia, and facial edema with rash. Laboratory investigations revealed a hepatic dysfunction, significantly raised lactate dehydrogenase with marked leukopenia and thrombocytopenia. A diagnosis of leptospirosis was confirmed. The patient was treated with antibiotic therapy for leptospirosis. She developed dyspnea after one week. The echocardiogram revealed global hypokinesia with a decreased ejection fraction. A positivity of antinuclear, anti-DNA, and anti-Smith antibodies, together with clinical and laboratory improvement by steroid therapy, led to the diagnosis of SLE. This case highlights the presence of concurrent SLE and leptospirosis. As the symptoms of SLE are similar to leptospirosis, accurate diagnosis through high suspicion is essential for appropriate treatment.

Keyword

Systemic lupus erythematosus; Leptospirosis; Myocarditis

MeSH Terms

Adult
Antibodies
Diagnosis
Dyspnea
Edema
Exanthema
Female
Fever
Humans
Hypokinesia
L-Lactate Dehydrogenase
Leptospira
Leptospirosis*
Leukopenia
Lupus Erythematosus, Systemic*
Myalgia
Myocarditis
Thrombocytopenia
Antibodies
L-Lactate Dehydrogenase

Figure

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  Figure 1 Chest X-ray showed cardiomegaly with left-sided pleural effusion on the 13th day of illness.

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  Figure 2 (A) Electrocardiogram showing a normal sinus rhythm with T wave inversion in leads II, III and V2 to V6. (B) After the prednisolone treatment, the electrocardiogram showed a normal sinus rhythm with normally positive T wave.

Reference

1. Laxminarayana D. Molecular insights into systemic lupus erythematosus pathogenesis. Clin Med Insights Pathol. 2014; 20(7):7–9.

2. Esposito S, Bosis S, Semino M, Rigante D. Infections and systemic lupus erythematosus. Eur J Clin Microbiol Infect Dis. 2014; 33:1467–1475.

3. Bal AM, Bharadwaj RS, Gita N, Joshi SA, Thakare JP. Guillain-Barre syndrome in a pediatric patient following infection due to Leptospira. Jpn J Infect Dis. 2003; 56:29–31.

4. Urganci N, Kalyoncu D, Cayonu N, Erdem E, Yildirmak Y, Yilmaz B. Acute liver failure, autoimmune hepatitis, and leptospirosis: a case report. Pediatr Emerg Care. 2011; 27:963–965.

5. Makhija P, Gopinath S, Kannoth S, Radhakrishnan K. A case of post-leptospirosis autoimmune epilepsy presenting with sleep-related hypermotor seizures. Epileptic Disord. 2017; 19:456–460.

6. Levett PN. Leptospirosis. Clin Microbiol Rev. 2001; 14:296–326.

7. Petri M, Orbai AM, Alarcón GS, Gordon C, Merrill JT, Fortin PR, et al. Derivation and validation of the systemic lupus international collaborating clinics classification criteria for systemic lupus erythematosus. Arthritis Rheum. 2012; 64:2677–2686.

8. Budihal SV, Perwez K. Leptospirosis diagnosis: competancy of various laboratory tests. J Clin Diagn Res. 2014; 8:199–202.

9. Puca E, Pilaca A, Kalo T, Pipero P, Bino S, Hysenaj Z, et al. Ocular and cutaneous manifestation of leptospirosis acquired in Albania: a retrospective analysis with implications for travel medicine. Travel Med Infect Dis. 2016; 14:143–147.

10. Barnabe C, Fahlman N. Overlapping clinical features of lupus and leptospirosis. Clin Rheumatol. 2008; 27:Suppl 1. S23–S25.

11. Castro LA, Davis DM, Davis MD, Bruce AJ, Pittelkow MR. Facial edema and crusted patches: a precursor to life-threatening acute systemic lupus erythematosus. J Am Acad Dermatol. 2007; 56:5 Suppl. S126–S127.

12. Crouzet J, Faucher JF, Toubin M, Hoen B, Estavoyer JM. Serum C-reactive protein (CRP) and procalcitonin (PCT) levels and kinetics in patients with leptospirosis. Eur J Clin Microbiol Infect Dis. 2011; 30:299–302.

13. Mori M, VAN Esbroeck M, Depoorter S, Decaluwe W, Vandecasteele SJ, Fretin D, et al. Outbreak of leptospirosis during a scout camp in the Luxembourg Belgian province, Belgium, summer 2012. Epidemiol Infect. 2015; 143:1761–1766.

14. Navinan MR, Rajapakse S. Cardiac involvement in leptospirosis. Trans R Soc Trop Med Hyg. 2012; 106:515–520.

15. Trivedi SV, Bhattacharya A, Amichandwala K, Jakkamsetti V. Evaluation of cardiovascular status in severe leptospirosis. J Assoc Physicians India. 2003; 51:951–953.