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