Lymphadenopathy as the initial presentation in systemic lupus erythematosus: A disease manifestation or co-existing association and review of the literature

Author(s): Shams M Reda, Anan H El Aini, Aya El-Hindawy, Heba H ElHadidi, Lobna Thabet, Lobna A Maged, Nora Y Elsaid, NahlaN Eesa, Samar M Fawzy, Tamer A Gheita*

Systemic lupus erythematosus (SLE) is a systemic autoimmune disease that exhibits a variety of clinical symptoms in many organs.Lymphadenopathyis a frequent and usually nonspecific feature of SLE. Some patients have lymphadenopathy at diagnosis or at follow-up. Objective: to present a rare case of lymphadenopathy presenting as the initial presentation of SLE. Case presentation: A 34 years old female patient presented with cervical and axillary LN enlargement for 2 month duration after which she developed arthritis affecting mainly small joints of both hands initial labs workup revealed microcytic hypochromicanemia, leukopenia and elevated ESR hematological work up revealed antinuclear antibodies and anti-smith antibodies were positive rheumatoid factor and anti CCP were negative. As that time the diagnosis of SLE was made but suspicious LNS lead us to extensive work up for infection and malignancy which revealed generalized lymphadenopathy suspicious for lymphoma, malignancy concern lead us to excisional biopsy from cervical LN and revealed at first a picture highly suggestive for Hodgkin lymphoma but repeated biopsy showed a picture of reactive hyperplasia with positive CD staining PET scan also wasn’t conclusive and revealed metabolically active supra and infra diaphragmatic LNS with lymphoma among possibilities for histopathological correlation. After ruling out infections and not being able to confirm malignancy, patient was started on steroids 20mg with a significant improvement of joint condition and she is under regular follow-up. Conclusion: Diffuse lymphadenopathy may be a presenting feature of SLE and should be considered in the differential diagnosis of patient presenting with diffuse lymphadenopathy