Epstein barr virus infection and systemic lupus erythematosus (SLE) debut in an adolescent
Abstract
Introduction: Systemic lupus erythematosus (SLE), prototype of
autoimmune disease, progresses with flares and remissions. Given
the diversity of possible presentations, its diagnosis and treatment
are a challenge for the clinician, and a high index of suspicion is
required.
Objective: To present the clinical case of an adolescent who
debuted with SLE in the form of hemolytic anemia, probably
triggered by Epstein Barr virus infection.
Clinical case: 14 – year – old male, with no history to highlight.
Consultation for fever of 7 days of evolution of up to 39º C,
odynophagia, asthenia and adynamia. Physical examination revealed
mucous skin pallor, jaundice, cervical lymphadenopathy, and
hepatosplenomegaly. The laboratory shows severe regenerative
anemia with increased bilirubin at the expense of indirect without
hepatitis. Positive Coombs test. Specific antibodies for Epstein
Barr were positive, with which hemolytic anemia secondary to
mononucleosis was diagnosed and corticosteroid treatment was started.
In the evolution, it adds malar erythema and limitation in
flexion of the elbows and knees. Positive antinuclear and anti-native
DNA antibodies are received with severe hypocomplementemia.
With a diagnosis of SLE, hydroxychloroquine and azathioprine were
started, maintaining prednisone.
Conclusions: Many viruses (hepatitis C, Parvovirus B19, Epstein Barr
and Cytomegalovirus) have been described as possible inducers or
mimics of SLE. It is necessary to maintain a high index of suspicion for
timely diagnosis and early treatment.
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References
2) Aringer M, Costenbader K, Daikh D. 2019 European League Against Rheumatism/American College of Rheumatology Classification Criteria for Systemic Lupus Erythematosus.2019.Vol 7 (9): 1400-1412.
3) Petri M, Orbai AM, Alarcón GS, et al. Derivation and validation of the Systemic Lupus International Collaborating Clinics classification criteria for systemic lupus erythematosus. Arthritis Rheum. 2012 Aug;64(8):2677-86.
4) Pons-Estel BA, Bonfa E, Soriano ER, et al. Primera Guía latinoamericana de práctica clínica para el tratamiento del Lupus eritemastoso sistémico:Grupo Latino-Americano de Estudio del Lupus (GLADEL)-Liga Panamericana de Asociaciones de Reumatología(PANLAR),2018
5) Stichweh D, Pascual V. Lupus eritematoso sistémico pediátrico. Anales de pediatría. 2015;63(4):321-9
6) Silva CA. Childhood onset sistemyc lupus erithematosus: early disease manifestations that the pediatrician must know. Expert review of clinical inmumology. 2016.12:9,907-910.
7) Sánchez N, Zubicaray J, Sebastián E, et al. Anemia hemolítica autoinmune: revisión de casos. An pediatric (Barc)2020.
8) González H. Anemias hemolíticas en la infancia.Pediatría Integral.2012,XVI(5): 378-386.
9) Ortíz JR, Mendez M, García L, et al. Anemia hemolítica autoinmunitaria.Un reto diagnóstico y terapéutico.Rev hematol Mex. 2017.(4): 168-176.
10) Mejía M. Anemias hemolíticas autoinmunes. Rev.Med Inst Mex Seguro Soc.2005; 43(Supl 1): 25-28.
11) Vera VS, Chavez N, Lizardi J, et al. Mononucleosis infecciosa.2003. 10:2 76-88.
12) Fadeyi E, Simmons J, Jones M, et al. Fatal autoinmune hemolytic anemia due to inmunoglobulin G autoantibody exacerbated by Epstein barr virus.2015; 46: 12-59
13) García A, Villegas A, Gonzalez F. Manifestaciones hematológicas del lupus eritematoso sistémico. 2002, 19:534-543.
14) Ramos-Casales M, Brito Zerón M.P, Gil.V, et.al. Las infecciones virales como simuladoras de un lupus eritematoso sitémico. Med Integral 2003; 41(1): 25-33.
15) Draborg AH, Duus K, Houen G. Epstein-Barr Virus and Systemic Lupus Erythematosus. Clin Dev Immunol. 2012; Article ID 370516.
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