A Rare Case of Rhupus Syndrome With Systemic Involvement: A Case Report and Literature Review

Abstract

Based on clinical signs, symptoms, radiological, and serological findings, a 37-year-old woman was diagnosed with an overlap between rheumatoid arthritis and systemic lupus erythematosus, referred to as rhupus syndrome. Her condition was complicated by lupus nephritis, autoimmune hemolytic anemia, and central nervous system (CNS) vasculitis. She improved after receiving steroids, hydroxyquinone, and cyclophosphamide. There are no established criteria for diagnosing rhupus syndrome. Being aware of autoimmunity and overlapping illness signs and using specific diagnostic tests are crucial. Early therapy may avoid irreversible organ damage.

Treatment of Rhupus Syndrome With Aplastic Anemia Using Cyclosporine and Hydroxychloroquine: A Case Report

“…Autoimmune hemolytic anemia has been reported in rhupus syndrome but the incidence is found very sparingly. Aplastic anemia in rhupus syndrome is mostly due to immune-mediated destruction of bone marrow stem cells leading to the classic hypocellular picture as seen in our patient as well but in general hematological manifestations are uncommon [ 7 ].…”

“…The best treatment for SLE-associated aplastic anemia has not been defined and different combinations of steroids with immune suppressants have been reported in literature. Immunosuppressive therapy using steroids, HCQ, cyclosporine, intravenous immunoglobulins, anti-thymocyte globulin, and rituximab has been used in various combinations [ 7 , 8 ]. Our patient responded very well to low-dose steroids, cyclosporine and HCQ with complete hematological and clinical remission.…”

Rhupus syndrome. a case report of a rare combination

“…In RA patients, the time for the onset of the clinical manifestations of SLE ranges between 4 and 7 years 3 , 7 , while, in the case of SLE patients with initial SLE, is approximately 4 years for the onset of the articular manifestations of RA 2 , 3 , 8 . In our case study, this period was shorter since articular manifestations started 3 years after SLE diagnosis.…”

“…Although, specific criteria were found by different collegues, groups, and leagues to diagnose these RDs, up to 25% of patients cannot be diagnosed as they did not meet the criteria for a specific disease 2 .…”