Diagnostic Pitfalls in a Man with Systemic Lupus Erythematous

Abstract

Systemic lupus erythematosus (SLE) is a chronic multi-systemic immune-mediated disease with confusing symptoms and delayed diagnosis. We report the case of a 32-year-old man with a persistent Venereal Disease Research Laboratory (VDRL)-positive reaction treated for syphilis 5 years previously, who was admitted for rash, weight loss, pancytopenia, inflammatory syndrome, and an important spontaneous prolongation of activated partial thromboplastin time (aPTT). Antiphospholipid antibodies were identified in the patient and he was diagnosed with SLE. The unrecognized false positive VDRL reaction and the delayed diagnosis of SLE were harmful as the patient had developed renal and cardiac complications by the time of diagnosis.LEARNING POINTSVDRL positive reaction as a diagnostic tool for syphilis must be confirmed by other tests like TPHA and Western Blot reaction, especially in the absence of a clinical context, taking into account the possibility of false positive results.Spontaneous prolongation of aPTT can be related to the presence of antiphospholipid antibodies.In medical practice, the clinician must always consider the uniqueness of a diagnosis that integrates all the clinical and laboratory data, even if the associations might seem confusing.

False-Positive Serologic Reactions for Syphilis

“…As for chronic false-positive reactions, they can be noted in such clinical cases as hepatitis C virus (HCV) infection, intravenous drug use, malignancy, older age, malaria, Chagas disease, tuberculosis, leprosy, and connective tissue diseases [28]. Besides, false-positive test is a characteristic clinical sign in patients with systemic lupus erythematosus [42,43]. It is proved now that false-positive results of serologic reactions for syphilis may be caused by HCV [44].…”