Onset of systemic lupus erythematous complicated by severe multiorgan involvement

Abstract

The authors report the case of a 51-year-old man with a 1-month history of mild gastroenteritic symptoms, daily fever and malaise. The patient was febrile (38.5°C) and laboratory data showed renal failure (creatinine 2.5 mg/dL), proteinuria and hemoglobinuria. A 10-day antibiotic therapy was started since an infective gastrointestinal process was initially suspected. When autoimmune immunologic patterns, associated with renal, neurologic and hematologic signs, confirmed the diagnosis of systemic lupus erythematous the patient was infused with high-dose intravenous corticosteroids. Despite the treatment, the patient developed rhabdomyolysis, acute pancreatitis, worsening of renal function (creatinine 5.5 mg/dL) to oliguria, and marked cognitive impairment. Our case focuses on the importance of an early recognition of laboratory and anamnestic data that may suggest a systemic autoimmune involvement, so as to rapidly undertake an aggressive immunosuppressive therapy.