Systemic lupus erythematosus manifestation following COVID-19: a case report

Abstract

Background Systemic lupus erythematosus (SLE) is a complex and challenging autoimmune disease. Severe acute respiratory syndrome coronavirus 2 (SARS‑CoV‑2) is a novel viral agent that can cause a life-threatening respiratory disorder named coronavirus disease 2019 (COVID‑19). Association between SARS‑CoV‑2 and SLE is not clear. We reported the first case of SLE manifestation following COVID-19. Case presentation A 39-year-old Iranian/Persian man with complaints of fever, scaling on the palms of the hands and feet, lower extremity edema, and ankle swelling was referred to Kashan Rheumatology Clinic in 2020. He was infected with SARS-CoV-2 2 months ago. The patient had proteinuria and was positive for SLE laboratory tests. After one week of treatment with prednisolone (30 mg daily) and hydroxychloroquine, paresthesia, proteinuria, and edema continued. The patient was treated with pulse methylprednisolone (1000 mg for three consecutive days), gabapentin, and vitamin B (300 mg daily), which reduced paresthesia. Conclusions This is the first case of SLE manifestation following COVID-19. SARS-CoV-2 may produce autoantibodies or develop the clinical features of subclinical SLE.

Fulminant granulomatosis with polyangiitis presenting with diffuse alveolar haemorrhage following COVID-19

“…5 6 Others have demonstrated a relationship between coronaviruses and the increased incidence of rheumatoid arthritis and multiple sclerosis. 7 In a case similar to our patient, a middle-aged man developed symmetric polyarthritis and diffuse myalgia a week before testing positive for SARS-CoV-2 . Six weeks later, his symptoms dramatically worsened.…”

Rheumatological complications of Covid 19

“…There are 2 case reports where SLE developed after SARS-CoV-2 infection [ 63 , 64 ]. These cases fulfil the classification criteria for SLE, and have needed treatment with immunosuppression.…”

A Flare of Systemic Lupus Erythematosus Disease After COVID-19 Infection: A Case of Lupus Cerebritis

“…Epstein-Barr virus, cytomegalovirus, retroviruses, and parvovirus B19 are the possible triggers of SLE [ 10 , 11 ]. SLE triggered by COVID-19 has also been reported in many cases [ 12 ]. SLE patients are at increased risk of infections due to prolonged use of immunosuppressive drugs and autoimmune syndromes.…”

“…SARS-CoV-2 induces a severe immune response, resulting in the release of inflammatory and pro-inflammatory cytokines and chemokines, disrupting the blood-brain barrier and leading to neuropsychiatric manifestations [ 2 ]. Another mechanism may be microangiopathy arising from cytokine storm and complement activation leading to cerebral ischemia and microinfarction [ 12 ]. The cytokine storm induced by SARS-CoV-2 leads to immune-mediated damage to neuronal cells by molecular mimicry such as the production of autoantibodies like antinuclear antibodies (ANAs) [ 14 ].…”