Fever and rash as initial signs of systemic autoimmune disease. Case Report.

Abstract

Introduction: Systemic lupus erythematosus is an autoimmune disorder with a very wide spectrum of clinical presentations. It can affect multiple organs and systems however the disease mainly affects the skin with a variable presentation that can range from the classic butterfly-wing malar erythema to extensive lesions. It affects areas of the face such as the chin and forehead, the trunk, and the extremities. Patients can also present arthralgias, fever of unknown origin, and weight and hair loss. The cause of the fever and the presentation of a rash in the extremities are non-specific symptoms and they represent a challenge for the clinician when trying to find their origin, especially when presented separately, as it was in this case. The diagnosis of the cutaneous manifestations of systemic lupus erythematosus is based on the symptoms, histopathology, and immunohistology of the skin lesions. For the diagnosis of Systemic lupus erythematosus, the 2019 EULAR/ACR classification system is used, which indicates that a total score of ≥10 is required to classify systemic lupus erythematosus. For assessing the activity of Systemic lupus erythematosus, the SLEDAI scale is applied, which indicates that a score of less than 3 is compatible with (low activity), a score of 3-12 (moderate activity), and a score greater than 12 (severe activity). Objective: To describe one of the diagnostic challenges for the clinician regarding the presentation of fever and rush in SLE or infection since both symptoms can manifest similarly in the two conditions. Therefore, the search for characteristics that allow us to differentiate SLE from infection is a need that must be addressed promptly. Case presentation: The following case describes a 15-year-old female who presented with fever and skin rash separately for 1 month, as the initial manifestation of SLE. Additionally, the patient responded adequately to immunosuppressive treatment. Conclusions and recommendations: Systemic lupus erythematosus underlies a wide spectrum of clinical presentations with repercussions at the level of organs and systems that can present with symptoms. In this case, fever and rash appeared separately within 1 month of evolution. Other symptoms such as weight loss, asthenia, and hair loss occurred upon admission of the patient. The diagnosis should be based on the exclusion of other pathologies, timely examinations, and adequate immunosuppressive treatment, as well as distinguishing whether the fever is due to an active infectious process or is secondary to the activity of systemic lupus erythematosus.