Maitra Somnath, Roy Sasmit, Mukherjee Aveek, Naramala Srikanth, Bose Subhasish
General Medicine, Jagannath Gupta Institute of Medical Sciences and Hospital, Kolkata, IND.
Nephrology, University of Virginia, Charlottesville, USA.
Cureus. 2020 Sep 11;12(9):e10375. doi: 10.7759/cureus.10375.
Systemic lupus erythematosus is a multisystem disorder much more common in females than males due to the effect of the hormone estrogen. There are also specific differences in clinical presentation in men and women. We present a unique case of a 54-year-old middle-aged Asian male presenting with only generalized weakness without other systemic features and with only incidental finding of thrombocytopenia. Notable laboratory values were positive for antinuclear antibody (ANA) and anti-double-stranded DNA (dsDNA), low complement 3 level with normal complement 4 levels, along with severe thrombocytopenia and mild anemia. The patient was eventually diagnosed with systemic lupus erythematosus based on these parameters. Bone marrow biopsy revealed an increased number of megakaryocytes without hypocellular or hypercellular marrow and no dysplasia of cell lines. He was initiated on oral prednisone, and his symptoms recovered remarkably with normalization of lab values upon discharge. The case's importance lies in the fact that the diagnosis of lupus can be missed in male patients with nonspecific clinical features due to certain differences in presentation from females. This diagnosis should be included in the workup of any thrombocytopenia.
系统性红斑狼疮是一种多系统疾病，由于雌激素的作用，女性比男性更为常见。男女在临床表现上也存在特定差异。我们报告一例独特病例，一名54岁的中年亚洲男性，仅表现为全身乏力，无其他全身症状，仅偶然发现血小板减少。值得注意的实验室检查结果为抗核抗体（ANA）和抗双链DNA（dsDNA）阳性，补体3水平低而补体4水平正常，同时伴有严重血小板减少和轻度贫血。根据这些指标，该患者最终被诊断为系统性红斑狼疮。骨髓活检显示巨核细胞数量增加，骨髓细胞数量正常，无细胞系发育异常。患者开始口服泼尼松治疗，出院时实验室检查结果恢复正常，症状明显改善。该病例的重要性在于，由于男性患者与女性患者在临床表现上存在某些差异，具有非特异性临床特征的男性患者可能会漏诊狼疮。对于任何血小板减少症的检查，都应考虑这一诊断。
