Department of Infectious Disease, Fattouma Bourguiba University Hospital, University of Monastir, Monastir, Tunisia.
Department of Internal Medicine, Fattouma Bourguiba University Hospital, University of Monastir, Monastir, Tunisia.
Pan Afr Med J. 2021 Apr 19;38:377. doi: 10.11604/pamj.2021.38.377.28762. eCollection 2021.
Infections are an important cause of morbidity and mortality in Systemic Lupus Erythematosus (SLE). Mediterranean spotted fever (MSF) is a tick-borne disease caused by Rickettsia conorii. This infection is endemic in Tunisia with summer seasonality. Herein, the case of a 45 years old woman, admitted to hospital with fever and erythema nodosum. On examination, she had a diffuse skin rash, malar rash, and polyarthritis. Serology demonstrated Rickettsia Conoriiinfection. The diagnosis of MSF was made and the patient had a course of doxycycline for 5 days with a prompt improvement of the fever, the skin lesions but she had a persistent malar rash, polyarthritis, and lymphopenia. The immunological profile was positive for antinuclear antibodies (ANA), anti-DNA antibodies, anti-nucleosomes antibodies, and anti-citrullinated protein antibodies (ACPA). The diagnosis of SLE was established. We report the first case of SLE associated with MSF and with erythema nodosum as the initial presentation.
感染是红斑狼疮（SLE）患者发病率和死亡率的重要原因。地中海斑疹热（MSF）是一种由贝纳柯克斯体引起的蜱媒疾病。这种感染在突尼斯流行，夏季具有季节性。本文报告了一例 45 岁女性，因发热和结节性红斑入院。检查时，她全身皮疹，蝶形红斑，多发性关节炎。血清学检测提示贝纳柯克斯体感染。诊断为 MSF，患者接受 5 天多西环素治疗，发热、皮肤病变迅速改善，但仍有蝶形红斑、多发性关节炎和淋巴细胞减少症。免疫谱检测抗核抗体（ANA）、抗 DNA 抗体、抗核小体抗体和抗瓜氨酸蛋白抗体（ACPA）阳性。确诊为 SLE。我们报告首例与 MSF 相关的 SLE 病例，初发表现为结节性红斑。
