Basham Ayoub, Soleimani Sanaz, Ab Parvar Atash, Rahimi Arash, Evazi Ebrahim, Moosavy Seyed Hamid
Student Research Committee, Faculty of Medicine, Hormozgan University of Medical Sciences, Bandar Abbas, Iran.
Department of Pulmonology, Shahid Beheshti University of Medical Science, Tehran, Iran.
J Med Case Rep. 2024 Dec 25;18(1):608. doi: 10.1186/s13256-024-04914-4.
Systemic lupus erythematosus is a multi-organ autoimmune disorder that is treated by immunosuppressive agents that weaken the immune defense against opportunistic pathogens and latent infections such as strongyloidiasis. Herein, we report the case of a 43-year-old woman known to have systemic lupus erythematosus who presented with gastrointestinal symptoms, edema, and bone pain 2 months after receiving immunosuppressive treatment.
A 43-year-old Iranian female known to have systemic lupus erythematosus and antiphospholipid syndrome presented with abdominal pain, nausea, vomiting, and generalized edema. She was on CellCept, prednisolone, and hydroxychloroquine. The vital signs were within the normal range. On physical examination, no rash was observed on the skin. There was only a mild tenderness in epigastric region. The results of blood analysis revealed hypochromic microcytic anemia, normal leukocyte count with mild eosinophilia. Liver enzymes as well as renal function tests were within the normal range. Stool examination was negative for trophozoites, ova, or cysts of parasites. Endoscopic findings included a generalized nodular appearance of duodenum with an infiltrative mucosa in the wall of duodenum, suggesting lymphoma. The pathology report determined the diagnosis of strongyloidiasis. Cap albendazole 400 mg was administered twice a day for 2 weeks. Abdominal pain was completely relieved 1 week after starting the treatment. The patient was eventually discharged after 10 days.
The significance of this case report is the necessity to send complete blood count and serologic assays to screen latent strongyloidiasis before receiving immunosuppressive agents in patients with systemic lupus erythematosus.
系统性红斑狼疮是一种多器官自身免疫性疾病，需用免疫抑制剂治疗，而这些药物会削弱机体对机会性病原体和潜伏感染（如类圆线虫病）的免疫防御。在此，我们报告一例43岁已知患有系统性红斑狼疮的女性病例，该患者在接受免疫抑制治疗2个月后出现胃肠道症状、水肿和骨痛。
一名43岁的伊朗女性，已知患有系统性红斑狼疮和抗磷脂综合征，出现腹痛、恶心、呕吐和全身水肿。她正在服用骁悉、泼尼松龙和羟氯喹。生命体征在正常范围内。体格检查时，皮肤未观察到皮疹。上腹部仅有轻度压痛。血液分析结果显示低色素小细胞性贫血，白细胞计数正常，伴有轻度嗜酸性粒细胞增多。肝酶以及肾功能检查均在正常范围内。粪便检查未发现寄生虫滋养体、虫卵或包囊。内镜检查结果显示十二指肠普遍呈结节状外观，十二指肠壁黏膜浸润，提示淋巴瘤。病理报告确诊为类圆线虫病。给予阿苯达唑400毫克，每日两次，共2周。治疗开始1周后腹痛完全缓解。患者最终在10天后出院。
本病例报告的意义在于，对于系统性红斑狼疮患者，在接受免疫抑制剂治疗前，有必要进行全血细胞计数和血清学检测以筛查潜伏的类圆线虫病。
