Ceasovschih Alexandr, Alexa Raluca-Elena, Șorodoc Victorița, Asaftei Andreea, Stoian Denisa Cristiana, Morărașu Bianca Codrina, Balta Anastasia, Lionte Cătălina, Stoica Alexandra, Sîrbu Oana, Constantin Mihai, Diaconu Alexandra-Diana, Lăcătușu Cristina-Mihaela, Grigorescu Elena-Daniela, Șorodoc Laurențiu
Faculty of Medicine, 'Grigore T. Popa' University of Medicine and Pharmacy, 700115 Iasi, Romania.
2nd Internal Medicine Clinic, 'Sf. Spiridon' Clinical Emergency Hospital, 700111 Iasi, Romania.
J Clin Med. 2025 Apr 8;14(8):2558. doi: 10.3390/jcm14082558.
Systemic lupus erythematosus (SLE) is a heterogeneous autoimmune disease predominantly affecting young individuals; however, its late-onset manifestation poses distinct clinical and diagnostic challenges. This report describes the case of a 93-year-old patient who presented in the Emergency Department with exertional dyspnea, lower limb edema, fatiguability, diffuse abdominal pain, predominantly in the hypogastric region, and loss of appetite. Based on the clinical examination, laboratory tests, and imagistic investigations, we excluded the most common etiologies of edema (decompensated chronic heart failure, glomerular nephropathy/chronic kidney disease, decompensated vascular cirrhosis, hypothyroidism, and hypoproteinemia). Further diagnostic evaluation revealed elevated levels of anti-nuclear antibodies and anti-dsDNA antibodies, along with reduced complement levels, indicating active SLE as the underlying cause of the patient's edema. During hospitalization, the patient received corticosteroid therapy and, after discharge, was referred to the Rheumatology Department for further treatment. In elderly patients, late-onset SLE exhibits distinct clinical manifestations compared to its early-onset counterpart, likely due to age-related alterations in immune system function.
系统性红斑狼疮（SLE）是一种异质性自身免疫性疾病，主要影响年轻人；然而，其迟发性表现带来了独特的临床和诊断挑战。本报告描述了一名93岁患者的病例，该患者因劳力性呼吸困难、下肢水肿、易疲劳、弥漫性腹痛（主要位于下腹部）和食欲不振就诊于急诊科。基于临床检查、实验室检查和影像学检查，我们排除了水肿的最常见病因（失代偿性慢性心力衰竭、肾小球肾病/慢性肾脏病、失代偿性血管性肝硬化、甲状腺功能减退和低蛋白血症）。进一步的诊断评估显示抗核抗体和抗双链DNA抗体水平升高，同时补体水平降低，表明活动性SLE是患者水肿的潜在原因。住院期间，患者接受了糖皮质激素治疗，出院后被转诊至风湿科进行进一步治疗。在老年患者中，迟发性SLE与其早发性表现相比具有独特的临床表现，这可能是由于免疫系统功能的年龄相关改变所致。
