Clinical Misdiagnosis of Atypical Systemic Lupus Erythematosus

SUN Xiaomei; LIU Wei

doi:10.3969/j.issn.1002-3429.2024.06.002

Abstract：Objective To explore the clinical characteristics,causes of misdiagnosis and preventive measures of atypical systemic lupus erythematosus(SLE).Methods The clinical data of misdiagnosed SLE patients admitted to our hos-pital from February 2021 to April 2023 were retrospectively analyzed.Results A 14-year-old female presented with rash on the limbs as initial symptoms,which was worsened after exposure to cold,and later developed symptoms of joint swelling,pain,and fever.She was diagnosed with anaphylatic purpura in another hospital,and symptomatic treatment was far from sat-isfactory.After admission to our hospital,the rheumatism and immune-related examination and skin tissue biopsy were per-formed,SLE was confirmed.After receiving glucocorticoid shock therapy,the patient was discharged.Another 46-year-old fe-male patient was diagnosed with mixed cervical spondylosis in Department of Orthopedics of another hospital due to sleep disor-ders and neck discomfort,accompanied by skin erythema,low mood,coughing when drinking water,dysphagia,and inability to take care of themselves.After admission to our hospital,combined with the clinical manifestations and immunological exam-inations,the patient was diagnosed with SLE.After treatment with Glucocorticoid and Cyclophosphamide shock,the symptoms gradually improved and the patient was discharged from hospital.Conclusion The initial symptoms of SLE are varied,often insidious,atypical,and more likely to be misdiagnosed.Clinicians should strengthen their understanding of the atypical mani-festations of SLE,be familiar with the pathogenesis and common population of SLE,carefully observe the characteristics of the rash,inquire about the history in detail,carefully perform differential diagnosis,and perform the hematologic and immunologi-cal examination as soon as possible to reduce or avoid the misdiagnosis and mistreatment.