Abstract
Systemic Lupus Erythematosus (SLE) is a multifaceted autoimmune disease characterized by various clinical manifestations, complicating its diagnosis and management. This case report discusses the diagnostic challenges of SLE, mainly when initial presentations include symptoms suggestive of allergic reactions or are linked to environmental exposures, such as a tick bite. A 45-year-old male presented with symptoms including progressive lower limb edema, photosensitivity, and generalized weakness, initially attributed to a toxic-allergic reaction following a tick bite. Overlapping symptoms with Lyme disease and other autoimmune conditions further complicated the diagnostic process. Despite initial treatments for presumed allergic and infectious causes, the patient's condition deteriorated, ultimately leading to a diagnosis of SLE. This case underscores the importance of maintaining a broad differential diagnosis and employing a comprehensive, multidisciplinary approach when evaluating patients with complex and overlapping clinical histories. Early recognition and targeted diagnostic strategies are essential to prevent delays in diagnosis and ensure timely, appropriate management, thereby reducing the risk of severe complications.
References
Correia de Sá A, Batista M, Ferreira AL, Casanova D, Faria B, Cotter J. Diagnostic Challenges of Systemic Lupus Erythematosus. Cureus, 2023, 15(12), e50132 doi: 10.7759/cureus.50132
Piga M, Arnaud L. The Main Challenges in Systemic Lupus Erythematosus: Where Do We Stand? J Clin Med, 2021, 10(2), 243 DOI: 10.3390/jcm10020243
Allen ME, Rus V, Szeto GL. Leveraging Heterogeneity in Systemic Lupus Erythematosus for New Therapies. Trends Mol Med, 2021, 27(2), 152-171 DOI: 10.1016/j.molmed.2020.09.009
Pisetsky DS, Lipsky PE. New insights into the role of antinuclear antibodies in systemic lupus erythematosus. Nat Rev Rheumatol, 2020, 16(10), 565-579 DOI: 10.1038/s41584-020-0480-7
Ameer MA, Chaudhry H, Mushtaq J, Khan OS, Babar M, Hashim T, Zeb S, Tariq MA, Patlolla SR, Ali J, Hashim SN, Hashim S. An Overview of Systemic Lupus Erythematosus (SLE) Pathogenesis, Classification, and Management. Cureus, 2022, 14(10), e30330 DOI: 10.7759/cureus.30330
Weiss NL, Sadock VA, Sigal LH, Phillips M, Merryman PF, Abramson SB. False positive seroreactivity to Borrelia burgdorferi in systemic lupus erythematosus: the value of immunoblot analysis. Lupus, 1995, 4(2), 131–137 DOI: 10.1177/096120339500400209
Doskaliuk B, Zimba O. Borrelia burgdorferi and autoimmune mechanisms: implications for mimicry, misdiagnosis, and mismanagement in Lyme disease and autoimmune disorders. Rheumatol Int, 2024, 44, 2265–2271 DOI: 10.1007/s00296-024-05580-x
Doskaliuk B, Zimba O, Yatsyshyn R, Kovalenko V. Rheumatology in Ukraine. Rheumatol Int, 2020, 40(2), 175–182 DOI: 10.1007/s00296-019-04504-4
Fijałkowska A, Kądziela M, Żebrowska A. The Spectrum of Cutaneous Manifestations in Lupus Erythematosus: A Comprehensive Review. J. Clin. Med, 2024, 13, 2419 DOI: 10.3390/jcm13082419
Vale ECSD, Garcia LC. Cutaneous lupus erythematosus: a review of etiopathogenic, clinical, diagnostic and therapeutic aspects. An Bras Dermatol, 2023, 98(3), 355-372. DOI: 10.1016/j.abd.2022.09.005
Ekpenyong HJ, Olaosebikan HB, Aliyu HH, et al. Generalized lymphadenopathy as an initial presentation of systemic lupus erythematosus: case report and review of the literature. Egypt Rheumatol Rehabil, 2024, 51, 41 https://doi.org/10.1186/s43166-024-00274-5
Vasquez-Canizares N, Wahezi D, Putterman C. Diagnostic and prognostic tests in systemic lupus erythematosus. Best Pract Res Clin Rheumatol, 2017, 31(3), 351-363 DOI: 10.1016/j.berh.2017.10.002
Dema B, Charles N. Autoantibodies in SLE: Specificities, Isotypes and Receptors. Antibodies (Basel), 2016, 5(1), 2 DOI: 10.3390/antib5010002
Pawlak-Buś K, Leszczyński P. 2022 Systemic lupus erythematosus remission in clinical practice. Message for Polish rheumatologists. Reumatologia, 2022, 60(2), 125-132 DOI: 10.5114/reum.2022.115667

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Copyright (c) 2025 Bohdana Doskaliuk, N. Cherniuk, Khrystyna Fedorovych, M. Derkach, Yatsyshyn Roman (Author)
