# Generalized lymphadenopathy in the presence of acute Epstein–Barr virus infection as the initial manifestation of systemic lupus erythematous: A case report

## TL;DR

A case report highlights generalized lymphadenopathy during acute Epstein-Barr virus infection as an early sign of systemic lupus erythematosus.

## Contribution

This case report presents a rare initial manifestation of SLE with generalized lymphadenopathy and sacroiliitis during acute Epstein-Barr infection.

## Key findings

- Generalized lymphadenopathy can be an early sign of SLE in the context of viral infections.
- Early diagnosis and treatment with prednisolone and hydroxychloroquine led to symptom resolution.
- SLE can mimic other conditions, requiring clinical awareness for accurate diagnosis.

## Abstract

Clinicians should carefully consider generalized lymphadenopathy, particularly post viral infections, as one of the possible systemic lupus erythematous (SLE) first signs regarding unusual joint involvements such as sacroiliitis. Late diagnosis of this autoimmune inflammatory disease, could lead to irreversible morbidity and higher mortality.

Lymphadenopathy could represent various etiologies, including infections, malignancies, and rheumatologic diseases. SLE is known as the great mimicker which could be presented with different first manifestations. We report a 42‐year‐old woman in the acute phase of Epstein–Barr infection, admitted with polyarticular peripheral arthritis, sacroiliitis, and generalized lymphadenopathy. She had no similar history or taken unpasteurized dairy. Nodes were soft, mobile, and tender without skin change on top. During the process, she was diagnosed with SLE and discharged with prednisolone 30 mg/day and hydroxychloroquine 400 mg/day. After 2 weeks of follow‐up, all lymphadenopathy and symptoms were diminished. This case underscores the thousand faces innate of SLE. Clinical awareness would lead to an accurate diagnosis and early intervention.