Challenges in the Diagnosis of Systemic Lupus Erythematosus in an Adolescent With Sexually Transmitted Infections: A Case Report and Review of the Literature

TL;DR

A case report shows how SLE diagnosis in an adolescent was complicated by overlapping symptoms and tests with STIs like syphilis and HIV.

Contribution

Highlights diagnostic challenges when SLE symptoms overlap with STIs and the importance of STI screening before lupus treatment.

Findings

An 18-year-old male had SLE-like symptoms but was found to have syphilis, gonorrhea, chlamydia, and HIV.

Positive autoantibody tests in infections can mimic SLE, complicating diagnosis.

STI screening is crucial before initiating immunosuppressive therapies for rheumatic conditions.

Abstract

Systemic lupus erythematosus (SLE) is often referred to as the great imitator, as it can mimic the presentation of several diseases, including infections. We present the case of an 18-year-old male adolescent with clinical and laboratory findings of SLE who was later found to have concurrent syphilis, gonorrhea, chlamydia, and human immunodeficiency virus (HIV) infections. Diagnosis of these concurrent infections was complicated by symptom overlap between these diseases, primarily between SLE, HIV, and syphilis, as well as positive autoantibody tests. Treatment for lupus was stopped after infections were found; however, thorough retesting for SLE has not been performed, as the patient was lost to follow-up. This case highlights the need to keep a broad differential when diagnosing and treating patients with SLE, as false-positive serologic tests for SLE may be present in individuals with infections. This case also underscores the need to perform screening for sexually transmitted infections (STIs) in individuals who are being considered for a rheumatologic diagnosis, especially before starting immunosuppressive therapies.

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