Thank God for Lab: Systemic Lupus Erythematosus - A Difficult Diagnosis, a Difficult Disease

Systemic Lupus Erythematosus (SLE) involves autoimmune mechanisms that affect multiple systems and has variable clinical manifestations. It affects mainly feminine gender, usually of child-bearing age. Very late onset SLE (patients older than 75 years) is rarely met and difficult to diagnose due to the unspecific symptoms. The diagnosis is frequently mistaken for drug-induced SLE or for other age-specific disorders.

We present the case of a 78 years old male patient complaining of hemoptysis in small amounts, fever, dyspnea at small efforts, weight loss, and important asthenia. Based on physical examination, severe anemia and thoracic CT aspect, several diagnosis were taken into account: anemic syndrome and pleurisy due to refractory pneumonia, pulmonary neoplasm, pulmonary tuberculosis, congestive heart failure and Wegener granulomatosis. Only when direct Coombs test came positive and all the other serological tests resulted negative, diagnosis of SLE was considered. Confirmation came along with high titers of antinuclear antibodies, anti double strained DNA antibodies and lupic anticoagulant and low levels of C3c and C4.

We conclude that the diagnosis of SLE must be taken into consideration even in elder male patients. Therapeutic options in these patients are challenging because of the associated comorbidities and side effects.