J Rheum Dis 2019; 26(1): 79-82  
Leptospirosis as Unusual Trigger of Systemic Lupus Erythematosus
Jinhee Lee, Yang Ree Kim, Chong-Hyeon Yoon
Department of Internal Medicine, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
Correspondence to: Chong-Hyeon Yoon http://orcid.org/0000-0003-2305-4637 Division of Rheumatology, Department of Internal Medicine, Uijeongbu St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 271 Cheonbo-ro, Uijeongbu 11765, Korea. E-mail:chyoon@catholic.ac.kr
Received: May 8, 2018; Revised: June 1, 2018; Accepted: June 9, 2018; Published online: January 1, 2019.
© Korean College of Rheumatology. All rights reserved.

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Abstract
Systemic lupus erythematosus (SLE) is a chronic autoimmune disorder of an unknown origin. The role of leptospirosis as a triggering factor for SLE is unknown. This paper reports an uncommon case of SLE following a leptospira infection. A 29-year-old female was referred due to fevers, myalgia, and facial edema with rash. Laboratory investigations revealed a hepatic dysfunction, significantly raised lactate dehydrogenase with marked leukopenia and thrombocytopenia. A diagnosis of leptospirosis was confirmed. The patient was treated with antibiotic therapy for leptospirosis. She developed dyspnea after one week. The echocardiogram revealed global hypokinesia with a decreased ejection fraction. A positivity of antinuclear, anti-DNA, and anti- Smith antibodies, together with clinical and laboratory improvement by steroid therapy, led to the diagnosis of SLE. This case highlights the presence of concurrent SLE and leptospirosis. As the symptoms of SLE are similar to leptospirosis, accurate diagnosis through high suspicion is essential for appropriate treatment. (J Rheum Dis 2019;26:79-82)
Keywords: Systemic lupus erythematosus, Leptospirosis, Myocarditis


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