Neslihan GÖKÇEN, Hacer KAYA, Fatma TUNCER, Ayten YAZICI, Ayşe CEFLE

Sistemik Lupus Eritematozusu Taklit Eden İnsan İmmün Yetmezlik Virüsü Pozitif Bir Olgu

Amaç: İnsan immune yetmezlik virüsünün (HIV) kendisi veya HIV tedavisinde kullanılan ajanlar romatizmal bulgulara neden olabilir. Bu bulgular arasında, sistemik lupus eritematozus (SLE) hastalarında da görülen artalji, artrit, fotosensitivite, oral ülser, sikka sendromu, ateş, hipergamaglobulinemi, sitopeni, nöropati ve anti-nükleer antikor (ANA) pozitifliği yer almaktadır. HIV, sadece SLE’yi taklit etmez, ayrıca SLE ile birlikte de olabilir. Olgu: Oral ülser, bulanık görme, vertigo, konuşma bozukluğu ve ataksik yürüme şikayetleri olan 40 yaşındaki hasta kliniğimize başvurdu. Serebellar testleri anormaldi ve tandem yürüyüşü yapamıyordu. Laboratuvarda lökopeni, lenfopeni, karaciğer fonksiyon testlerinde ılımlı yükseklik saptanması ve manyetik rezonans görüntülemede (MRG) ensefalit izlenmesi üzerine otoantikor ve viral panel istendi. Otoantikorlar negatif bulunurken, HIV enzim bağlı immunosorbent assay (ELISA) pozitifti. Sonuç: HIV, sistemik otoimmün ve otoinflamatuvar durumlara neden olabilir. Bu nedenle, özellikle romatizmal bulgular ile başvuran hastalarda HIV dışlanmalıdır.

A Patient with Human Immune Deficiency Virus Mimicking Systemic Lupus Erythematosus

Background: Human immunodeficiency virus (HIV) can cause rheumatological manifestations due to infectious itself or treatment. Among these findings take part arthralgia, arthritis, photosensitivity, oral ulcer, sicca syndrome, fever, hypergammaglobulinemia, cytopenia, neuropathy and anti-nuclear antibody (ANA) positivity, which have been also observed in systemic lupus erythematosus (SLE). Not only does HIV imitate SLE, but also it might coexist with. Case Report: A 40-year-old man who presented with oral lesions, blurry vision, vertigo, speech difficulty and ataxic gait admitted to the clinic. Cerebellar tests were abnormal. He could not walk in tandem gait. After observing leukopenia, lymphocytopenia and mildly increased liver function tests in laboratory and encephalitis on magnetic resonance imaging (MRI), autoantibodies and viral panel were requested. While autoantibodies were negative, HIV Enzyme-Linked Immunosorbent Assay (ELISA) was found positive. Conclusion: HIV can lead to systemic autoimmune and autoinflammatory conditions. Notably, ruling out HIV in patients who have rheumatological findings is necessary.

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1. Aringer M, Costenbader K, Daikh D, Brinks R, Mosca M, Ramsey-Goldman R, et al. 2019 European League Against Rheumatism/American College of Rheumatology classification criteria for systemic lupus erythematosus. Ann Rheum Dis. 2019;78(9):1151-1159. https://doi.org/10.1002/art.40930
2. Chasset F, Richez C, Martin T, Belot A, Korganow AS, Arnaud L. Rare diseases that mimic Systemic Lupus Erythematosus (Lupus mimickers). Joint Bone Spine. 2019;86(2):165-171. https://doi.org/10.1016/j.jbspin.2018.10.007
3. Jara LJ, Medina G, SaavedraMA.Autoimmune manifestations of infections.Curr Opin Rheumatol. 2018;30(4):373-379. PMID: 29528865. https://doi.org/ 10.1097/BOR.0000000000000505
4. Prabhu S, Harwell JI, Kumarasamy N. Advanced HIV: diagnosis, treatment, and prevention. Lancet HIV. 2019;6(8):e540-e551. https://doi.org/10.1016/S2352-3018(19)30189-4
5. Vega LE, Espinoza LR. Human immunodeficiency virus infection (HIV)-associated rheumatic manifestations in thepre- and post-HAART eras. Clin Rheumatol. 2020;39(9):2515-2522. https://doi.org/10.1007/s10067-020-05082-8
6. Virot E, Duclos A, Adelaide L, Miailhes P, Hot A, Ferry T, Seve P. Autoimmune diseases and HIV infection: A cross-sectional study. Medicine (Baltimore). 2017; 96 (4): e5769. https://doi.org/10.1097/MD.0000000000005769
7. Cuellar ML, Espinoza LR. Rheumatic manifestations of HIV-AIDS. Baillieres Best Pract Res ClinRheumatol. 2000;14(3):579-93.
8. Battafarano DF. HIV-associated rheumatic syndromes. Rheumatology secrets. Ed: West SG. Third Ed. Elsevier Mosby. Philedelphia 2015. p 319-324.
9. Liao HY, Tao CM, Su J. Concomitant systemic lupus erythematosus and HIV infection: A rare case report and literature review. Medicine (Baltimore). 2017;96(51):e9337. https://doi.org/10.1097/MD.0000000000009337
10. Hax V,Moro ALD, PiovesanRR, Goldani LZ, Xavier RM, Monticielo OA. Human immunodeficiency virus in a cohort of systemic lupus erythematosus patients.AdvRheumatol. 2018;58(1):12. https://doi.org/10.1186/s42358-018-0003-2
11. O’Kelly B, McNally C, McConkey S, Durcan L. HIV and systemic lupus erythematosus: where immunodeficiency meets autoimmunity. Lupus. 2020;29(9):1130-1132. https://doi.org/10.1177/0961203320934851