A case of systemic lupus erythematosus with thrombocytosis diagnosed by lymph-node biopsy.

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In this report, we described a 60 year-old man with systemic lupus erythematosus (SLE) who was diagnosed by lymph node biopsy.He was admitted to our hospital because of fever of unknown origin (FUO). Polyarthralgia and fever developed six months ago. Four months later, he was admitted to hospital because of left hemiparesis. He was diagnosed as multiple cerebral infarction by computed tomography. The laboratory studies revealed elevated erythrocyte sedimentation rate and C-reactive protein (CRP) level, and lymphocytopenia. Two months ago, he was admitted to that hospital again because of high fever. A biopsy of inguinal lymph-node showed the necrotizing lymphadenitis. On admission to our hospital, laboratory examinations revealed lymphocytopenia, marked thrombocytosis (74.5×104/mm3) and elevation of CRP (13, 193μg/dl). But infections and neoplastic diseases were excluded with an extensive work up. He was suspected to have SLE due to the positive antinuclear antibody (640×, homogenous and peripheral pattern), LE cell phenomenon, and Coomb's test.Re-examination of his lymph-node biopsy specimens revealed the hematoxylin bodies with diffuse paracortical necrosis of lymphofollicules. From these findings, he was diagnosed as SLE. Positive anticardiolipin antibody detected by ELISA and multiple cerebral infarction indicated that he also had complicated antiphospholipid syndrome. Immediately after corticosteroid therapy, fever and abnormalities of the laboratory data including thrombocytosis improved.Recent advances in immunological examinations have diminished the possibility that patients with SLE will remain undiagnosed as FUO. Futhermore, a tissue biopsy is rarely necessary to establish the diagnosis of SLE. But this patient had several unusual manifestations of SLE, high fever persisting beyond six weeks without specific symptoms of SLE and marked thrombocytosis.Therefore, this case suggested the clinical diversity of SLE and the importance of Lymph-node biopsy.
日本臨床免疫学会の論文

A case of systemic lupus erythematosus with thrombocytosis diagnosed by lymph-node biopsy.

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