MO320 LUPUS FLARE MIMICKING COVID-19 INFECTION: A CASE REPORT

Sabah, Meryem; Jabrane, Fatimzahra; El oury, Hiba; Khalfaoui, Mohamed Amine; Chehab, Nasreddine; Medkouri, Ghizlaine

BACKGROUND AND AIMS: The world is in midst of the coronavirus disease 2019 (COVID-19) pandemic. METHOD: Studies of the COVID-19 pathophysiology show that its defining character is an overt inflammatory response, similar to cytokine release syndrome, causing a dysregulated immune response. Systemic lupus erythematosus (SLE) is also a disease of immune dysregulation contributing to multisystem compromise. There is very little literature to suggest that COVID-19 could potentially mimick SLE presentation. We describe the case of a female patient who presented with typical Covid19 clinical features, later diagnosed as a new-onset SLE. RESULTS: A 51-year-old female presented with fever, dyspnea, cough and desaturation at the emergency room. Chest computed tomography scan showed bilateral areas of ground-glass opacities in a peripheral distribution. She was admitted in a Covid-19 ICU. She then progressed to severe acute respiratory distress syndrome, and worsening renal function with proteinuria and hematuria. Further investigations showed bilateral pleural effusions, ascites, leukopenia and thrombocytopenia, positive antinuclear and anti-double-stranded DNA antibodies, and low levels of C3 and C4. SARS-Cov-2 PCR was negative twice. After the establishment of the diagnosis, the patient was transferred to the internal medicine department where she received decongestive therapy, intravenous (IV) pulses of methylprednisolone, along with hydroxychloroquine. She improved sustainably and was discharged after two weeks. CONCLUSION: A patient with new-onset lupus presented with clinical features typically seen in COVID-19 patients. The adequate management of the patient was delayed due to the misguided diagnosis.