SLE classification and generalized lymphadenopathy. SLE is a multisystem inflammatory process with a wide spectrum of clinical presentations. The American College of Rheumatology (ACR) has established validated criteria to aid in the diagnosis of SLE,3 which were most recently updated in 2012 to improve clinical utility. For a diagnosis to be made, at least 1 clinical and 1 immunologic criterion must be present or a renal biopsy must show lupus nephritis.3
Notably, lymphadenopathy is not included in this validated model, despite its occurrence in 25% to 50% of patients with SLE.1,3,4 With this in mind, SLE should be considered in the work-up of generalized lymphadenopathy.
ANA and SLE. Although it is estimated that 30% to 40% of patients with SLE test positive for ANA,5 the presence of ANA also is not part of the diagnostic criteria for SLE. Interestingly, the co-occurrence of the 2 has clinical implications for patients. In particular, patients with SLE and a positive ANA have higher prevalence of thrombosis, valvular disease, thrombocytopenia, and hemolytic anemia, among other complications.5 Although our patient’s presentation of thrombocytopenia and hemolysis clouded the initial work-up, such a combination is consistent with co-presentation of SLE and APS.
Differences in sex, age, and race. SLE is more common in women than in men, with a prevalence ratio of 7:1.6 It is estimated that 65% of patients with SLE experience disease onset between the ages of 16 and 55 years.7
The median age of diagnosis also differs based on sex and race: According to Rus et al,8 the typical age ranges are 37 to 50 years for White women; 50 to 59 for White men; 15 to 44 for Black women; and 45 to 64 for Black men. These estimates of incidence stratified by race, sex, and age can be helpful when evaluating patients with confusing clinical presentations. Our patient’s age was consistent with the median for his sex and race.
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