Even the hardest puzzles have the solutions :Recurrent Encapsulated bacteraemia as presentation of systemic lupus erythematous


Khizer Iqbal, Fahd Adeeb, Muhammad Haroon


Rheumatology Department, University Hospital Kerry


We are reporting the case about the critical encapsulated bacteraemia in the young female patient on two different occasions found to be underlying low complements levels secondary to systemic lupus erythematous as presentations


A 17 year old lady with no medical history presented with headache associated with photo phobia and generalized purpuric rash and unexplained weight loss. Investigations revealed positive meningococcal antigen on LP.By considering her weight loss history CT TAP was done revealed diffuse bronchial thickening and general lymphadenopathy . She was treated with antibiotics as per protocol and discharged .After a month she was presented again with septic shock in the hospital with very raised inflammatory markers .Subsequently Blood cultures showed streptococcus pneumoniae . CT thorax showed focal consolidation and with bilateral effusion. Again she was treated with antibiotics as per local guidelines. During her stay in ITU she developed genital ulcers ,multiple drug reactions leading us to think about underlying connective tissue disorder .On further investigations she had hypocomplementinemia and strongly positive ANA ,anti Ro and anti U1RNP and anti smith leading to the diagnosis of lupus .
Patient was started on immunosupressive therapy along with vaccination and patients didnt develop any other encapsulated infections and she is under the regular follow up in the rheumatology service .


A case report




Timely diagnosis and treatment of the connective tissue disorders prevent the complications associated with high mortality and morbidity .A few cases of lethal infections secondary to low complements levels leading to the underlying connective tissue disorders had been reported .
It is important to think about connective tissue disorder if patients present with capsular microorganisms infections
In the future it is important to establish between the role of timely vaccinations encapsulated organisms and its effects on the prevention of these infections in patients with connective tissue disorders.