Systemic lupus erythematosus (SLE) is an
autoimmune disease known to affect a variety of organ systems. Patients with SLE are more prone to developing common
infections that can mimic the complications of SLE. As such, it is essential to differentiate complications of SLE from
infection to ensure appropriate management and to improve morbidity and mortality of this patient population. Here we present a 24-year-old, Hispanic male, with SLE complicated by dialysis-dependent
end-stage renal disease and
dilated cardiomyopathy. The patient presented to the emergency room with
nausea,
vomiting, and
abdominal pain and admitted to the medicine service. Initial evaluation showed
hypoalbuminemia coupled with elevated
transaminases, INR, and total
bilirubin consistent with
acute liver failure. Further evaluation was negative for viral, toxic, metabolic, or vascular causes of acute failure. The patient was diagnosed with lupus
hepatitis and associated
acute hepatic failure, and started on high dose
prednisone (60 mg daily). Complete resolution of liver function and symptoms was observed within 1 week at follow-up. The patient was readmitted 2 weeks after discharge with left scrotal
pain and swelling after abruptly decreasing the prescribed
prednisone dose 3 days after discharge. Physical exam and scrotal ultrasound in the emergency department were consistent with
epididymitis. Urinalysis, urine culture, and
gonorrhea and chlamydia PCR were all negative. Without evidence of
infection, and upon reconfirmation of low serum
complement levels, the patient was diagnosed with lupus
epididymitis and restarted on high dose
prednisone. Complete resolution of symptoms was attained within 1 week at follow-up. This case emphasizes the importance of differentiating the clinical manifestations of SLE from
infection and the complexity of disease presentation in Hispanic patients.