Lupic Outbreak and Covid-19 Pneumonia-Case Report

Tamayo Luis

doi:10.31579/2690-4861/152

Abstract

Coronavirus disease 2019 (COVID-19) is a respiratory infection that can cause mild symptoms or even death, to patients who suffer from it. It affects all population groups without distinction. Systematic Lupus Erythematosus (SLE) is a chronic and fluctuating autoimmune disease. One of the goals of the treatment is to avoid flare-ups and thereby reduce mortality. Their innate alterations in immunity, added to the use of immunosuppressive drugs to control the disease and prevent outbreaks makes them more vulnerable to develop severe symptoms in SARS-CoV-2 infection. We present the case of a patient with SLE infected by SARS-CoV-2 with a lupus flare during hospitalization, entailing a diagnostic and therapeutic challenge.

Highlights

It has been more than a year (March 11, 2020) since the World Health Organization (WHO) declares the coronavirus disease 2019 (COVID-19) as a pandemic [1]
Research has been conducted prior to the pandemic showing that patients with Systemic Lupus Erythematosus (SLE) are at increased risk of infection, a risk that is greater if patients have higher levels of disease activity, the use of corticosteroids on a regular basis, or who have previously received treatment with cyclophosphamide or rituximab [6,7]
Some studies suggest that immunosuppression secondary to SLE management may be beneficial by reducing the immune system's response to COVID19 [8,9], while other studies report that intense immunosuppression does not allow an effective antiviral response to the exposure to COVID-19, triggering a more severe form of the disease [10,11]

Summary

Introduction

It has been more than a year (March 11, 2020) since the World Health Organization (WHO) declares the coronavirus disease 2019 (COVID-19) as a pandemic [1]. The consensus definition of lupus flare refers to a measurable increase in the disease activity involving new or worse clinical signs and symptoms and/or laboratory markers. This should be considered clinically significant by the physician and generally leads to evaluate a treatment change or upscale [20]. A general urine test and 24 hrs urine collection test informed: Creatinine clearance: 56 ml / min, proteins in 24 hrs: 6.31 gr / 24hrs Given these findings with high suspicion of a lupus outbreak and without evidence of active infection (negative cultures), it was decided to start pulse corticosteroid therapy at a dose of 1 gram / day for 3 days.

Findings

Discussion

Conclusion and Final Considerations