Systemic lupus erythematosus (SLE) in activity triggered by sepsis secondary to urinary tract infection, associated with the initial manifestation of genital herpes

Abstract

Systemic Lupus Erythematosus (SLE) is an autoimmune disease that mainly affects women of reproductive age, characterized by inflammatory foci in tissues and organs causing multi-systemic aggression. This work proposes to report the case of a patient with SLE reactivated by an infectious process whose appearance of a genital ulcer triggered hospitalization, in addition to demonstrating the diagnostic tools and therapeutic approach used. This is a descriptive study, with a qualitative approach, of the clinical case report type, carried out by reviewing hospital records. The case discussed is a 29-year-old female patient, hypertensive, diabetic, with a previous diagnosis of lupus associated with proliferative lupus nephritis under drug control, who sought care due to the appearance of a painful peri-anal lesion, nausea, vomiting and fever 3 days ago. On physical examination, she presented cushingoid appearance, fever, tachycardia, hypotension, skin-mucosal pallor and genital ulcers in the vaginal furcula and mirror in the intergluteal region. Laboratory tests showed anemia, acute kidney injury, metabolic acidosis, increased inflammatory tests and growth of gram-negative bacilli in urine and blood cultures. The patient received volume expansion upon arrival and was started on antibiotics and antivirals due to possible genital herpes. She developed tachydyspnea and worsened general condition, requiring oxygen therapy through a nasal catheter, red blood cell transfusion, oral corticosteroids and electrolyte replacement. Maintaining clinical worsening, therapy was transitioned to intravenous corticosteroids for three days. The patient was discharged after two weeks of hospitalization, with referral for outpatient follow-up, in good general condition, with remission of symptoms and genital lesions. The present study therefore reveals a case of a clear exacerbation of lupus disease due to an infectious process, with a genital lesion as the first manifestation. Therefore, it highlights the importance of always valuing the patient's pathological history, related to current complaints in order to carry out adequate diagnosis and clinical control aiming at the patient's well-being.