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D. J. Clutterbuck, J. Watson, A. De Ruiter, T. Godfrey, C. Bradbeer, Presence of HIV infection in patients diagnosed with systemic lupus erythematosus, Rheumatology, Volume 39, Issue 9, September 2000, Pages 1047–1048, https://doi.org/10.1093/rheumatology/39.9.1047-a
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Sir, Young females, the population in whom systemic lupus erythematosus (SLE) is most commonly diagnosed, are not regarded as being at high risk of HIV infection in the UK. We describe two cases in which a diagnosis of seronegative SLE was made on clinical grounds some time before the detection of HIV infection.
Case 1 was a 35‐yr‐old white Colombian‐born woman who presented in November 1996 with knee and elbow pain, dry eyes and mouth and symptoms suggestive of Raynaud's phenomenon. She had been diagnosed with SLE elsewhere in 1995, when she had been found to have a florid butterfly rash and hair loss. Investigations revealed an erythrocyte sedimentation rate (ESR) of 88 mm/h, a low C4 level and lymphopenia of 0.8 × 109/l (normal value >1.5 × 109/l). Antinuclear antibodies (ANA), anti‐double‐stranded DNA (anti‐dsDNA), antiphospholipid antibody and lupus anticoagulant were negative. The diagnosis of active seronegative SLE was agreed and prednisolone was added to her hydroxychloroquine therapy. She developed difficulty in walking. MRI appearances were felt to be suggestive of transverse myelitis. She was treated with pulse cyclophosphamide and prednisolone and later azathioprine. She developed dysarthria, dysphagia and urinary retention, and at this stage had finger–nose ataxia and horizontal nystagmus in addition to spastic paraparesis, with no evidence of a sensory level. Cerebrospinal fluid (CSF) findings were consistent with inflammatory myelopathy. At this time she had oesophageal candidiasis, chronic, pathogen‐negative diarrhoea and orolabial herpes. She had lost 7 kg in weight.
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