Clinical and Hematological Manifestations of Systemic Lupus Erythematosus at Initial Presentation in a Tertiary Healthcare Center
Aruna Bathina, Dilip Chandra Chintada, Nikhil Kumar Reddy Yellu, Jami Vijayashree, Mahmuda Begum, Pooja Unnikrishnan
Abstract
Background Systemic Lupus Erythematosus (SLE) is a multifaceted autoimmune disorder with diverse clinical presentations, among which hematological abnormalities often serve as early and critical indicators of disease. These manifestations, including anemia, leukopenia, lymphopenia, and thrombocytopenia, correlate with disease activity and provide essential diagnostic insights, particularly in resource-limited settings where access to advanced diagnostic tools may be constrained. This study emphasizes the significance of hematological findings that frequently appear at the initial presentation of SLE. They can guide early diagnosis and management, thereby improving patient outcomes. Objective This study aims to identify and analyze the clinical and hematological manifestations of SLE at initial presentation in a tertiary healthcare center. It focuses on hematological abnormalities as critical early indicators and highlights typical and atypical features that can aid in timely and accurate diagnosis. Methods A retrospective observational study was conducted at the dermatology department of the Great Eastern Medical School & Hospital. It included 53 patients diagnosed with SLE according to the Systemic Lupus International Collaborating Clinics (SLICC) criteria. Demographic data, clinical symptoms, hematological abnormalities, and immunological markers were recorded. The frequency and types of atypical manifestations were also noted. Results The study sample comprised 45 (85%) female patients and 8 (15%) male patients, with a mean age of 26 years. Common clinical manifestations included fever 49 (92%), joint pain 45 (85%), fatigue 43 (81%), oral ulcers 40 (75%), malar rash 40 (75%), and photosensitivity 44 (83%). Hematological abnormalities were prominent, with anemia observed in 52 (98%) of patients, leukopenia in 49 (92%), lymphopenia in 45 (85%), and thrombocytopenia in 20 (38%). Antinuclear antibody (ANA) test was positive in all cases, with elevated erythrocyte sedimentation rate (ESR) and CRP levels in newly-diagnosed patients. Atypical presentations included angioedema, toxic epidermal necrolysis (TEN)-like lesions, psoriasiform lesions, and pyrexia of unknown origin. Conclusion This study underscores the critical need to identify both typical and atypical clinical and hematological features of SLE, particularly at the initial presentation. Integrating comprehensive clinical evaluation with basic laboratory investigations can significantly enhance early detection, paving the way for timely and effective management to improve patient outcomes.