November 10-15

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ACR Convergence 2023

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Fever, cytopenia complicate presentation of lupus


3 minutes

Chelsey Forbess Smith, MD

Lupus is never a simple disease, but it can be easy to overlook complicating factors that transform a straightforward presentation into something more complex and challenging. And few factors offer more potential for complexity and complication than fever and cytopenia.

“Rheumatologists are often asked to consult on patients who have fever of unclear origin, which may or may not be accompanied by cell line dyscrasias. These non-specific signs frequently present significant diagnostic challenges,” said Chelsey Forbess Smith, MD, rheumatologist at the University of California, San Diego. “While fever and cytopenias are often manifestations of systemic lupus, they may also be seen in a variety of other conditions. This case is a good example to learn from because it is not straightforward. And it is important to stay on one’s toes, so to speak, in clinical rheumatology.”

Dr. Smith will present a case during CPC: Fever & Cytopenia in a Lupus Patient: Nothing Is as Simple as It Seems, from 9:00 – 10:00 am Monday in Room 6 A, that demonstrates why clinicians should look for the unexpected in every patient. It’s also a concrete reminder that what you see on the initial exam may not be what you really have to deal with.

“There are several critical points in which a patient’s clinical course can go awry along the path, from the initial stages of diagnosis to dealing with the aftermath of immunosuppression,” Dr. Smith said. “Treatment may be more aggressive than is really appropriate, and the consequences of an overly aggressive treatment can become quite catastrophic.”

While lupus alone might seem to explain a clinical scenario, less common and more difficult to distinguish mimics can confound a clinical picture for even the most experienced clinician. The key to a successful diagnosis often lies in a complete history, physical exam, and workup showing different patterns of immune dysregulation and cytokine activation.

The session will explore the differential diagnosis for a presentation of a patient with lupus, including potential autoimmune, infectious, and malignant causes of fever and cytopenia. Dr. Smith will also review the pathophysiology, epidemiology, and clinical presentation of a rare, complex, and aggressive condition associated with autoimmune diseases such as lupus.

Attendees can expect a detailed look at different options for the clinical treatment and continuing management of the mystery condition, which can vary depending on the clinical scenario.

“The ACR [meeting] is filled with a plethora of wonderful sessions and updates on what is new and exciting in rheumatology since the last meeting,” Dr. Smith said. “This session is designed to bring us all back to clinical rheumatology and enhance our awareness for certain complications of autoimmune diseases like lupus. Amid all the exciting new developments and meeting options, we can all use a reminder of bread-and-butter clinical medicine and the need to be vigilant for some of the less common complications.”