Coexistence of Axial Spondyloarthritis, Systemic Lupus Erythematosus, Sjögren’s Syndrome and Secondary Antiphospholipid Syndrome: Case Report

Year 2022, , 73 - 76, 29.04.2022

Emine Figen Tarhan , Gökhan Keser , Özgür İlhan Çelik Rabia Mihriban Kılınç , İsmail Kırlı , Servet Akar

https://doi.org/10.47572/muskutd.890480

Abstract

Hereby we report a 55-year-old female patient having the association of non-radiographic axial spondyloarthritis (nr-AxSpA), systemic lupus erythematosus (SLE), secondary antiphospholipid antibody syndrome (APS), and Sjögren's Syndrome (SjS). Diagnosis of nr-AxSpA was made based upon the presence inflammatory low-back pain, human leukocyte antigen B27 positivity, and presence of sacroiliitis only in magnetic resonance imaging (MRI). SLE was diagnosed with butterfly-shaped rash on her cheeks, inflammatory arthritis, photosensitivity, erythema involving dorsal inter-joint area of hand fingers, alopecia together with antinuclear antibody (ANA) and anti-dsDNA positivity, low serum complement levels, leucopenia and thrombocytopenia. Additional presence of sicca symptoms, low Schirmer I test, anti SSA/Ro and anti-SSB/La positivity, supported by positive labial salivary gland biopsy led to the diagnosis of SjS. Furthermore, this patient also had miscarriage at 16th week and cerebral vascular disease at 33 years. Besides, IgG and IgM anticardiolipin antibodies were found to be positive twice. Therefore, she was also diagnosed as secondary APS. She fulfilled the relevant classification criteria for AxSpA, SLE, SjS and APS. To our knowledge, this is the first case report showing the association of these four diseases, with different genetic, etiopathogenetic and clinical systemic inflammatory diseases.

Keywords

Antiphospholipid Antibody Syndrome, Non-Radiographic Axial Spondyloarthritis, Systemic Lupus Erythematosus, Sjögren Syndrome

Supporting Institution

None

Project Number

None

Aksiyel Spondiloartrit, Sistemik Lupus Eritematozus, Sjögren Sendromu ve Sekonder Antifosfolipid Sendromunun Birlikte Görüldüğü Olgu Sunumu

Abstract

Non-Radyografik aksiyel spondiloartrit (nr-axSpA), sistemik lupus eritematozus (SLE), sekonder antifosfolipid antikor sendromu (APS) ve Sjögren Sendromu (SjS) birlikteliğine sahip 55 yaşında bir kadın hastayı sunuyoruz. Nr-AxSpA tanısı enflamatuar bel ağrısı, insan lökosit antijeni B27 pozitifliği ve manyetik rezonans görüntülemede sakroileit varlığına dayanılarak yapıldı. SLE tanısı yanaklarında kelebek şeklinde döküntü, enflamatuar artrit, fotosensitivite, el parmaklarının dorsal eklemler arası alanı tutan eritem, antinükleer antikor (ANA) ve anti-dsDNA pozitifliği, alopesi, düşük serum kompleman seviyeleri, lökopeni ve trombositopeni varlığı ile konuldu. Pozitif labiyal tükürük bezi biyopsisi ile desteklenen sicca semptomları, düşük Schirmer testi, Anti SSA/Ro ve anti-SSB/La pozitifliği ile SjS tanısı konuldu. Ayrıca bu hastada 16. haftada düşük ve 33 yaşında serebrovasküler olay öyküsü vardı. IgG ve IgM antikardiolipin antikorlarının iki kez pozitif olduğu bulundu. Bu nedenle, kendisine sekonder APS tanısı konuldu. Hasta Ax-SpA, SLE, SjS ve APS için sınıflandırma kriterleri doldurmaktadır. Bilindiği üzere farklı genetik, etiyopatogenetik ve klinik özellikleri olan bu dört hastalığın bir arada bulunduğu ilk vaka sunumudur.

Keywords

Antifosfolipit Antikor Sendromu, Radyolojik Olmayan Aksiyel Spondilartrit, Sistemik Lupus Eritamatozus, Sjögren Sendromu

Project Number

None

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