A complex case of severe thrombocytopenia in systemic lupus erythematosus complicated by Corynebacterium spp. infection

Authors

  • Muhamad Jefri Trinuansa Akbar Departement of Internal Medicine, Oetomo Hospital, Bandung, Indonesia
  • Handono Kalim Division of Rheumatology, Department of Internal Medicine, Universitas Brawijaya, Malang, Indonesia

DOI:

https://doi.org/10.69863/dim.2024.e472

Keywords:

SLE, hematologic abnormalities, infection, immunosuppressive drugs, thrombocytopenia

Abstract

BACKGROUND: Systemic Lupus Erythematosus (SLE) is a chronic autoimmune inflammatory disease the course of which is still indefinite. Thrombocytopenia concurrent with Corynebacterium spp.—an infrequent complication in SLE patients—is seldom reported.

CASE A 34-year-old female was admitted for continuous bleeding from the gums that had been ongoing for three days. The patient had been suffering from SLE since 2018 and took immunosuppressive medication regularly. The anemia, lymphocytopenia, and severe thrombocytopenia were shown in her laboratory tests. Besides, the infection of Corynebacterium spp. was detected in the patient. In fact, hematologic abnormalities and infections in SLE patients usually mutually overlap for the reason that these conditions possess the potential to influence each other. Infection can be both the cause and result of hematologic abnormalities in SLE. Thus, the pathophysiology of hematologic abnormalities in SLE patients can often be related to the use of immunosuppressive drugs. However, some theories suppose that increased SLE activity correlates with infection occurrence in SLE—even without the use of immunosuppressive drugs.

CONCLUSION Thrombocytopenia and Corynebacterium spp. infection in SLE patients is a case rarely reported, and establishing the diagnosis requires detailed examination.

References

Moulton VR, Suarez-Fueyo A, Meidan E, et al. Pathogenesis of human systemic lupus erythematosus: A cellular perspective. Trends Mol Med 2017;23(7):615-635.doi: 10.1016/j.molmed.2017.05.006. PMID: 28623084

Sasidharan PK, Bindya M, Sajeeth Kumar KG. Hematological manifestations of sle at initial presentation: Is it underestimated? ISRN Hematol 2012;2012(1):961872.doi: 10.5402/2012/961872. PMID: 22830038

Jonny J, Putranto TA, Purnama Y, et al. Significant improvement of systemic lupus erythematosus manifestation in children after autologous dendritic cell transfer: a case report and review of literature. Ther Adv Vaccines Immunother 2023;11(1):25151355231186005.doi: 10.1177/25151355231186005. PMID: 37719802

Fanouriakis A, Tziolos N, Bertsias G, et al. Update omicronn the diagnosis and management of systemic lupus erythematosus. Ann Rheum Dis 2021;80(1):14-25.doi: 10.1136/annrheumdis-2020-218272. PMID: 33051219

Li Y, Lee PY, Reeves WH. Monocyte and macrophage abnormalities in systemic lupus erythematosus. Arch Immunol Ther Exp (Warsz) 2010;58(5):355-364.doi: 10.1007/s00005-010-0093-y. PMID: 20676786

Tosepu R, Gunawan J, Effendy DS, et al. The outbreak of diphtheria in Indonesia. Pan Afr Med J 2018;31(1):249.doi: 10.11604/pamj.2018.31.249.16629. PMID: 31448005

Ott L, Moller J, Burkovski A. Interactions between the re-emerging pathogen corynebacterium diphtheriae and host cells. Int J Mol Sci 2022;23(6):3298.doi: 10.3390/ijms23063298. PMID: 35328715

Chanh HQ, Trieu HT, Vuong HNT, et al. Novel clinical monitoring approaches for reemergence of diphtheria myocarditis, vietnam. Emerg Infect Dis 2022;28(2):282-290.doi: 10.3201/eid2802.210555. PMID: 35075995

Nguyen Thi Nguyen T, Parry CM, Campbell JI, et al. Endemic erythromycin resistant Corynebacterium diphtheriae in Vietnam in the 1990s. Microb Genom 2022;8(10):mgen000861.doi: 10.1099/mgen.0.000861. PMID: 36259695

Kunzler ALF, Tsokos GC. Infections in patients with systemic lupus erythematosus: The contribution of primary immune defects versus treatment-induced immunosuppression. Eur J Rheumatol 2023;10(4):148-158.doi: 10.5152/eurjrheum.2023.23068. PMID: 37850609

Dangel A, Berger A, Konrad R, et al. NGS-based phylogeny of diphtheria-related pathogenicity factors in different Corynebacterium spp. implies species-specific virulence transmission. BMC Microbiol 2019;19(1):28.doi: 10.1186/s12866-019-1402-1. PMID: 30709334

Schick J, Etschel P, Bailo R, et al. Toll-like receptor 2 and mincle cooperatively sense corynebacterial cell wall glycolipids. Infect Immun 2017;85(7):e00075-17.doi: 10.1128/IAI.00075-17. PMID: 28483856

Ramos JN, Araujo MRB, Baio PVP, et al. Molecular characterization and phylogenetic analysis of the first Corynebacterium rouxii strains isolated in Brazil: a recent member of Corynebacterium diphtheriae complex. BMC Genom Data 2023;24(1):65.doi: 10.1186/s12863-023-01167-w. PMID: 37940844

Weerasekera D, Fastner T, Lang R, et al. Of mice and men: Interaction of Corynebacterium diphtheriae strains with murine and human phagocytes. Virulence 2019;10(1):414-428.doi: 10.1080/21505594.2019.1614384. PMID: 31057086

Santacruz JC, Mantilla MJ, Rueda I, et al. A practical perspective of the hematologic manifestations of systemic lupus erythematosus. Cureus 2022;14(3):e22938.doi: 10.7759/cureus.22938. PMID: 35399432

Strizova Z, Benesova I, Bartolini R, et al. M1/M2 macrophages and their overlaps - myth or reality? Clin Sci (Lond) 2023;137(15):1067-1093.doi: 10.1042/CS20220531. PMID: 37530555

Sun S, Urbanus RT, Ten Cate H, et al. Platelet activation mechanisms and consequences of immune thrombocytopenia. Cells 2021;10(12):3386.doi: 10.3390/cells10123386. PMID: 34943895

WHO. Diphtheria vaccine: WHO position paper, August 2017 - Recommendations. Vaccine 2018;36(2):199-201.doi: 10.1016/j.vaccine.2017.08.024. PMID: 28822645

Downloads

Published

2024-12-10

How to Cite

Akbar, M., & Kalim, H. (2024). A complex case of severe thrombocytopenia in systemic lupus erythematosus complicated by Corynebacterium spp. infection. Deka in Medicine, 1(3), e470. https://doi.org/10.69863/dim.2024.e472

Issue

Section

Case report

Most read articles by the same author(s)