5 Minute Poster Presentation ARA-NSW 2020 - 42nd Annual NSW Branch Meeting

A Case of Contemporaneous SLE and Eating Disorders in an Adolescent Patient and Literature Review (#42)

Jeremy Wang 1 , Gabor Major 1
  1. John Hunter Hospital, New Lambton Heights, NSW, Australia

Purpose

To describe a case of contemporaneous onset of systemic lupus erythematosus and eating disorders in an adolescent and review the literature.

 

Case Description

A 14-years old girl was referred to Outpatient Rheumatology with a provisional diagnosis of systemic lupus erythematosus. Six months earlier, she had inflammatory arthritis of the right knee. Investigations showed anti-nuclear antibody was positive (homogeneous pattern, titre 1:1280). Extractable nuclear antigens were positive for Ro52/60 and ribosomal P protein. Rheumatoid factor was 207 IU/mL and anti-CCP antibody was negative. Double stranded DNA was 32.4 IU/mL. Erythrocyte sedimentation rate was 64 mm/hr and c-reactive protein was 2.3mg/L.

 

On examination, she was emaciated with body weight of 31.6kg (BMI 11.9, below 1st percentile) and had diffuse hair loss consistent with telogen effluvium. Given the severe weight loss, she was admitted for enteral feeding and further management. Further characterisation including 18F-fluorodeoxyglucose positron emission tomography, small bowel ultrasound, magnetic resonance imaging of brain, and ventilation-perfusion scan demonstrated pleural involvement of SLE but no definitive evidence of CNS lupus or inflammatory bowel disease. Clinical psychology assessment revealed severe eating disorder causing severe weight loss and anxiety around specific food types.  

 

She was commenced on hydroxychloroquine 200mg daily and oral prednisone 12.5mg daily (0.4mg/kg) with ongoing psychology input. Her general well-being, appetite and inflammatory markers improved. At three months follow-up, her weight was 39.3kg (BMI 15.3, 4th percentile).

 

Discussion

Co-existence of SLE and anorexia nervosa has been previously described (1-3). The timing of the clinical presentation of AN in relation to the diagnosis of SLE and response to SLE treatment suggests that AN may be a specific presentation of neuropsychiatric SLE (2). In our case however, no other manifestations of CNS lupus and mechanistic linkage hav been demonstrated beyond a chronological association. It is possible that hormonal changes during adolescence has brought on changes in the immune system and menarche with associated body-image issues in our patient, resulting contemporaneous onset of the two conditions.

 

 

 

  1. 1. Bambery, P et al. “Anorexia nervosa in a patient with systemic lupus erythematosus.” Rheumatology international vol. 7,4 (1987): 177-9. doi:10.1007/BF00270367.
  2. 2. Sloan, D et al. “Anorexia nervosa complicating systemic lupus erythematosus (SLE).” Irish medical journal vol. 91,3 (1998): 97.
  3. 3. Toulany, Alene et al. “Chicken or the egg: anorexia nervosa and systemic lupus erythematosus in children and adolescents.” Pediatrics vol. 133,2 (2014): e447-50. doi:10.1542/peds.2012-3048.