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Diffuse Lymphadenopathy Syndrome as a Flare-Up Manifestation in Lupus and Mixed Connective Tissue Disease Following Mild COVID-19.
Karsulovic, Claudio; Hojman, Lia P; Seelmann, Daniela L; Wurmann, Pamela A.
  • Karsulovic C; Rheumatology Section, Clinical Hospital of the University of Chile, Santiago, Chile.
  • Hojman LP; Neuroendocrine Immunomodulation Laboratory, Institute of Biomedical Sciences, Faculty of Medicine, University of Chile, Santiago, Chile.
  • Seelmann DL; Department of Dermatology, Alemana Clinic of Santiago, Santiago, Chile.
  • Wurmann PA; Rheumatology Section, Clinical Hospital of the University of Chile, Santiago, Chile.
Am J Case Rep ; 22: e932751, 2021 Sep 10.
Article in English | MEDLINE | ID: covidwho-1404094
ABSTRACT
BACKGROUND Manifestations of Coronavirus disease 2019 (COVID-19), caused by the SARS-CoV-2 virus, are highly variable among healthy populations. In connective tissue disease patients, the spectrum of clinical manifestations is even broader. In mild COVID-19 patients, diffuse lymphadenopathy (DL) has not been described as a late manifestation, and only severe COVID-19 has been associated with lupus flare-ups. Herein, we report 3 cases of connective tissue disease patients that presented with DL after diagnosis and complete resolution of mild COVID-19 disease. CASE REPORT Case 1. A 28-year-old man with inactive lupus, mixed connective tissue disease (MCTD), and a history of lung and cutaneous involvement. He presented with fever, polyarthralgia, and multiple lymphadenopathies 3 weeks after COVID-19 disease resolution. After evaluation, immunosuppressive treatment was initiated, with rapid response. Case 2. A 25-year-old woman with inactive lupus with a history of articular, hematologic, and cutaneous involvement. Four weeks after resolution of COVID-19 disease, she presented with malaise and cervical lymphadenopathies. After laboratory testing and imaging, she was treated for lupus flare-up, with rapid response. Case 3. A 68-year-old woman with inactive lupus with a history of articular and cutaneous involvement. Four weeks after COVID-19 resolution, she presented with malaise and cervical and axillary lymphadenopathies. After extensive evaluation, immunosuppressive treatment resulted in a rapid response. CONCLUSIONS After 3 to 4 weeks of mild, outpatient-treated COVID-19 and complete resolution of symptoms, 3 patients with connective tissue disease presented diffuse lymphadenopathy associated with inflammatory and constitutional symptoms. Infectious and neoplastic causes were thoroughly ruled out. All patients responded to reintroduction of or an increase in immunosuppressive therapy. We recommend considering the diffuse lymphadenopathy as a possible post-acute COVID-19 syndrome (PACS) manifestation in these patients, mainly when they are in the inactive phase.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: AIDS-Related Complex / COVID-19 / Lupus Erythematosus, Systemic / Mixed Connective Tissue Disease Type of study: Case report / Diagnostic study / Experimental Studies / Prognostic study Topics: Long Covid Limits: Adult / Aged / Female / Humans / Male Language: English Journal: Am J Case Rep Year: 2021 Document Type: Article Affiliation country: AJCR.932751

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Full text: Available Collection: International databases Database: MEDLINE Main subject: AIDS-Related Complex / COVID-19 / Lupus Erythematosus, Systemic / Mixed Connective Tissue Disease Type of study: Case report / Diagnostic study / Experimental Studies / Prognostic study Topics: Long Covid Limits: Adult / Aged / Female / Humans / Male Language: English Journal: Am J Case Rep Year: 2021 Document Type: Article Affiliation country: AJCR.932751