Systemic Lupus Erythematosus Lymphadenopathy

Abstract

Definition • Lymphadenopathy associated with SLE (a.k.a. lupus lymphadenitis) Clinical features Epidemiology • SLE is an autoimmune disorder with worldwide distribution • Both prevalence and severity vary by race and gender • In the United States, prevalence among African Americans is 3-4 times greater than whites • 3.5 times greater prevalence among women than men • Median age of onset is 20-30 years Presentation • SLE has widely varying presenting symptoms (affecting most of the major organ systems) and exhibits a highly variable clinical course, including prolonged remissions in which symptoms may completely resolve • Constitutional symptoms include fever, fatigue, malaise, and weight loss • Skin manifestations are common and include, but are not limited to, the classic malar or "butterfly" rash over the cheeks and nose • Rheumatologic symptoms include arthritis, arthralgias, and myalgias • Renal, pulmonary, cardiac, and neurologic manifestations are also common • Lymphadenopathy is common (but may be decreasing in incidence), can be prominent, is more frequently found in younger patients, and is associated with more active disease; it most commonly involves cervical, then mesenteric, then axillary, then inguinal, and lastly retroperitoneal lymph nodes • ≈12% of patients have generalized lymphadenopathy Pathology Laboratory findings • Elevated erythrocyte sedimentation rate and C-reactive protein • Decreased serum complement levels • Elevated antibody titers to a variety of autoantigens including: anti-nuclear antibodies (ANA), anti-double-stranded DNA (ds-DNA), anti-phospholipid (a.k.a. lupus anti-coagulant), anti-Smith, anti-ribonucleoprotein (RNP), and anti-Rho/SSA and anti-La/SSB