P21 Lupus or else?

Abstract Introduction Systemic Lupus Erythematosus (SLE) is a systemic, autoimmune inflammatory disease with an unknown aetiology and various presentations. Wide spectrum of clinical manifestations can be seen in different infectious diseases, which may mimic SLE. Syphilis caused by the spirochete Treponema pallidum. Secondary syphilis characterised fever, lymphadenopathy, malaise, weight loss rash but hepatitis, tenosynovitis, polyarthritis, renal impairment have also been reported. mimicking SLE widely reported; it though not part routine screening. We describe case secondary 47-year-old female, presented skin joint manifestations. Case description A 5 weeks history polyarthralgia, rash, affecting torso, face malaise. No significant past medical She diffuse slightly urticated indurated plaques over face, scalp, neck, back, abdomen axillary/upper arm regions, some minimal surface scale. suspicion connective tissue (CTD) was raised; biopsy taken. Hydroxychloroquine (HCQ) 200mg BD prednisolone 40mg OD were initiated dermatology. Migratory arthritis (wrists, elbows, knees) Her CRP 99mg/L, ESR 55 mm/hr, ferritin at 274 ug/L. has mildly deranged LFTs (ALT U/L, ALP 498 U/L). Considering aetiology, view uncertainty diagnosis her rheumatoid screen, anti-double-stranded DNA antibodies (anti-dsDNA) lupus anticoagulant requested negative. Complement levels (C3/C4) normal. HIV, EBV CMV screen Anti-nuclear (ANA) weakly positive reported fine speckled pattern while cardiolipin IgM IgG raised. antineutrophil cytoplasmic (ANCA) as atypical marginally raised MPO 9U/ml negative PR3 levels. The significance those results this stage unclear patient presentation. then treated for suspected methotrexate (MTX) introduced. Two later, she developed right posterior uveitis, mouth ulcers, alopecia worsening polyarthralgia. In deterioration toxoplasma, serology CXR done point suggestive sarcoid. keeping active infection (RPR confirmation test positive). HCQ MTX stopped benzathine penicillin G given. final granulomatous arthritis, non-scarring alopecia. Discussion This very interesting that involved least 4 specialties before made. Malaise several causes presence explained other CTDs,vasculitides, drug eruptions infections. Our did present “typical” syphilitic involving palms soles. patient's constellation signs symptoms could fully compatible both syphilis; however, only ANA dsDNA, normal complements make questionable; our fulfil (SLICC) or EULAR/ACR classification criteria synovitis, (medium high titres are required diagnosis) present. Furthermore, changes SLE, hence performed diagnostic uncertainty.Uveitis, on hand, described patients usually anterior uveal. Posterior uveitis less common compared to uveitis. syphilis, pan most ocular presentations; It arguable alternative diagnosis.Retrospectively, following further discussion patient, one herpartners, similar few ago he referred GUM evaluation. Having information earlier, would potentially guided us look all STD’s immunosuppression highlighted importance recognising features who CTD’s so appropriate investigations carried out Key learning points key exclude infective CTD cases Important include dermatology team consideration when main organ Ensure sexual health taken from new diseases When do respond treatment expected, case, ensure excluded escalating consider multidisciplinary approach there showing granolumatous inflammation, among differential Consider screening remains great imitator; often mimics acute chronic disorders