Description Coronavirus disease 2019 (COVID-19) pandemic, had posed a huge impact among patients with deranged or dysregulated immune systems, these include autoimmune rheumatic diseases, specifically lupus and Human Immune deficiency Virus or Acquired Immune Deficiency Syndrome (HIV-AIDS). These subsets of patients, eg. SLE and People living with HIV (PLWH) are unique populations considering the risk for them of contracting COVID-19 infection and its outcomes. Here, we report a rare case of a 22-year-old Filipino male, who was diagnosed to have SLE pre-pandemic. His presentations included progressive easy bruisability with persistent bicytopenia (anemia and thrombocytopenia), malaise, arthralgia and ill-defined flat, non -pruritic, erythematous lesions on his legs and dry cough. On work up he was found to have interstitial lung disease, high titers ANA and positive anti-dsDNA. He was given prednisone, hydroxychloroquine and mycophenolate moefetil which offered significant improvement. He was lost follow up until pandemic set in. He experienced crampy abdominal pain, rashes on his legs, weight loss, diffuse alopecia, low grade fever and bicytopenia. Work up revealed positive HIV test, low CD4 count, and positive for RTPCR for Covid. Neoplastic process was ruled out. Given his condition, his antimalarial and mycophenolate were temporarily held. He was managed according to COVID 19 guidelines and eventually referred to treatment hub for HIV-AIDS therapy.
Conclusions This case illustrates the unfathomable relationship of infections and immune system. Identifying the clinical symptoms described as the presenting signs of a specific infection or a flare of lupus or one of the HIV associated clinical syndromes has remained a challenge for clinicians. A high index of suspicion must be kept in mind for appropriate and timely diagnosis. Management options must be tailored for the patient’s best outcomes.
This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
Statistics from Altmetric.com
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.