Systemic lupus or HIV: The wolf also shall dwell with the lamb

Background: Systemic lupus erythematosus (SLE) is rarely reported in association with HIV infection. The coincidence of autoimmune diseases in the setting of immunocompetence loss during HIV infection may seem paradoxical. Case Report: A 35-year-old woman presented with a 9-month history of diffuse progressive colicky abdominal pain, weight loss, and watery diarrhoea. Colonoscopic biopsy revealed nonspecific proctocolitis. Steroids plus mesalazine were initiated with no improvement. Few months later, she suffered from alopecia, arthritis of the small joints, photosensitivity associated with fever and abnormal behaviour in the form of aggression, depressed mood, diminished interest in daily activities as well as a decline in her self-care, memory impairment and deficits in attention. On physical examination patient was pale, emaciated, malar rash and oral candidiasis were noted higher cerebral functions examination revealed impaired sustained attention recent memory and restricted affect. Neurological examination revealed with bilateral upper limb tremors, paraparesis symmetrical rigidity, and exaggerated deep tendon reflexes. Plantar reflexes were bilaterally extensor. Blood tests revealed pancytopenia, with reticulocytosis, positive coomb’s test and ESR 100mm/h. ANA test was positive homogenous with titre 1/320. Anti-ds DNA was negative and Hepatic and renal parameters were normal. HIV by ELISA and Western Blot was positive. Her CD4 count was 44/mm 3 . Viral load by PCR was HIV RNA 68,962, other virology screen was negative copies/ml). Magnetic resonance imaging of the brain revealed diffuse cortical atrophy, thick sheets of abnormal MR signals were seen within the paraventricular white matter and subcortical level, with capacious ventricular system. Conclusion: HIV could be a great mimicker and we suggest screening for HIV more often than is generally done now in the context of evaluation of suspected autoimmune disease.