title: Bone marrow fibrosis as a feature of systemic lupus erythematosus: a case report and literature review.
abstract: BACKGROUND
  Peripheral cytopenias are common in systemic lupus erythematosus (SLE), but bone marrow involvement is rarely reported. Myelofibrosis is a rare disorder characterized by reticulin fibrosis of the bone marrow, which usually occurs in response to clonal proliferation of hematopoietic stem cells in myeloproliferative disorders. However, bone marrow fibrosis has also been described in association with auto-immune diseases, especially SLE.
  
  
  METHODS
  We will report here a new case of bone marrow fibrosis associated with SLE. We also reviewed the 27 cases published in the English language literature, and will discuss the clinical presentation, outcome, treatment, and pathophysiology of bone marrow fibrosis occurring in association with SLE.
  
  
  RESULTS
  Over one half of patients were diagnosed concomitantly with bone marrow fibrosis and SLE. Epidemiological, clinical and biological features of lupus were unremarkable. Except for the presence of reticulin fibrosis, the findings from the bone marrow biopsies proved highly variable. Overall mortality was about 14% but corticosteroid-based therapy lead to clinical improvement and reverted bone marrow fibrosis in most cases. Data on the usefulness of other immunomodulatory therapies are inconclusive.
  
  
  CONCLUSIONS
  SLE may be complicated by bone marrow involvement, of a likely autoimmune origin. Bone marrow fibrosis occurring with SLE is probably similar to "primary autoimmune myelofibrosis" and may respond to steroid and immunomodulatory therapies. Further studies with standardised proofreading of bone marrow aspirations and biopsies are needed to delineate the clinical and biological features of this rare complication of SLE.
authors.affiliation: Service de médecine interne, Hôpital Nord, CHU de Saint-Étienne, Saint-Étienne, Cedex 2, 42055 France.
authors.forename: Emilie
authors.initials: E
authors.lastname: Chalayer
authors.affiliation: Laboratoire d'hématologie, Centre Hospitalier Lyon Sud, 165 Chemin du Grand Revoyet, 69495 Pierre Bénite, France.
authors.forename: Martine
authors.initials: M
authors.lastname: Ffrench
authors.affiliation: Service de médecine interne, Hôpital Nord, CHU de Saint-Étienne, Saint-Étienne, Cedex 2, 42055 France.
authors.forename: Pascal
authors.initials: P
authors.lastname: Cathébras
keywords: Bone marrow; Primary myelofibrosis; Systemic lupus erythematosus