title: Visceral leishmaniasis mimicking systemic lupus erythematosus: Case series and a systematic literature review.
abstract: OBJECTIVE
  Systemic lupus erythematosus (SLE) is an autoimmune disease that may present manifestations that resemble other diseases. Visceral leishmaniasis (VL) is a parasitic infection whose hallmarks may mimic SLE symptoms. Here, we report a case series and evaluate the published, scientific evidence of the relationship between SLE and VL infection.
  
  
  METHODS
  To assess original studies reporting cases of VL-infected patients presenting manifestations that are capable of leading to inappropriate suspicions of SLE or mimicking an SLE flare, we performed an extensive search in several scientific databases (MEDLINE, LILACS, SciELO, and Scopus). Two authors independently screened all citations and abstracts identified by the search strategy to identify eligible studies. Secondary references were additionally obtained from the selected articles.
  
  
  RESULTS
  The literature search identified 53 eligible studies, but only 17 articles met our criteria. Among these, 10 lupus patients with VL mimicking an SLE flare and 18 cases of VL leading to unappropriated suspicions of SLE were described. The most common manifestations in patients infected with VL were intermittent fever, pancytopenia, visceromegaly, and increased serum level of acute phase reactants. The most frequent autoantibodies were antinuclear antibodies, rheumatoid factor, and direct Coombs' test.
  
  
  CONCLUSIONS
  In endemic areas for VL, the diagnosis of SLE or its exacerbation may be a clinical dilemma. Hepatosplenomegaly or isolated splenomegaly was identified in the majority of the reported cases where VL occurred, leading to unappropriated suspicions of SLE or mimicking an SLE flare. Furthermore, the lack of response to steroids, the normal levels of complement proteins C3 and C4, and the increased level of transaminases suggest a possible infectious origin.
authors.affiliation: Serviço de Clínica Médica do Hospital Geral Roberto Santos, Salvador, Brazil.
authors.forename: Iuri Usêda
authors.initials: IU
authors.lastname: Santana
authors.affiliation: Serviços Especializados em Reumatologia (SER) da Bahia, Rua Conde Filho, 117, Graça, Salvador, Bahia CEP 40150-150, Brazil.
authors.forename: Blenda
authors.initials: B
authors.lastname: Dias
authors.affiliation: Serviços Especializados em Reumatologia (SER) da Bahia, Rua Conde Filho, 117, Graça, Salvador, Bahia CEP 40150-150, Brazil.
authors.forename: Eduardo Araújo Santana
authors.initials: EA
authors.lastname: Nunes
authors.affiliation: Serviço de Reumatologia do Hospital Universitário Walter Cantídio, Ceará, Brazil.
authors.forename: Francisco Airton Castro da
authors.initials: FA
authors.lastname: Rocha
authors.affiliation: Serviço de Reumatologia do Hospital Universitário Walter Cantídio, Ceará, Brazil.
authors.forename: Francisco Saraiva
authors.initials: FS
authors.lastname: Silva
authors.affiliation: Serviços Especializados em Reumatologia (SER) da Bahia, Rua Conde Filho, 117, Graça, Salvador, Bahia CEP 40150-150, Brazil. Electronic address: mbsantiago2014@gmail.com.
authors.forename: Mittermayer Barreto
authors.initials: MB
authors.lastname: Santiago
mesh_terms: D000293:Adolescent; D000328:Adult; D000974:Antibodies, Antinuclear; D003298:Coombs Test; D003937:Diagnosis, Differential; D005260:Female; D005334:Fever; D006801:Humans; D007898:Leishmaniasis, Visceral / Q000175:diagnosis*; D008180:Lupus Erythematosus, Systemic / Q000175:diagnosis*; D010198:Pancytopenia; D012217:Rheumatoid Factor
chemical_list: D000974:Antibodies, Antinuclear; D012217:Rheumatoid Factor
keywords: Autoantibodies; Case series; Systemic lupus erythematosus; Visceral leishmaniasis