Macrophage activation syndrome as an initial presentation of systemic lupus erythematosus

Abstract

In a recent article on World J Clin Cases 2019; 7: 3859-3865, Sun et al reported a case of 36-year-old female with macrophage activity syndrome as an onset of systemic lupus erythematosus. Although this is a very interesting case, some concerns still need to be addressed. First, the patient had an extremely elevated serum ferritin but a normal C-reactive protein level, which was unparallel with the inflammatory condition before she received any treatments. Second, the diagnosis of systemic lupus erythematosus seemed to be insufficient according to the patient’s medical information presented, most of which were not specific to lupus but could be explained by macrophage activity syndrome. Hence, more medical information on the patient should be provided, and a profound discussion needs to be addressed.

Keywords: Systemic lupus erythematosus; Macrophage activity syndrome; Diagnosis; Ferritin; C-reactive protein; Inflammatory

Core tip: The recent report (World J Clin Cases 2019; 7: 3859-3865) about a 36-year-old female with macrophage activity syndrome as an onset of systemic lupus erythematosus was rare and interesting. However, the presented patient diagnosed with macrophage activity syndrome should have a high inflammatory status, but reported a normal C-reactive protein level. Furthermore, the medical information on the patient was inadequate for a diagnosis of systemic lupus erythematosus. Therefore, a profound discussion needs to be addressed.