Lymphadenopathy as a prodrome for systemic lupus erythematous.

A 41-year-old woman presented to the hospital with one month of fever, chills, lymphadenopathy, abdominal pain, a bilateral upper extremity rash, and malaise. The patient had no significant prior medical history and was physically active, kickboxing twice a week and working 16-hour days. She reported increased difficulty getting out of bed over the span of one month. Physical exam was notable for tender, palpable posterior cervical lymph nodes that were mobile and about 1 cm in maximum diameter. There was mild abdominal tenderness to deep palpation without guarding or rebound tenderness. A computerized tomography (CT) scan of the abdomen and pelvis was notable for diffuse mesenteric fat stranding and prominent right retroperitoneal lymph nodes. The patient was readmitted two months later with worsening fatigue, abdominal pain, subjective fever, night sweats, and swelling and tenderness of her wrists and fingers despite ibuprofen. After extensive infectious, hematologic and autoimmune evaluations, a diagnosis of systemic lupus erythematous (SLE) was made and treatment with high-dose steroids and hydroxychloroquine, which resulted in gradual improvement in symptoms. This report highlights fevers and generalized lymphadenopathy as a subtle prodrome of SLE.