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SLE Flare vs Infection — SCE Rheumatology MCQ

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HardSLE & Antiphospholipid SyndromeSLE Flare vs InfectionSCE Rheumatology

A 40-year-old woman with SLE and active disease (SLEDAI 16) develops high fever and confusion. Her WCC has dropped to 1.8 x10^9/L. She is on Prednisolone 30 mg and Mycophenolate. What is the critical clinical challenge?

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Correct answer: E — Differentiating active SLE flare from infection is critical as both can present with fever cytopenias and organ dysfunction; infection screen must be completed urgently before escalating immunosuppression

One of the most challenging clinical scenarios in SLE is differentiating an acute flare from infection as both can present with fever leucopenia rising CRP and organ dysfunction. Features suggesting infection include: high procalcitonin sustained high CRP without corresponding anti-dsDNA or complement changes positive blood/urine cultures and absence of typical lupus flare serology. Features suggesting flare include: falling complement rising anti-dsDNA new active urinary sediment and characteristic rash. Empiric antibiotics should be started alongside infection workup BEFORE escalating immunosuppression.

Reference: EULAR 2023 SLE recommendations