一例人类免疫缺陷病毒阳性合并系统性红斑狼疮病例分析

Case Analysis of Human Immunodeficiency Virus Positive Complicated with Systemic Lupus Erythematosus

摘要: 本文报告一例45岁女性人类免疫缺陷病毒(HIV)阳性患者合并系统性红斑狼疮(SLE)的诊疗过程。患者因“反复双下肢水肿半年余，发现血小板减少3天”入院，经实验室及影像学检查，符合2019年ACR/EULAR的SLE分类标准(积分25分)，诊断为HIV感染合并SLE(重度活动)。经糖皮质激素冲击、环孢素、利妥昔单抗及贝利尤单抗等多方案治疗，期间出现狼疮危象、骨髓抑制等并发症，病情多次反复。最终经贝利尤单抗治疗后狼疮肾炎达缓解，SLE转为轻度活动。本病例揭示了HIV与SLE共存的诊断与治疗挑战，提示临床需警惕两种疾病重叠时可能出现的复杂临床进程与治疗反应。

Abstract: This article reports the diagnosis and treatment process of a 45-year-old female patient with human immunodeficiency virus (HIV) positivity complicated with systemic lupus erythematosus (SLE). The patient was admitted due to “repeated edema of both lower limbs for more than half a year and discovered thrombocytopenia for 3 days”. Laboratory and imaging examinations met the 2019 ACR/EULAR classification criteria for SLE (score 25 points), leading to a diagnosis of HIV infection combined with SLE (severely active). Treatment involved multiple regimens including glucocorticoid pulse therapy, cyclosporine, rituximab, and belimumab. Complications such as lupus crisis and bone marrow suppression occurred during treatment, with the condition relapsing multiple times. Ultimately, after belimumab treatment, lupus nephritis achieved complete remission, and SLE transitioned to mild activity. This case highlights the diagnostic and therapeutic challenges of HIV and SLE coexistence, suggesting that clinicians should be vigilant about the complex clinical course and treatment responses that may occur when the two diseases overlap.