Major Systemic Lupus Erythematosus Exacerbation after Severe Clostridium Difficile Infection: A Case Report

Introduction: Systemic lupus erythematosus (SLE) is a multisystem autoimmune disease presenting with remission and flares. Relapses may be triggered by various factors, with infections being one of the most common. The following case is the first clostridium difficile infection (CDI)-induced SLE flare that resulted in involvement of organs not previously affected in patient's history before, such as lupus nephritis. Case presentation: We present a case of a 77-year-old woman, who experienced a major flare, involving renal impairment, cardiorespiratory deterioration and pleuritis, along with signs of haemolytic anaemia, three weeks after a severe CDI. She received corticosteroids, rituximab (RTX), and cyclophosphamide (CYC), but the outcome was still fatal. Conclusion: CDI infections are highly increasing in frequency and severity, given the antibiotic tolerance, so clinicians should bear in mind the risk of immune-mediated disorders reactivation.