Rare clinical manifestations in systemic lupus erythematosus: a review on frequency and clinical presentation

Chiara Tani (Coresponding Author), Elena Elefante, Laurent Arnaud, Sofia C Barreira, Inita Buliņa, Lorenzo Cavagna, Nathalie Costedoat-Chalumeau, Andrea Doria, João Eurico Fonseca, Franco Franceschini, Micaela Fredi, Luca Iaccarino, Maarten Limper, Judit Majnik, Gyorgy Nagy, Cristina Pamfil, Simona Rednic, John A Reynolds, Maria G Tektonidou, Anne TroldborgGiovanni Zanframundo, Marta Mosca

Research output: Contribution to journalReview articlepeer-review

2 Citations (Scopus)


OBJECTIVES: The purpose of this study was to review the frequency and clinical presentation of the rarest clinical manifestations of systemic lupus erythematosus (SLE).

METHODS: A list of 6 rare SLE manifestations were defined: gastrointestinal, liver, pulmonary, cardiac, ocular and neurological manifestations. Each topic was assigned to a pair of authors to perform a literature search and article review.

RESULTS: In total, 149 articles were included in the literature review: 37 for gastrointestinal manifestations, 6 for liver manifestations, 27 for pulmonary manifestations, 50 for cardiac manifestations, 16 for ocular manifestations, 13 for neurological manifestations. Gastrointestinal disorders included several clinical presentations with variable frequency (from 0.5% to 10.7% of the cases); liver involvement included lupus-related hepatitis (9.3%) and autoimmune hepatitis (2.3%). The rarest pulmonary manifestations identified were shrinking lung syndrome, described in 1.5% of patients, while interstitial lung disease and lupus pneumonia were reported in 4% and 3% of patients respectively. Myocarditis and pulmonary hypertension were also rarely described in SLE patients although ranging from 0.4-16% and 1-14% respectively, depending on the methodology used for its identification. Ocular manifestations in SLE included some rare manifestations (reported in less than 5% of patients) and lupus retinopathy that is described in 1.2-28.8% of patients depending on methods of ascertainment. Aseptic meningitis and chorea were also confirmed as very rare manifestations being reported in less than 1% and in 0.3-2.4% of cases respectively.

CONCLUSIONS: The results of this literature review provide the basis for a better understanding of some less-known manifestations of SLE and for stressing the need for a higher awareness in diagnostic and therapeutic protocols regarding these rare disease aspects.

Original languageEnglish
Pages (from-to)S93-S102
Number of pages10
JournalClinical and Experimental Rheumatology
Issue number5 (Suppl.134)
Publication statusPublished - May 2022
Externally publishedYes


  • Hepatitis, Autoimmune
  • Humans
  • Hypertension, Pulmonary
  • Lung Diseases
  • Lupus Erythematosus, Systemic/complications

Field of Science*

  • 3.2 Clinical medicine

Publication Type*

  • 1.1. Scientific article indexed in Web of Science and/or Scopus database


Dive into the research topics of 'Rare clinical manifestations in systemic lupus erythematosus: a review on frequency and clinical presentation'. Together they form a unique fingerprint.

Cite this