Psychosomatic Fever Mimicking Lupus Flare in a Young Male with Cutaneous SLE and Severe Hyponatremia: a Rare and Challenging Diagnostic Scenario

Abstract

Fever in systemic lupus erythematosus (SLE) may result from disease activity, infection, or non-inflammatory conditions, making the diagnostic process challenging. We report a case of a man in his twenties with a history of cutaneous lupus who presented with persistent fever, fatigue, vomiting, and active skin lesions. Laboratory findings revealed mild anemia, vitamin D deficiency, and positive anti-ribosomal P and anti-Ro60 antibodies without evidence of major organ involvement. The patient received immunosuppressive therapy and metabolic correction; however, the fever persisted. Psychiatric evaluation revealed a depressive episode, and following the initiation of maprotiline therapy, the fever completely resolved. This case highlights the importance of considering psychogenic fever in patients with SLE in order to avoid overtreatment and underscores the need for a multidisciplinary approach.