Loading

Case Report Open Access

Macrophage Activation Syndrome: An Atypical Initial Presentation of Systemic Lupus Erythematosus

  • 1PGY Internal Medicine, Western Reserve Health Education, Warren, Ohio, USA
  • 2Regional Arthritis & Rheumatology Associates, Hermitage, Pennsylvania, USA
+ Affiliations - Affiliations

Corresponding Author

Shrushti Dalal, shrushtidalal97@gmail.com

Received Date: July 22, 2025

Accepted Date: September 15, 2025

Abstract

Macrophage Activation Syndrome (MAS) is a severe inflammatory complication often linked to autoimmune disorders such as systemic lupus erythematosus (SLE). We describe a 57-year-old woman who presented with persistent fever, polyarthralgia, pancytopenia, and markedly elevated ferritin levels (>40,000 ng/mL). Extensive evaluation ruled out infection and malignancy. A diagnosis of MAS was made, and she responded well to high-dose corticosteroids and anakinra. Subsequent autoimmune workup revealed anti-dsDNA antibodies, leading to a new diagnosis of SLE. She has remained clinically stable over long-term follow-up without ongoing immunosuppressive therapy. This case illustrates the importance of considering MAS in adults with unexplained systemic inflammation and cytopenias, particularly when it reveals underlying autoimmune disease. Early recognition and treatment are important to improving outcomes.

Keywords

Systemic lupus erythematosus, Macrophage activation syndrome, Pancytopenia

Author Information X