AUTOIMMUNITY IN AN IMMUNOSUPPRESSIVE CONDITION: A CASE OF PEDIATRIC HIV WITH SYSTEMIC LUPUS ERYTHEMATOUS.

Background: Systemic Lupus Erythematosus(SLE) is a chronic autoimmune disease and its coexistence with human immunodeficiency virus (HIV) (simultaneously) has been rarely reported in literature with only 10 such reported cases, to the best of our knowledge. We report a case of an 11 year old girl with concomitant SLE and HIV infection with tuberculosis. Clinical Description: An 11 year old girl, newly diagnosed with HIV infection was detected to have disseminated tuberculosis (pulmonary with abdominal) radiologically. She was admitted and started on antituberculosis treatment, following which Highly active antiretroviral therapy was introduced. However, she had continuous fever spikes and joint pain along with progressively deranged renal function tests. Immunological workup was sent which revealed ANA-2+, anti dsDNA- strongly positive and antihistone antibodies- negative. The diagnosis of HIV with SLE was confirmed on basis of SLE diagnostic criteria. Management & Outcome: Child was started on prednisolone (1 mg/kg/day) and low dose hydroxychloroquine (HCQ). Antituberculosis treatment (ATT) was continued with Anti-retroviral therapy- abacavir/ lamivudine/dolutegravir. Renal function tests normalised in next 2 week. Child was given pyridoxine and nutritional supplements. She is on regular follow up and monitoring. Conclusion: HIV and SLE are two diseases with exact opposite pathogenesis. HIV is immunosuppressive, while SLE is autoimmune disease and the coexistence of both can pose a dilemma both diagnostically and therapeutically