Systemic Lupus Erythematosus: A case report and discussion

Vinothini

Physician Assistant, Kauvery Hospital, Hosur, Tamil Nadu

Introduction

Systemic Lupus Erythematous is a chronic autoimmune disease characterized by an inflammation of connective tissue with variable manifestations.

SLE may affect many organ systems with immune complexes and a large array of autoantibodies, particularly antinuclear antibodies (ANA’s)

Although abnormalities in almost every aspect of the immune system have been found, the key defect is thought to result from a loss of self-tolerance to autoantigens. Common manifestations, in addition to the malar rash, include cutaneous photosensitivity, nephropathy, serositis and polyarthritis The overall outcome of the disease is highly variable with extremes ranging from permanent remission to death.

Background

Physicians play crucial role in the diagnosis and management of Systemic Lupus Erythematous a chronic autoimmune disease by understanding the disease’s manifestation, utilizing diagnostic criteria and collaborating with specialist

Early and accurate diagnosis is essential for preventing organ damage and improving patient outcomes

Symptoms

  • Chest pain when taking a deep breath
  • Fatigue
  • Fever
  • Weight loss
  • Mouth ulcer
  • Sensitivity to sunlight
  • Skin rash- A “butterfly rash” develops in about half of the people with SLE. The rash is mostly seen over the cheeks and bridge of the nose. It can be widespread. It gets worse in sunlight.
  • Swollen Lymph nodes

Other symptoms and signs depend on which part of the body is affect:

Brain and Nervous system – Headache, weakness, numbness, seizure, vision problem

Digestive Tract – Abdominal pain, nausea and vomiting

Lung – Build-up of fluid in the pleural space, difficulty in breathing, coughing up blood

Skin – Sores in the mouth

Kidney – Swollen legs

Circulation – Clots in veins or arteries, inflammation of blood vessels, constriction of arteries in response to cold (Raynaud phenomenon)

Blood – abnormalities include anemia, low white blood cell or platelet count

Renal manifestations

Renal biopsy is an important guide to prognosis in SLE

  • Minimal proteinuria, haematuria, cellular casts (so regularly screen urine for protein and blood)
  • Nephrotic syndrome
  • Chronic renal failure
  • Urinary tract infection

Classification of Lupus Nephritis:

Class I- Minimal mesangial lupus nephritis

Class II –Mesangial proliferative lupus nephritis

Class III- Focal lupus nephritis

Class IV –Membranous lupus nephritis

Class V – Advanced sclerotic lupus nephritis

Test used to diagnose SLE may include:

  • Antinuclear antibody (ANA) panel
  • Chest X- ray
  • Complete blood count
  • RFT, LFT
  • Complement component (C3 and C4)
  • Antibodies to double -stranded DNS
  • Erythrocyte sedimentation rate (ESR)
  • C-Reactive protein (CRP)

Case presentation

A 20-year female came to OPD with the presenting complaints of fever 5days, swollen lips 4 days with ulceration, cough with mucoid sputum, abdominal pain 4days, fatigue, decreased appetite, and tachycardia.

Vitals

  • Height – 132 cm
  • Weight – 38 kg
  • Bp – 100/70 mmHg
  • Pulse – 128b/mt
  • SpO2 – 97%
  • Temperature – 0⁰F

O/E

  • conscious /oriented
  • Malar rash+
  • RS- clear no added sounds
  • P/A- Soft
  • CNS- NFND
  • CVS -S1, S2+

Past medical history- Nil

Immunization history -Fully immunized

Developmental history -Normal

Allergic history -Nil

Family history- Parents have no significant history of any illness

N/K/C/O- Thyroid /epilepsy

Lab investigation:

7/4/2025

Hb- 13.0g/dl

TC- 3220cells/cumm

Platelet-111000Lakhs/cumm

CRP- <5.0mg/dl

Globulin serum- 3.8g/dl

SGOT-148 U/L

SGPT-92U/L

Urea serum-10.5mg/dl

Sr. Creatinine-0.3mg/dl

Na+ -135mmol/L

K+ -3.3mmol/L

Chloride-104mmol/L

Culture results: Scrub typus IGM-Negative &MP Negative

Dengue- IgM-Negative, Ns1-Negative

Typhoid Igm – Negative

11/4/2025

ANA-profile -Positive

Treatment plan

DrugsDosageFrequencyDuration
Tab. Omnacortil20mg1-0-115 days
Tab. Hydroxychloroquine200mg1-0-115 days
Tab. MMF500 mg0-0-115 days
Tab. Shelcal 0-1-015 days
Tab. Zincovit 0-0-115 days
Tab .Omez 20 mg 1-0-115 days

Review

After 15 days’ patient came to OPD for review, patient symptomatically better, vitals ware normal. Only presented with complaints of itching. After 15 days.

Lab summary

Hb – 13.2g/dl

WBC – 5700cells /cumm

Platelet – 169000 lakhs /cumm

Sr. Creatinine –  0.5mg /dl

SGPT – 48u/L

Advice on medication

Same medication for 30 days along with Mometasone cream-0-0-1 for 3 weeks

Review investigation

  • CBC
  • Renal function test
  • Liver function test

Routine follow up

After 30 days’ patient came to OPD for review. Had no complaints, symptomatically better, vitals were stable. Weight gain, normal appetite, doing daily routine.

Lab summary

Hb -13.1g/dl

Wbc -5230 cells /cumm

Platelet – 160000 lakhs / cells

S. Creatine – 0.5mg/dl

SGOPT – 42u/L

Advice on medication

DrugsDosageFrequencyDuration
Tab. Omnacortil5mg1-0-1 60 days
Tab. Hydroxychloroquine200mg1-0-160 days
Tab. MMF500 mg0-0-160 days
Tab. Zincovit 0-0-160 days
Tab .Omez 20 mg 1-0-160 days

Review investigation

  • CBC
  • Renal function test
  • Liver function test
  • Urine routine
  • ESR

Patient counselling

  • Physicians play a vital role in educating patients about SLE, it’s treatment and potential complications. This include providing information about lifestyle modification, medications and resources for support
  • Avoid smoking, alcohol altering medications and missing regular checkup
  • Please alert your Physician if you are unable to take your medicine
  • Avoiding sunlight is the primary change in life style
  • Occupational exposure to silica, pesticides, and mercury can also make the disease worse
  • Don’t stop any drug when feeling better
  • Regular physician follow up
  • Report to the physician if you experience any adverse effects
  • Eat a healthy diet. A healthy diet is one that is low in saturated fat and rich in whole grains, fruits and vegetables

Elaboration

Initial assessment and differential diagnosis

Physicians are often the first point of contact for patients experiencing SLE symptoms. They must be able to recognize the non-specific symptoms of SLE such as fever, fatigue, and joint pain and distinguish them from other conditions.

When a patient’s symptoms are suggestive of SLE, or if a patient’s condition is complex a referral to a Rheumatologist is often necessary. This may involve regular checkup, blood investigation.

Summary

A 20-year female presented in general medicine department with a history of fatigue, fever, swollen lips with ulceration, cough with mucoid sputum, abdominal pain, decreased appetite, tachycardia, and weight loss in 5 days. Physical examination revealed malar rashes. Laboratory investigation shows leukocytopenia and thrombocytopenia. Renal function test was normal, S. Creatinine – Positive, Antinuclear antibodies, anti dsDNA, anti-histones, anti-nucleosomes, anti RibPos. The patient was diagnosed with SLE based on the 2019 EULAR /ACR criteria and treated with prednisone (1mg/kg/day) and Hydroxychloroquine. She showed significant improvement in 4 to 8 weeks follow –up.

 

Kauvery Hospital