active sle with lupus nephritis from rau

active sle with lupus nephritis from rau

1. PRESENTER :DR.ARASAKARTHIYAYINI RHEUMATOLOGY DEPARTMENT 18 NOVEMBER 2024 ACTIVE SLE WITH LUPUS NEPHRITIS

2. 45 years old chinese lady ADL independant active smoker previously NKMI no known drug and food allergy Hx of admission on 7/7/24-15/7/24-TRO SLE AOR discharged

3. p/w: 1. SOB x 4/7- worsening today - a/w chest tightness 2. productive cough x 4/7 3. bilateral LL swelling x 4/7 4. passing out blackish stool x 3/7 - on hematinics

4. failure sx - orthopnea/PND/breathlessness/ lower limb swelling for 1 week right sided pleuritic chest pain productive whitish cough worsens upon lying flat reduced urine output

5. further hx taken from patient: No fever No RN,No abdominal pain/ GI loss No UTI symptoms No worsening joint pain no hemoptysis denies OTC/traditional medications

6. Suspected SLE as 1.MCC involvement->Facial and Mucocutaneous rashes 2.MSK->Arthralgia involving 2 large joints( rigth knee and left elbow and multiple small joint of hand 3.Serositis->B/L Pleural effusion(minimal)-echo done 4.Posssible Lupus Nephritis->UPCI 124mg/dl 5.Hematological-Low WCC and Hb(Coombs direct and indirect negative 6.Serology-low c3 with normal C4

7. ================================ ISSUES AND PROGRESS ================================ 1. Active SLE with class 3 LN/ serositis/ TRO lupus cardiomyopathy - renal biopsy (18/7/24): Immune complex mediated glomerulonephritis featuring mesangioproliferative pattern with focal active lesions (class 3) - given IV MTP 500mg OD x3/7 - given IV cyclophosphamide cumulative 3 g cycle 1(2/8/24 ) :1000mg cycle 2 (5/9/24 ) :750mg cycle 3 (3/10/24 ):750mg cycle 4 (4/11/24):500mg

8. - anti Ro6o + ve - anti dsDNA 67.9 - anti cardiolipin IgM 2.4 - anti cardiolipin IgG 13.3 - anti B2 Glycoprotein-1 IgM 1.4 - anti B2 Glycoprotein-1 IgG <6.4 - discharge with: T Prednisolone 45mg OD for 2/52, then 40mg OD until readmission

9. 2. dilated cardiomyopathy - aetiology (lupus, ischemia, tx as NSTEMI) - echo (30/7): EF 35.5%, diffuse hyokinesia , pericardial effusion 0.7 - 0.9cm, trace MR - trop i 260.2 > 81.4 > 94 3. transaminitis (resolved) ast 554 > 216 > 165 > 131 > 24 alt 418.8 > 345.1 > 279 > 268.2 > 74 4. NCNC anemia - FBP (11/7): NCNC anemia, leucopenia tro cause - hb 10.3 > 10.9 > 10.3 > 9.6