SLE- Systemic Lupus Erythematosus- Autoimmune Disorder

Systemic Lupus Erythematosus is a multisystem autoimmune disorder characterized by the production of autoantibodies (especially anti-nuclear antibodies) that cause inflammation and damage in multiple organs — including skin, joints, kidneys, brain, heart, and blood.

1. SUMMARY 25 year old female patient without no known comorbidities, presented with aphthous ulcer since 2 months which was acute in onset and was painful. Initially it was painful with redness and peeling of lips, gradually it become painless. Along with this on 12/02/2023, patient noticed multiple red colored palpable rash over the neck which later spread into the forehead and bridge of nose within 2 days. They consulted nearby hospital and medications were taken. Then the rash was spread to both upper limb above elbow, sparing trunk and also both hands. No itching or discharge. Since 3 days, patient had loss of appetite and abdominal discomfort. No history of weakness, facial deviation, uprolling of eye. No history of abdominal pain, loose stools, vomiting, burning micturition.

2. No history of cough, breathlessness, hemoptysis. hematemesis, melena. No history of chest pain, palpitation, syncope, orthopnea, PND, weight loss, high grade fever, bleeding manifestation. On examination patient was conscious and oriented. PR: 88/min, BP: 110/70mmhg, RR: 22/min, SpO2: 98% in RA. Pallor (+), edema (+). All systemic examinations were within normal limits. On routine blood investigation CBC showed Hb (10.7), WBC (2490), RBC (3.7), neutrophil (77.8), lymphocyte (16.2), eosinophil (0.2), monocyte (5.4), basophil (0.4), platelet count (74000). RFT showed urea (29), creatinine (1), BUN (13). Vitamin B12 (>1000), ferritin (>1000).LDH (411). CRP (0.1). LFT showed SGOT (624), SGPT (228), ALP (123), protein (7.7), albumin (4.33), globulin (3.4), AVG ratio (1.3), GGT (142). C3 (40), C4 (8). PT (13.5), INR (1.00) Direct coombs (+++). Urine protein (26), Creatinine (37.7), PC ratio (0.68). URE showed albumin (faint trace), pus cells (1-2), RBC (nil), epithelial cells (1-2),bacteria (+). US abdomen (14/04/2025) showed mild perportal cuffing in liver - ? significant. ANA profile sent and it showed strong positivity for SLE. Blood C/S showed no growth. Stool c/s showed no growth.

3. Provisional diagnosis SYSTEMIC LUPUS ERYTHEMATOSUS MIXED CONNECTIVE TISSUE DISORDER

4. INVESTIGATIONS 5/3/25 11/3/25 18/3/25 26/3/25 14/4/25 17/4/25 18/4/25 21/4/25 HB 11.1 9.5 10.4 11.3 10.7 9.5 9.1 TC 2700 2400 5300 3800 2490 1860 1750 NEUTROPHILS 59 78 75 68 77.8 62.4 59.8 LYMPHOCYTE 29 13 15 22 16.2 31.7 35.7 PLATELET 1.27 1.61 50000 58000 CRP 0.1 0.1

5. 5/3/25 11/3/25 18/3/25 26/3/25 14/4/25 17/4/25 18/4/25 11/04/25 UREA 29 CREATININE 0.5 1.0 0.7 SODIUM 135 POTASSIUM 3.6

6. LFT 21/4/25 TOTAL BILIRUBIN 0.5 DIRECT BILIRUBIN 0.1 SGOT 142 SGPT 90 ALP 88 TOTAL PROTEIN 7.8 ALBUMIN 4.47 GLOBULIN 3.3 A/G RATIO 1.3 GGT 22 03/04/25 APTT 32 PT 13.5 INR 1 URE 03/04/25 PUS CELLS 1-2 RBC NIL EPITHELIAL CELLS 1-2 SUGAR NIL ALBUMIN FAINT TRACE

7. 10/04/25 TOTAL CHOLESTEROL 137 TRIGLYCERIDE 137 HDL CHOLESTEROL 26 LDL CHOLESTEROL 84 VLDL CHOLESTEROL 27

8. SAMPLE ORGANISM SENSITIVITY 07/04/25 BLOOD NO GROWTH 07/04/25 URINE NO GROWTH 08/04/25 SPUTUM E.COLI
HEAVY GROWTH S to AMOXCLAV, GENTAMYCIN,CEFAPERAZONE/SULBACTUM, COTRIMOXAZOLE,PIPERACILLIN/TAZOBACTUM R to CEFIROXIME , CEFTRIAXOBE I to CIPROFLOXACIN

9. COURSE IN THE HOSPITAL Patient was admitted with complaints of aphthous ulcer and rashes since 2 months. On evaluation she was found to have pancytopenia and transaminitis. She was treated with IV fluids and other supportive measures. Dermatology consultation was done, skin biopsy was taken and other orders carried out. Autoimmune disease workup and blood and stool culture & sensitivity was sent and was found to have SLE. Blood culture showed no growth, stool culture showed normal flora. Bone marrow aspiration and biopsy was done in view of pancytopenia done ANA profile sent and it showed strong positivity for SLE. IV steroids was initiated. Dermatology review was done and orders carried out. Nephrology consultation was done in view of proteinuria and orders carried out They advised review on 28/04/25 (MONDAY) for renal biopsy. Now the patient is symptomatically better and hence being discharged with following advice.

10. DIAGNOSIS SLE