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Systemic Lupus Erythematosus — RACP Adult Medicine MCQ

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EasyRheumatologySystemic Lupus ErythematosusRACP Adult Medicine

A 32-year-old woman presents with a photosensitive malar rash, oral ulcers, arthritis, and pleuritic chest pain. She has proteinuria (ACR 120 mg/mmol) and an active urinary sediment with RBC casts. ANA is positive (1:640), anti-dsDNA is elevated, and C3/C4 are both low. What is the most likely diagnosis?

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Correct answer: D — Systemic lupus erythematosus

This patient meets multiple ACR/EULAR 2019 SLE classification criteria: malar rash, oral ulcers, arthritis, serositis, renal involvement (proteinuria + RBC casts suggesting nephritis), positive ANA, elevated anti-dsDNA, and hypocomplementaemia. Active urinary sediment with proteinuria mandates kidney biopsy to classify lupus nephritis (ISN/RPS classification).

Reference: ACR/EULAR – 2019 – SLE Classification Criteria; EULAR 2024 SLE Management