iatroX Rounds #15
The clues
- 1
A 28-year-old woman of Afro-Caribbean heritage presents with fatigue and joint pains that have been worsening over several months.
- 2
She describes pain and swelling in her hands and wrists, noting that the morning stiffness lasts for about 45 minutes.
- 3
She mentions that she develops a prominent red rash across her cheeks and the bridge of her nose whenever she spends time in the sun.
- 4
Examination reveals painless ulcers on the hard palate and a faint pleuritic rub on chest auscultation.
- 5
Laboratory tests show a normocytic anaemia, leucopenia, and a positive antinuclear antibody (ANA) titre of 1:640.
- 6
Further serology is positive for anti-double stranded DNA (anti-dsDNA) and anti-Smith antibodies, with low levels of complement C3 and C4.
Systemic lupus erythematosus is a chronic multisystem autoimmune disorder where the immune system produces antibodies against its own cells. It typically presents with a relapsing and remitting course of symptoms including fatigue, joint pain, and characteristic skin rashes.
- Malar (butterfly) rash sparing the nasolabial folds
- Non-erosive inflammatory arthritis
- Serositis such as pleurisy or pericarditis
- Haematological abnormalities including lymphopenia or thrombocytopenia
for education and entertainment. not medical advice.