CASE #9: SYSTEMIC LUPUS ERYTHEMATOSUS (SLE)

A 30 –year old female sought consult due to multiple joint pains and rashes. Her condition started three months ago
with a miscarriage. Her obstetrician said that the fetus died because of lack of oxygen supply secondary to thrombosis in the
fetal circulation. During this time, she noticed scaly rashes on her face, particularly on her cheeks and nose (like a butterfly-
shaped distribution of rash). This gets particularly worse during sun exposure. The rash eventually spread to her chin, ears
and neck.
She also started to experience frequent headaches and forgetfulness. Her husband concluded that these symptoms
were probably just due to stress brought about by the miscarriage. Aside from the symptoms mentioned, she also started to
complain of joint pains on her knees, hands and wrists. These pains became so disabling that she needed to stop from working.
At the clinic, vital signs were normal. Scaly, raised, erythematous rashes were seen on her face and neck which are
similar to the rashes seen in Psoriasis. Her knees were noticed to be swollen and tender to touch. During interview, she looked
so concerned. It also took her a long time to respond to questions. The physician ordered several laboratory examinations
revealing anemia and (+) ANA.

Past Medical History:

- No allergies
- No previous surgical operations and hospitalization
- Immunization history is unknown

Family History:
- Only child, parents are both alive
- Mother with DM II
- No history of cancer, bronchial asthma, and cardiovascular disease

Social History:
- Non-smoker, non-alcoholic beverage drinker
- Works as a hotel receptionist

Obstetric History:
- Menarche at 13 years old
- Regular, 29-days cycle; consumes 3-4 pads/day
- Has been taking OCP for 3 years

Make a presentation on the following:

1. Brief description of SLE.
a. What is SLE?
b. What causes SLE?
c. What are the signs and symptoms of SLE?
2. Present a concept map showing the pathophysiology of SLE in the patient. Please make sure to include the following in
the concept map either as outcomes or contributing factors:
a. Butterfly rash
b. Polyarthritis
c. Miscarriage
d. Forgetfulness
e. Headaches
f. Anemia
g. (+) ANA
h. History of OCP use
3. General overview of how the patient may be managed based on the concept map presented.