A CASE REPORT AT FAHCQMU Systemic Lupus Erythematosus (SLE): Frequently missed at first visit CASE REPORT BY: Dr. Mohan Khadka, MBBS (KU, Nepal), ECFMG certified (USA), MD resident, CQMU, Chongqing, China TUTOR: Prof. Xiaohong Tao, Head of Department of Gastroenterology, First Affiliated Hospital of CQMU ABSTRACT Background: Frequently many SLE cases especially in young women are missed in the first visit because of which patient suffers in terms of morbidity, economic expenditure and time. Methods: We had reported a case of a 30-year-old woman patient on antitubercular treatment (ATT) in local hospital for false diagnosis of Pulmonary tuberculosis at First Affiliated Hospital of Chongqing Medical University (FAHCQMU) with complaints of abdominal pain, chest pain, photosensitive skin rashes, fatigue, malaise, multiple joint pain, nausea, anorexia, loss of weight, amenorrhea and various other laboratory abnormalities. Further investigations at FAHCQMU, lead to a diagnosis of Systemic Lupus Erythematosus (SLE). A literature search, using the key words "Systemic Lupus Erythematosus", "Tuberculosis", “Amenorrhea” and relationship among them was undertaken. Results and Conclusions : The case was further investigated in line of any disease which could have been presented with multisystem involvement and was found to be SLE. The first diagnosis of Tuberculosis at local hospital was declined here with regard to the lack of adequate laboratory support. Steroid was started and good improvement was seen. SLE can involve any organ system. It is important that the physician, who treats patient as a whole, must rule out SLE when a straightforward diagnosis is associated with inexplicable multiple concomitant abnormalities. CASE REPORT A 30-year-old Chinese woman, previously well, came to the FAHCQUMS complaining of a 4 days history of new onset of skin rashes with fever. On further inquiry she revealed that she was on Anti-tubercular treatment (ATT) Regime for 4 days. She was diagnosed as pulmonary tuberculosis a half month before when she presented at the local hospital with complaints of low grade fever, fatigue, malaise, myalgia, arthralgia, anorexia, significant weight loss, occasional cough and non specific chest and abdominal discomfort for 4 months. According to reports from local hospital, she underwent CT abdomen/chest and the findings were cholelithiasis with multiple small sized stones, splenomegaly and mild pleural effusion with negative
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A CASE REPORT AT FAHCQMU
Systemic Lupus Erythematosus (SLE): Frequently missed at first visit
CASE REPORT BY: Dr. Mohan Khadka, MBBS (KU, Nepal), ECFMG certified (USA), MD
resident, CQMU, Chongqing, China
TUTOR: Prof. Xiaohong Tao, Head of Department of Gastroenterology, First Affiliated Hospital
of CQMU
ABSTRACT
Background: Frequently many SLE cases especially in young women are missed in the first visit
because of which patient suffers in terms of morbidity, economic expenditure and time.
Methods: We had reported a case of a 30-year-old woman patient on antitubercular treatment (ATT) in
local hospital for false diagnosis of Pulmonary tuberculosis at First Affiliated Hospital of Chongqing
Medical University (FAHCQMU) with complaints of abdominal pain, chest pain, photosensitive skin
rashes, fatigue, malaise, multiple joint pain, nausea, anorexia, loss of weight, amenorrhea and various
other laboratory abnormalities. Further investigations at FAHCQMU, lead to a diagnosis of Systemic
Lupus Erythematosus (SLE).
A literature search, using the key words "Systemic Lupus Erythematosus", "Tuberculosis",
“Amenorrhea” and relationship among them was undertaken.
Results and Conclusions: The case was further investigated in line of any disease which could have
been presented with multisystem involvement and was found to be SLE. The first diagnosis of
Tuberculosis at local hospital was declined here with regard to the lack of adequate laboratory support.
Steroid was started and good improvement was seen. SLE can involve any organ system. It is important
that the physician, who treats patient as a whole, must rule out SLE when a straightforward diagnosis is
associated with inexplicable multiple concomitant abnormalities.
CASE REPORT
A 30-year-old Chinese woman, previously well, came to the FAHCQUMS complaining of a 4 days
history of new onset of skin rashes with fever. On further inquiry she revealed that she was on
Anti-tubercular treatment (ATT) Regime for 4 days. She was diagnosed as pulmonary tuberculosis a
half month before when she presented at the local hospital with complaints of low grade fever,
fatigue, malaise, myalgia, arthralgia, anorexia, significant weight loss, occasional cough and non
specific chest and abdominal discomfort for 4 months.
According to reports from local hospital, she underwent CT abdomen/chest and the findings were
cholelithiasis with multiple small sized stones, splenomegaly and mild pleural effusion with negative
ascites. Echocardiography was also done and was found to be mild pericardial effusion. Antibody
against Tuberculosis was equivocal (+/-). PPD test was not performed. At local hospital, she was
diagnosed as Tubercular pleuritis and peritonitis for which ATT with Isoniazid and Rifampicin was
started. Cholelithiasis was regarded as incidental finding. She developed sudden skin rashes with high
grade fever the day after she started ATT and was given dexamethasone for two days for the purpose.
After two days she came to FAHCMU for not being getting better for her complaints at local hospital.
Her past medical history was uneventful for diabetes, hypertension, tuberculosis, autoimmune diseases,
respiratory illness and cancer. She denied smoking, alcohol and illicit drug use. Her family history was
unremarkable for autoimmune disorders. She is married and living with her husband and a daughter.
She is also suffering from amenorrhea for last 3 months. She had regular menstruation of 4-6/30 until
she developed amenorrhea for last 3 months. She had menarche at the age of 13.
When examined at the time of admission, she was fully conscious, well oriented to time, place and
person but looking lethargic and moderately cachexic. She was mildly febrile with 37.5 degree Celsius;
her pulse rate was 90 beats per minute, and her blood pressure was 100/64 mmHg. She had a few skin
eruptions most of which were on the process of healing. A few left upper cervical and supraclavicular
lymphnodes were palpable and mild tenderness was present. Her eyes were normal on examination
except pallor. Her chest sounds were clear with no friction rubs, and she had no murmurs or rubs. Her
abdomen was moderately hard with guarding and rigidity, mild tenderness on palpation with mild
rebound tenderness was present. No liver, spleen and any masses were palpable and percussion
findings were also similar. Normal bowel sound was present. She had no vaginal discharge, cervical
motion tenderness, or adnexal masses. Her uterine size was normal. Her extremities showed no joint
swelling or tenderness. Neurologically, she was unremarkable.
Laboratory studies disclosed the following values: