A 40 year old female patient
presented with the complaints of:
1. Multiple recurrent erosions on
lips & buccal mucosa x 7 years
2. Multiple, raised red colored
lesions over chest, back, both
Upper Limbs & legs x 12 months
3. Aggravation of the symptoms
x 10 days
HISTORY OF PRESENT ILLNESS:
• Multiple erosions and ulcers in the oral cavity and lips which
were intermittent and recurring.
• Associated with difficulty in chewing and talking.
• Multiple, red colored lesions over body since 1 yr ; initially
over the chest which gradually increased in size, then
developed over B/L upper limbs & legs since 3 months;
associated with itching.
• H/o photosensitivity (lesions became red and painful on
• H/o increased hair loss , joint pain in shoulders,
knee joints; not associated with swelling.
• H/o low grade, continuous fever x 2 days .
• No h/o headache , change in wt/appetite, epigastric
pain/nausea/vomiting, chest pain/palpitation/breathlessness,
sleep disturbances, altered behavior , B/B dysfunction, blood
transfusion, drug sensitivity .
PAST HISTORY: k/c/o hypothyroidism ; being
treated with medication.
• H/o repeated episodes of paralysis since 4 years (hypokalemia
with Renal Tubular Acidosis).
• No h/o TB/Asthma/HTN/any other major chronic illness.
FAMILY HISTORY: No h/o such illness in the
MENSTRUAL HISTORY: H/o hysterectomy 5
OCCUPATIONAL HISTORY: used to
work in fields.
• GPE: conscious, co-operative, oriented to TPP, febrile
• PR: 80/min, regular, good volume, vessel wall not palpable
BP: 124/80 mmHg RR: 18/min
• O/E: multiple, erythematous, P- I- Cy- Cl- JVPNR LAP- PE-discoid
plaques with adherent scales
and well-defined hyperpigmented
border present over chest , lower
back, B/L upper limbs & legs.Carpet
Tack sign was positive. Grattage test
and Auspitz sign were negative.
• Oral mucosa: multiple ulcerations
and superficial erosions were present
on buccal mucosa and palate.
• Lips: multiple erosions were present over both lips ; associated with
crusting. Crust removal caused oozing of blood from the lesions.
• Nails :
Upper Limb Lower Limb
Plate Mild yellowish
Fold NAD NAD
Cuticle NAD NAD
Respi. Within normal limits
KIDNEY BIOPSY: biopsy specimen sent for
ECG , X-Ray(chest) : Normal
Plt 1.7 lac/mm3
U. Protein 1.6gm/day
SKIN BIOPSY : showed epidermal atrophy
with follicular plugging. The dermis showed
moderate to dense chronic inflammatory
1.ANA by IF: +ve(1:640 titre); speckled pattern
2.Antibodies to dsDNA (patient refused
3.Complement (C3,C4)levels for the tests)
PBF for LE cell : Negative
40 year female patient with following findings:
Skin lesions characteristic of DLE (Discoid Rash)
Positive ANA titre
Proteinuria (>0.5 g/day)
--is a case of Systemic Lupus Erythematosus as per the
RTA with hypokalemic paralysis and speckled IF pattern of
? Overlap syndrome of SLE with secondary
SYSTEMIC LUPUS ERYTHEMATOSUS
SLICC Diagnostic Criteria :
CLINICAL CRITERIA IMMUNOLOGIC
1. Acute cutaneous lupus
2. Chronic cutaneous
3. Oral or nasal ulcers
4. Non-scarring alopecia
7. Renal dysfunction
9. Hemolytic anaemia
4. Antiphospholipid Ab
5. Low Complement (C3,
6. Direct Coombs’ test
• Occurs after sun exposure;
followed by systemic manifestatons
within few weeks
• Localised form: malar rash
• Generalised form: can involve
whole body; systemic
manifestations are present
• Subtypes include:
1.DLE(localised or generalised)
~Avoid sun exposure
and use sunscreens
with high SPF.
can be used.
~Balanced diet low in
~ Topical steroids
~ Intralesional steroids
~ Oral steroids
+ low dose
~If organ threatening
SLE, high dose