Case presentation on sle

Pokhara University
School of Health and Allied Sciences
Case Presentation
on
Systemic Lupus Erythromytous
Presented By : Deepa Kumari Karn
M Pharm (C.P), 4th Sem
ClearkShip II

Pokhara University
Contents
• Patient Demographic
Information
• Complaints
• Medical History
• Medication History
• Social History
• Family History
• Physical Examination
• Laboratory Investigations
• Drugs Information
• Progress
Chart/Investigations Others
• Discharge Medications
• Subjective Analysis
• Objective Analysis
• Assessment and
Explanation
• Planning
• Refernces

Pokhara University
Patient Demographic Information:
Name Ashmita BK
Age 16 Years
Gender F
Weight 39Kg
Allergy Not Known
Address Lekhnath, Kaski
Contact Number 9806526125
Ward Medicine
Date of Admission 23-03-2018
Date of Discharge 02-04-2018
Hospital No 74052844

Pokhara University
Complaints
 Rashes in the face
 Swelling of B/L lower limbs × 4 days
 Fever × 1 days
 Complaints of hair loss and shortness of breath

Pokhara University
Medical History
 Asymptomatic 4years
 Developed rashes around bilateral cheeks, increased
rashes when exposed to sunlight initially itching too but
now no itching.
 However 4 days prior
 developed swelling of B/L lower limbs,
 shortness of breath while laying down,
 fever for 1 days
 Photosensitivity

Pokhara University
Medication History:
• No past medication history
and no history of hospital
admission.
Social History:
• Good on study.
• Non smoking history and
non alcoholic
Family History
• No similar history or illness
among siblings.

Pokhara University
Physical Examination:
General Fair
CVS S1,S2, M0
RS B/L NVBS and no added sound
CNS Grossly intact
Others Normal Sleep, no multiple joint pain,
normal appetite and bowel movement,
no tender

Pokhara University
Laboratory Investigations
Test Value Range Test Value Range
Urea 21mg/dl 13-43 Retics: 0.6%
S. Cr 0.8mg/dl 0.6-1.1 Hb: 8.9gm/dl 11.7-15.5
Sodium 144mEq/l 135-146 PCV: 27.3% 40-50
Potassium 3.6mEq/l 3.5-5.5 MCV: 74fl 83-100
Alb 1.7gm/dl 3.5—5.2 MCH: 24pg 27-32
RBC 3.71×5×10×^6
/cumm
4.5-6 MCHC: 33% 31-35
Platelets 180×10^3/cumm 150-400 ESR: 58mm/hr <20
WBC 4.5×10^-3/cumm 4-11

Pokhara University
Urine Analysis
• Others
– Rheumatoid Factor- Positive
– USG- Hepatosplenomegaly
Test Value Range
WBC: 15-18/HPF <5
EP cells 2-3/HPF <15-20
RBC 3-4/HPF <5
Crystals Nill

Pokhara University
Drugs Information
S.N. Generic Name Dose Route F
1
2
3
4
5
6
7
8
9
10
Ranitidine
Fexofenadine HCL
Frusemide
Prednisolone
Hydrochlorothiazne
Iron
Azithromycin
Frusemide
Nebu A:I:N:S
Fusidic Acid +
Dexamethasone
150mg
120mg
20mg
20mg
200mg
1Tab
500mg
20mg
P/O
P/O
I/V
P/O
P/O
P/O
P/O
P/O
IV
topial
BD
HS
TDS
OD
OD
OD
OD
BD
6hrly
BD

Pokhara University
Progress Chart/Investigations Others
Day -1
• B/L pitting edema, PR:
60bpm, RR: 22/min, BP:
80/60, flap -, fever-, nausea-
, vomiting-
Day- 4
• PR: 65bpm, RR: 22/mim, BP:
120/70mmHg, Temp: 98.6°F
.

Pokhara University
Day -9
• PR: 65bpm, RR: 22/min, BP: 120/70mmHg, Alopecia
+, photosensitivity+, Renal Biopsy done and
dermatological consultation was done
Day- 10
• PR: 64bpm, RR: 22/min, BP: 100/70mmHg, Temp:
98.6°F, Renal Biopsy Report: No collection visualized
in perirenal space

Pokhara University
Discharge Medications
1. Tab ranitidine 150mg P/O OD
2. Tab prednisolone 10mg P/O OD
3. Tab Hydrochlorothiazide 200mg P/O OD
4. Iron Tab 1 tab P/O OD
5. Fusid B cream
6. Ray Shlolod cream SPF 50++
7. Dermoist Creame BD

Pokhara University

Pokhara University
Subjective Analysis
Rashes in the face
Swelling of B/L lower limbs × 4 days
Fever × 1 days
Complaints of hair loss and shortness of
breath and photosensitivity

Pokhara University
• The current symptom could be of systemic lupus
erythromytous and upon examinations she was
finally diagnosed with the
Systemic Lupus
Erythromyus

Pokhara University
Objective Analysis
• On clinical examination,
– Molar rash,
– Protein urea,
– Blood Disorder
– Photosensitivity

Pokhara University
• She had BP of 80/60mmHg, PR of 82/min,
Rheumatoid factor positive, bilateral pitting
pedalodema was also found on day 1 and day 4
examination
• Renal biopsy was done on day 9 and no collections
was visualized in perirenal space

Pokhara University
Assessment and Explanation
• SLE is multisystem connective tissue disease
• Inflammatory autoimmune disorder characterized
by auto antibodies to nuclear antigens which can
affect multiple organ systems
• The severity may vary from a mild episodic disorder
to a rapidly fulminant, life-threatening illness

Pokhara University
Image Source: http://www.mcvitamins.com/causes%20of%20neuropathy/lupus-
neuropathy.htm

Pokhara University
• Factors:
– Gender,
– Race,
– Genetic inheritance
– Drugs (Procainamide, hydralazine, and isoniazide )
• Before making a diagnosis of SLE, it is imperative to
ascertain that the condition has not been induced by
a drug

Pokhara University
Diagnostic criteria of SLE
Malar Rash
Discoid Rash
Serositis
Oral ulcers
Arthritis
Photosensitivity
Blood disorders
Renal involvement
Antinuclear antibodies (ANAs)
Immunologic phenomenon
Neurological Disorder
4 out of
11
criteria
conform
SLE

Pokhara University
Drugs Used Causes
Hydroxychloroquine Helpful in treating lupus rashes or joint
symptoms and appear to reduce the
incidence of severe disease flares
Given to the patient at a dose of 200mg
OD.
Prednisolone Control the inflammations and
suppresses the immune system by
reducing the production of lymphocytes
and eosinophils
Given at a dose of 20mg OD

Pokhara University
Fexofenadine Reduces or block the release of
histamine and thus reduces the allergic
reaction to appear
Relieve allergic symptoms such as
itching, runny nose that was appeared in
patient
Frusemide  loop diuretic which inhibits the
reabsorption of sodium and chloride from
the loop of henle and reduces the oedema
To reduce the oedema furesemide 20
mg was given.
Azithromycin WBC count in urine was increased that
may show that the there is bacterial
urinary tract infection and as a prophylaxis
Azithromycine was given which is the
widely distributed to the most of the cell
of the body including WBC.

Pokhara University
Tab Iron Haematological alterations such as
anemia, neutropenia and
thrombocytopenia are frequent in (SLE)
Patient was also prescribed with iron
tablet P/O OD
Tab Ranitidine Competitively blocks histamine at H2
receptors of gastric parietal cells which
inhibits the gastric acid secretion
Ray Shoiold SPF 50++ and fusid B cream Developed the photosensitivity and to
prevent and protect from the sunlight

Pokhara University
• Management goals in patients with SLE include the
early diagnosis and appropriate therapy whilst
preserving overall kidney function without undue
side-effects.
• In order to realize such goals, it is clear that a kidney
biopsy is essential in establishing diagnosis and
prognosis, and guiding treatment.
• In this patient the renal biopsy was performed on
day 10 which showed no any collection in the peri
renal space.

Pokhara University
PLANNING
• Prior to discharge all the investigations were
rechecked which were improved
• Patient was properly informed about that knowledge
and was prescribed with appropriate medication on
discharge with proper counseling
• Instructed to follow up after 1 week in the OPD
department.

Pokhara University
References
• Boon NA, Colledge NR and Walker BR (2006)Davidson’s Principles and practice of Medicine
(20th Ed) Churchill Livingstone,1132-1134.
• Shaifie KT, Shirwai AA, Samir N (2014) A Possible Case of Systemic Lupus Erythematosus
Presenting with Generalized Edema, Medical Journal,14(4),581.584.
• DIMS Nepal
• https://www.ncbi.nlm.nih.gov/pubmed/19412194 (Assessed on 6th June 2018)
• https://www.webmd.com/lupus/lupus-photosensitivity-uv#1 (Assessed on 6th June 2018)
• https://emedicine.medscape.com/article/330369-treatment (Assessed on 6th June 2018)
• https://academic.oup.com/ndt/article/21/7/1749/1821968 (Assessed on 6th June 2018)

Case presentation on sle

More Related Content

What's hot

Similar to Case presentation on sle

More from DeepaKarn

Recently uploaded

Case presentation on sle