original case in brief

1. CASE OF FEVER ASSOCIATED
WITH RASH

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• 21.FEBRUARY. 2017
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3. CHIEF COMPLAITNS
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4. HISTORY OF PRESENTING ILLNESS
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9. GENERAL PHYSICAL EXAMINATION
• DROWSY
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• POORLY NOURISHED
• PALLOR - PRESENT
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• EDEMA- PRESENT IN BOTH LOWER
LIMBS , FROM KNEE TO FOOT, PITTING
TYPE

10. • RASH
• , SPARING THE NASOLABIAL
FOLDS
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• , MACULOPAPULAR SKIN RASHES

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• MUSCULOSKELETAL SYSTEM
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• EYES BILATERAL RETINAL PIGMENT EPITHELIAL DEFECT
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12. DIFFERENTIAL DIAGNOSIS
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13. INVESTIGATIONS
22.2.2017 23.2.2017 26.2.2017
HGB 6.0 7.8 9.7
TC 4800 7400 8200
P.L.E.M 52.43.3.2 68.30.2.0 65.32.2.1
ESR 40
MCV.MCH. MCHC 84.27.31
PERIPHERAL
SMEAR
NORMOCYTIC
NORMOCHROMIC
PLATELET 1.02 lac

14. 22.2.2017 23.2.2017
RBS 96
B. UREA 26 25
B. CREATININE 0.7 0.7
S. BILIRUBIN TOTAL 0.4
ALP 175
AST 163
ALT 44
SODIUM 136 134
POTASIUM 4.2 4.0

15. • PROTEIN 1+
• 24 HOUR URINARY PROTEIN – 364 MG
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• POSITITVE FOR STAPH AUREUS
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• WBC 16 ALL LYMPHOCYTES PROTEIN 578MG/DL

18. X - RAY

19. • 0.32
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• POSITIVE COOMBS TEST

20. •ANA – STRONGLY POSITIVE
•ANTI DS DNA – 125.31 ( POSITIVE
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21. CRITERIA
• SKIN- ACUTE , SUB ACUTE , CHRONIC CUTANEOUS LE
• ORAL ULCERS
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• BIOPSY
• NEUROLOGIC – SEIZURES,
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• ANA > REFERRENCE NEGATIVE VALU
• ANTI DS DNA
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• LOW SERUM COMLIMENT
• POSITIVE DIRECT COOMBS TEST

22. DIAGNOSIS
SYSTEMIC LUPUS ERYTHEMATISUS

23. MANAGEMENT
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24. LUPUS = WOLF

26. Double edged sword…

28. • 90% OF PATIENTS
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• 20 – 150 PER 100000 WOMEN
HOW MANY FACEBOOK FRIENDS YOU HAVE THEN !!!!!!!!!
SEND LUPUSORG.COM LINK RATHER THAN WRITING AMEN , RAM

29. PPPPPPPPATHOPHYSIOLOGYYYYYYYYYYYY

30. PAT H O P H Y S I O L O G Y

31. CLINICAL FEATURES

37. MALE VS FEMALE SLE

41. DIAGNOSIS
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42. CRITERIA
• SKIN- ACUTE , SUB ACUTE , CHRONIC CUTANEOUS LE
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• BIOPSY
• NEUROLOGIC – SEIZURES,
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• ANA > REFERRENCE NEGATIVE VALU
• ANTI DS DNA
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• LOW SERUM COMLIMENT
• POSITIVE DIRECT COOMBS TEST

43. WHAT IF …
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44. WHAT NEXT AFTER THE DIAGNOSIS
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46. MUSCULISKELETAL MANIFESTATIONS
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47. CUTANEOUS
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• 20 SLIDES

48. RENAL
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49. CLASSIFICATION ( ISN / RPS )
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• CLASS 3 – FOCAL LN – ACTIVE / INACIVE
FOCAL / SEGMENTAL / GLOBAL
ENDO / EXTRA CAPILLARY GN
<50% OF GLOMERULI INVOLVED
• CLASS 4 – DIFFUSE LN - > 50% OF GLOMERULI INVOLVED , SCLEROSING , WIRE LOOP DEPOSITS NOTED
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50. LABOROTARY TESTS
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51. TEST FOR AUTOANTIBODIES
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52. • ANTI RO / SSA
• MUST
BE SCREENED

53. TESTS FOR FOLLWING THE DISEASE COURSE
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54. PREDICTION OF FLARE
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55. CONSERVATIVE THERAPIES IN NON LIFE THREATENING
DISEASE
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56. ANTIMALARIAL DRUGS
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57. LUPUS DERMATITIS
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58. LIFE THREATENING SLE : PROLIFERATIVE FORMS OF
LN
• FIRST IS SYSTEMIC STEROIDS
• METHYL PREDNISOLONE SODIUM SUCCINATE

59. CYTO TOXIC / IMMUNO SUPPRESSIVE AGENTS
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• GRADE 3 OR 4 DISEASE
• REDUCES THE PROGRESSSION
• EQUAL BENEFIT WITH MMF
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• CYCLOPOSPPHOMIDE – AMENNORRHEA , LEUKOPENIA , NAUSEA
10

60. • HIGH DOSE
500 – 1000 MG / M2 BSA MONTHLY FOR 6 MONTHS
• LOW DOSE BY – 500 MG EVERY TWO WEEKS FOR SIX TOTAL DOSES
• RESPONSE OF CYCLOPOSPHOMIDE 3 TO 16 WEEKS AFTER STARTING
• STEROID RESPOND IN 24 HOURS
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61. ACTIVE SLE IN PREGNANCY
• OVARIAN FAILURE
REDUCED BY TREATMENT WITH A GNRH AGONIST
PRIOR TO MONTHLY DOSE OF CP
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• CP AND MMF ARE TERATOGENIC
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62. BELIMUMAB
SEROPOSITIVE PATIENTS WITH SLE WHO HAVE FAILED
FOR STANDARD TREATMENTS .

63. PREGNANCY AND LUPUS
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1. ANTI RO ++ IS A/W NEONATAL LUPUS – CHB IN INFANT BEING MORE COMMON
2. MOTHER WOTH ANTI RO ++ AND CHILD WITH CHB, IF TREATED WITH HCQ – REDUCE
CHANCE OF CHB IN SUBSEQUENT CHILD
• DEXAMETHASONE INJECTINS
HAVE DICREASED PROGRESSION OF HB
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• POOR MATERNAL OUTCOME OLY SEEN IN ACTIVE NEPHRITIS , IRREVERSIBLE DAMAGE AT
BRAIN OR HEART

65. DRUG INDUCED LUPUS
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66. HIGH RISK OF MORTALITY
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• ANEMIA < 12.4 HB .
• HYPOALBUMINEMIA .
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• MALE SEX .
• LOW SOCIO ECONOMIC STATUS .

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68. FIRST FOLLOW UP AFTER DISCHARGE
…15.3.2017
• EPISODE OF SEIZURE
• ACUTE CONFUSIONAL STATE
ADDED ONE MORE PUZZLE TO PARENTS MIND ???
WHILE HE FIGHTING WITH LUPUS IN THE BODY ,
THEY FIGHT IT IN THEIR MIND

69. • IF WE THINK STUDYING SLE OR
• LISTENING TO SLE IS OR
• PRONOUNCING SYSTEMIC LUPUS
ERYTHEMATOSUS IS TOUGH
• THEN IT’S WRONG
• ITS ACTUALLY LIVING WITH SLE
! ! Thank