A 40-year-old woman presents with a butterfly rash on her face along with arthralgia, alopecia, and fatigue but no fever. The most likely diagnosis is systemic lupus erythematosus (SLE). SLE is a multi-system autoimmune disease that commonly involves the joints and skin and can also affect organs like the brain, heart, lungs, kidneys and more. Laboratory tests would include a complete blood count, serum chemistry, and autoantibody tests like ANA, anti-dsDNA, and anti-Sm. For mild cases, treatment would include topical corticosteroids, NSAIDs, and antimalarial drugs. Regular check-ups are advised to

1. Systemic Lupus Erythematosus
Done By: Dalal F. Alanazi
Medical student at KFU

2. Case scenario
• A 40 year-old woman presents with a butterfly
rash on her face. She does not use any
medication. Other symptoms include
arthralgia, alopecia and fatigue, but there is no
fever.

3. 1. Which diagnosis is the most likely in view of the clinical
presentation?
2. Describe the extent to which other organs can be involved in this
disorder.
3. Which laboratory test would you order to establish the diagnosis in
this case, and to monitor involvement of other organs than the skin
and the joints?
4. Which initial therapeutic measures do you advice?
5. Suppose there is no involvement of other organs initially. What advice
would you give the patient regarding check-up visits?
THE OBJECTIVES

4. #1 The Diagnosis
• Systemic Lupus Erythematosus (SLE).

5. #2 The organs extent

6. Describe the extent to which other organs can
be involved in this disorder?
• Systemic lupus erythematosus (SLE) Multi systemic
autoimmune disease.
• Characterized by arthralgia and rashes being the most
common clinical features, While cerebral and renal disease
are the most serious problems.
• More than 90% of cases of SLE occur in women, frequently
starting at childbearing age.

7. 1997 Revised Criteria- SLE
4 OR MORE = SLE
• Malar Rash
• Discoid Rash
• Photosensitivity
• Oral ulcers
• Arthritis
• Renal Disorder
• Neurologic Disorder
e.g. Seizures,Pychosis
• Hematologic
Disorder –Hemolytic
Anemia,Leucopenia,
Lymphopenia,
Thrombocytopenia
• Immunologic
disorder Anti-ds
DNA,anti-SM,&/or
antiphospholipid

9. Organs can be involved including the Joint, heart, lungs,
blood vessels, eyes, brain, kidneys, GIT and skin.
-Joint: arthralgia.
-Brain: headache, loss memory or confusion.
-Heart/lungs: shortness of breath and/or pain in the chest.
-Raynaud phenomenon.
-Eyes: dry or puffy eyes.
-Brain: meningitis, encephalitis.
-Kidney: glomerulonephritis.
-GIT: abdominal pain.
-Skin: photosensitivity, butterfly.
-Nervous system: ataxia.

10. #3 Laboratory test

11. - Full blood count may show a leucopenia, lymphopenia
and/or thrombocytopenia. Anemia of chronic disease or
autoimmune haemolytic aneamia also occurs. The ESR is
raised with normal CRP.
- Low serum albumin, Urea and Creatinine only rise
when renal disease is advanced (indicators of Lupus
nephritis).

12. - Autoantibodies
• The most significant autoantibodies in SLE are ANA,
anti-dsDNA, anti-Ro, anti-Sm and anti-La.
• Antiphospholipid antibodies could be present.
• Serum complement C3 and C4 are often reduced.
- Histology
• characteristic histological and immunofluorescent
abnormalities are seen in biopsies from the kidney and
skin.

13. - Diagnostic Imaging:
• CT scans of the brain sometimes show infects or
haemorrhage with evidence of cerebral atrophy.
• MRI can detect lesion in spinal cord and may true
vasculities from small thrombi.

14. #4 Therapeutic
measures

15. • General measures:
- Avoid excessive exposure to sunlight.
- Reduce cardiovascular risk factors e.g.
hypertension, hyperlipidaemia and smoking
and so on.

16. - Mild case:
1. Topical corticosteroids.
2. NSAIDs.
3. Antimalarial drugs
(Hydroxychloroquine or
Chloroquine).
Symptomatic treatment:
- Severe case:
1. High dose oral
corticosteroids.
2. Immunosuppressive
(Cyclophosphamide).

17. #5 Advice the patient
• Regular doctor visits can help her keep her treatment
plan up-to-date. It also gives her the opportunity to
make her doctor aware of new symptoms or a
symptom that isn't well controlled by her
medications. That even will help in case if she wants
to get a pregnant.

18. THE CONCLUSION

19. THE
PREFERENCES
Kumar & Clark’s Clinical Medicine – Eighth edition

20. THANK YOU