25 yr female. 3yr /h/of. ..photosensitive malar rash. C/o Low grade fever on and off. Arthralgia. ..multiple joint pains . Nausea, diarrhoea with abdominal cramps. O/E. ..she had mouth and palatal ulcers Lab inv. .....hb 7.9, platelet. .2 97 000 Wbc. .5900, esr. .110 Anti dna strongly positive. Ur valuable comments. .



Good case and good history Dr. Husna Strongly positive of anti DNA multiple joint pains with Mouth ulcers and photosensitive Malar rash on face more favour to SYSTEMIC LUPUS ERYTHEMATOSUS Here the anti DNA antibodies malar rash and joint pains may be seen in SLE simulating problems..... These antibodies directed against the cell's genetic material. DD 1) Drug induced SLE ..Hydrallazine, procainamide 2) Rheumatoid Arthritis 3) Scleroderma 4)Polymyositis

SLE Preventative measures The following measures are important to reduce the chance of flares and organ damage. Carefulprotection from sun exposureusing clothing, accessories and SPF 50+ broad-spectrumsunscreens. Sunscreens alone are not adequate.SmokingcessationRest when needed Topical therapy Intermittent courses of potenttopical corticosteroidsare important in the treatment of CLE. They should be applied accurately to the skin lesions. Thecalcineurin inhibitorstacrolimusointment andpimecrolimuscream can also be used. Systemic therapy Treatment of SLE depends on which are the predominant organs involved in the disease. Typically, any of the following drugs may be used alone or in combination. Systemic corticosteroidssuch as prednisone or prednisolone. These are the mainstay of treatment in a seriously ill patient with acute LE.Hydroxychloroquineand other antimalarialsresponse rates are about 80% in CLE.Methotrexatebest response in subacute CLE anddiscoidCLEImmunosuppressives such asazathioprine,mycophenolateandcyclophosphamideIntravenous immunoglobulinAspirin is recommended forantiphospholipid syndrome.Targeted biologic therapies under evaluation for SLE include belimumab and off-labelrituximab, abatacept, tociluzimab and eculizumab.[3] CLE is also sometimes treated with: RetinoidsisotretinoinandacitretinDapsone

Hello dear Dr. Aditya Previously you questioned to Dr. Renuka for usage of excessive medicines. But now you are also doing same thing here. If need to use medicines , shall be prescribe. But main moto of ours are should not do any harm to any patient. Ok and also don't insist and criticise others. If you don't like it. Simply do Disagree. It is enough for them . As a senior , good friend and well wisher to you , accepting my advise. Ok

? SLE only point going against is high esr which is generally not raised in SLE , also bowel complaints not that frequent in SLE. DD Inflammatory bowel disease with reactive arthritis

SLE What about her menstrual history? Hair thinning ,hair loss Cardiac symptoms?

Thanks for sharing this case.Typical BOOKISH case n history.

Please check urine for casts, protein. Lupus nephritis is very important to endorgan damage to look out

Auto immune disorder Likely Rheumatoid arthritis And less likely sle Butterfly rash on face Need complete evaluation by lft Rft CBP Need to start immunosuppressant

Systemic Lupus Erythematosus Needs steroids

Systemic lupus erythematous

What is your diagnosis doc? Your history is classic for the diag!

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