Systemic Lupus Erythematosus: A case report and discussion

K. Uma Maheshwari1, I. Ruby2, V. Gayathri3, S.J. Sonya Mercy Anbu4

1Staff Nurse, MAA Kauvery Hospital, Trichy

2Deputy Nursing Superintendent, MAA Kauvery Hospital, Trichy

3Incharge PICU, MAA Kauvery Hospital, Trichy

4Nursing Educator, MAA Kauvery Hospital, Trichy

Case Presentation

A 6 year old female child admitted with the H/O fever for a month, maculopapular rashes for 20 days, abdominal pain 3 days, Vomitting, decreased activity, poor oral intake for a day.

  • Past surgical Medical History: Nil
  • Immunization History: Baby fully immunized
  • Developmental History: Normal
  • Allergic History: Nil
  • Family History: Parents has no significant history of any illness
  • Treatment History: The Child was treated elsewhere with antibiotics.

Investigations

Vitals24/1/2525/1/2527/1/2528/1/2529/1/25
HB6.68.510.111.210.3
TC34901720534063907950
Platelet2300013000510009600097000
Urea and creat-52/0.941/0.7848/0.6752/0.4
Uric Acid-7.948.01--
C3 compliment40---
C4 compliment8----
ANA-----

Chest X-ray

Culture Results

Scrub typhus IgM Negative & MP negative

Blood Culture: Sterile for 24 – 48 hr

Coagulation profile showed normal values

Sal. Typhi:

O-Positive 1:160 d/l

H-Positive 1:160 d/l

Sal. paratyphi A(H): Negative

Sal. paratyphi B(H): Negative

Management

Child received in hospital with the presenting symptoms of irritability,tachypneic.Palpable purpuric rashes presented in central scab formation all over body,malar rashes(Butterfly Rash),generalized lymphadenopathy,hepatospleenomegaly.Baby look hypoxemic,

Considered initial possibility of pyrexia of unknown origin and baby was under evaluation. Then extended to rule out systemic Lupus Erythmatous/small vessel vasculitis.

Initial investigations revealed pancytopenia with high ESR and CRP. LFT showed hypoalbuminemia with high globulin fraction. Elevated urea creatinine showed suggestive Acute kidney injury stage-I

Urine complete analysis showed proteinuria (3+) and mild haematuria.Hence work up was done for SLE; ANA-Test was positive, but ANCA C/P Negative. For closed monitoring purpose baby received in PICU. To correct hypoxemia started with 2L of O2 by nasal prongs in which baby’s spo2 improved.

Anemia corrected with Leukodepleted packed cell (Blood that has had white blood cells removed through a process) and hemoglobin increased. Platelet count has decreased to 13000 and platelet rich concentrate was transfused.

Pediatric Nephrology cross consultation was obtained to correct increased level of Urea & Creatinine suggested for Renal biopsy which was performed  and results showed class 3 Lupus Nephritis. Dermatologist Rheumatologist cross consultation were also obtained

Pediatric hematologist opinion obtained suggested Bone marrow study if ANA is negative (ANA Positive).

Intervention

  • Persistant Fever spikes: Antibiotics, Antipyretics , IV Fluids
  • Anemia: Blood transfusion
  • Thrombocytopenia: Platelet Transfusion.

Baby was transferred to Pediatric HDU in a condition of afebrile, alert and maintaining saturation of 99%on Room air. Uneventful stay in HDU for 48 hr.

Condition at Discharge

Child stable, afebrile, Hydration adequate, Urine output adequate, Vitals stable, Systems normal.

Advice on Discharge

  • Diet as advised
  • Review in Paediatric nephrology OPD on 8.2.2025 with CBC, Creatinine, Potassium & urine complete analysis.
  • Rheumatologist follow up
  • Report immediately: If baby has excessive dullness, continuous cough, cold, high grade fever, fast breathing, difficulty in breathing, excessive diarrhea, vomiting, reduced urine output.
Course in the Hospital Advice on Discharge
Inj:MeropenamTab. Linezolid
Inj:FluconazoleTab. Cepodem
Inj:PantoprazolTab. Fluconazole
Inj: EmesetTab. Omnacortil
Inj:FrusemideTab. Hydroxychloroquine
Tab:PrednisoloneTab. Mycomune
Tab:HydroxychlorideTab. Aldactone
Tab:AllopurinolTab. Lasix
Tab:AldactoneTab. Pantop
Tab:ZincovitTab. Shelcal
Tab:ShelcalTab. Zincovit
Vitamin D drops

Discussion

Systemic Lupus Erythematosus (Book Picture)

Systemic lupus Erythematosus (SLE) is an autoimmune disease. In this disease, the immune system of the body mistakenly attacks healthy tissue. It can affect the skin, joints, kidneys, brain, and other organs.

Causes

The cause of SLE is not clearly known. It may be linked to the following factors:

  • Genetic
  • Environmental
  • Hormonal
  • Certain medicines.

Sign and Symptoms

  • Fatigue
  • Fever
  • Weight loss
  • Mouth sore
  • Skin Rashes
  • Swollen Lymph Nodes
  • Anemia
  • Low white blood cells/ platelet count.

Tests used to diagnose SLE may include:

Image Illustrate: Malar Rash lupus

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