Question

Case Study 1

Ms. X, a 32-year-old Hispanic woman, has had a history of intermittent pleuritic chest pain and joint pain for the past several years. Recently, she went to her physician because she noticed that an erythematous, butterfly-shaped rash had appeared on her face. Further lab tests indicated protein in her urine. Her blood test indicated the presence of numerous antinuclear antibodies, especially anti-DNA, and mature neutrophils containing nuclear material. A diagnosis of systemic lupus erythematosus (SLE) was made.

Discussion Questions

Discuss possible reasons why SLE was not diagnosed earlier. (See SLE—Clinical Signs and Symptoms.)

Discuss how the presence of antibodies can cause such widespread damage in organ systems. (See SLE—Pathophysiology.)

Discuss treatments for SLE and a prognosis for the patient in this case. (See SLE—Treatment.)

Answer 1

Systemic Lupus Erythematous is an autoimmune disorder. It means body is unable to recognize body's own cells. Systemic Lupus Erythematous is a chronic disease and it affects all the systemic organs. It leads to organ failure. The specific cause for SLE is unknown.If the patient develop Erythematous , butterfly shaped rash on her face in early stage , she would have diagnosed earlier. But pleuritc chest pain and joint pain are also symptoms of SLE. In SLE pleuritc chest pain is caused by deposition of connective tissue and fibrin leads to cause necrosis and inflammation of pleura. The only specific signs and symptoms of SLE are butterfly rash over the face and erythema of the palms.

In SLE , Antinuclear Antibody test is positive. C - reactive protein and erythrocyte sedimentation rate is elevated. Since SLE is an autoimmune disorder , body's own cells invade the own cells and make them to destroy. Invasion of body's own cells leads to necrosis and inflammation of organs. This make the organs to diminish it's function. Prolong diminished functions of organs leads to organ failure. It affects major organs to fail in it's function that leads to systemic organ failure.

Symptomatic treatment can be provided for SLE. Due to erythema , integumentary system is affected. So periodic monitoring of skin integrity is important. Advise the patient to clean the skin and apply ointment for rash. If the patient is having anemia , administer iron supplements , folic acid supplements and vitamin supplements if prescribed. For joint pain and inflammation , provide systemic corticosteroids and NSAIDs if prescribed. Because of fibrin deposition , clotting mechanism is impaired. So advice the patient to monitor for bruising and bleeding. Provide support therapy , emotional support as and when needed for the patient. Check for organ involvement and failure. Monitor renal functions for the patient with SLE. Signs of renal impairment should be detected by monitoring the levels of blood urea nitrogen and creatinine. If there is no renal impairment , provide high protein diet for SLE patient.