Surreptitious Tales Of Systemic Lupus Erythematosis (Sle)

Abstract

Systemic lupus erythematosus (SLE) is an auto-immune, multi-systemic inflammatory disease affecting various major organs in the
body. This is an interesting case series on unanimous presentations of SLE in a tertiary care centre. This case series gives an idea of
approaching wide variety of clinical manifestations as initial symptoms in SLE. All 5 cases have been diagnosed with American college
of Rheumatology criteria. A young female with GTCS seizures as a presenting symptom was diagnosed as CNS lupus finally. Initial
symptoms like seizures, cognitive impairment, anxiety can also give the path-breaking clues to neuropsychiatric SLE. One of the causes
of pyrexia of unknown origin (PUO) is connective tissue disorders, although SLE is common among them, SLE presenting with gastrointestinal
symptoms in PUO is very rare. After reviewing literatures, only very few cases of male SLE reported and eventually, the
proteinuria was evaluated and diagnosed to have minimal change disease in renal biopsy in an 18yr old boy. Patient was temporarily
dialysed and started on pulse-steroids and his renal functions restored gradually. SLE can also present with other connective tissue
disorders like Sjogren’s syndrome, scleroderma, rheumatoid arthritis. Anti-RNP antibodies in higher titres in SLE patients supports the
diagnosis of mixed connective tissue disorders (MCTD). Although it has a multi-system involvement, diffuse alveolar heamorrhage
(DAH) as clinical presentation is life-threatening and very rare and only 2% cases reported in SLE. Among the 5 cases,4 cases survived
with I.V pulse-steroids and immune-modulators, while one patient with DAH succumbed to death.