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Abstract: Systemic lupus erythematosus is a chronic systemic autoimmune disease with multisystemic damage, and patients mainly present with skin damage, fever, and joint pain. In this case, the patient presented with joint pain for six months and skin ulceration all over the body as the main manifestation.
Basic information】Female, 46 years old
Disease Type】Systemic lupus erythematosus
Hospital】The First Hospital of China Medical University
Date of consultation】August 2019
Treatment plan】Medication (injectable methylprednisolone sodium succinate, injectable streptomycin sulfate, polyene phosphatidylcholine injection, injectable reduced glutathione, hydroxychloroquine sulfate tablets, amoxicillin capsules, cefaclor capsules)
[Treatment period] 12 days of inpatient treatment, 3 months of outpatient follow-up
Treatment effect】The condition improved and the skin symptoms gradually healed
I. Initial consultation
Patient, male, 73 years old. Six months ago, he developed joint pain, mainly in both ankles, with normal body temperature. 1 month ago, his family found that the patient had skin ulcers all over the body, and his body temperature increased to a maximum of 38.0℃, with local exudate, no cough or sputum, no chest tightness or breath-holding, no nausea or vomiting, no abdominal pain or diarrhea, and was treated with out-of-hospital infusion (specific drugs unknown), with poor results. The patient mainly presented with skin ulceration, joint pain, swelling and morning stiffness. On examination, there was no yellow staining of the skin mucosa, scattered ulcers on the skin with localized black spots, exudate at the elbow joint and posterior hip of the right upper limb, no subcutaneous hemorrhage, subcutaneous nodules, scarring, no subcutaneous edema, no liver palms, no spider nevus. The patient was given blood sedimentation test and liver function test, and the results showed that hematocrit was 104mm/h, glutathione aminotransferase was 87.7U/L, glutathione aminotransferase was 346.6U/L, total serum protein was 85.9g/L, albumin was 24.7g/L. Combined with the patient’s symptoms, the preliminary diagnosis was “systemic lupus erythematosus”.
II. Treatment process
After admission, the patient was given glucocorticoid and hepatoprotective therapy through relevant examinations. After communicating with the patient and his family and explaining the efficacy of the drugs, the patient and his family agreed to the treatment plan. The patient was given sodium methylprednisolone succinate for injection intravenously, streptomycin sulfate for injection for anti-infection treatment, and polyenyl phosphatidylcholine injection and reduced glutathione for injection for hepatoprotective treatment. On the third day of admission, the patient still saw multiple skin ulcers, so he was given hydroxychloroquine sulfate tablets orally to regulate immunity and continued anti-infection treatment. On the 6th day of admission, the patient’s blood count and platelets were better than before, and the hormone treatment was reduced. On the 12th day of admission, the patient’s systemic symptoms were relieved and he was discharged from the hospital. The patient was given amoxicillin capsules and cefaclor capsules for oral anti-inflammatory treatment.
III. Treatment effect
After drug treatment, the patient had no fever, skin ulcers were significantly better than before, no dry mouth and eyes, no skin rash, eating and sleeping, and normal urination and defecation. On examination: the whole body was wrapped with sterile gauze, the respiratory sounds of both lungs were clear, no dry rales were heard, the heart rhythm was regular, no murmurs, the abdomen was soft, the liver and spleen were not detected, and there was no edema in both lower limbs. The patient’s symptoms were stable, and he was advised to continue taking oral anti-inflammatory drugs outside the hospital and follow up on his discomfort.
IV. Notes
The patient was discharged from the hospital after her condition improved, but she did not recover completely, but her mental state was good and her condition was stable. The patient was advised to take rest after discharge, and to strengthen nutritional support, maintain nutritional balance, and avoid stimulating foods, such as lobster and scallops. You can participate in sports activities appropriately to enhance the immunity of the body. Pay attention to wearing loose clothing on a daily basis to avoid rubbing and stimulating the diseased skin. In addition, pay attention to protecting the skin from breaking down and bleeding to prevent infection. After being discharged from the hospital, you should continue to take oral anti-inflammatory drug treatment, do not stop the drug without authorization, and do not add or reduce the drug by yourself. If you have any uncomfortable symptoms, you should go to the hospital in time.
V. Personal insight
Systemic lupus erythematosus and rheumatoid arthritis can have joint lesions, which should be carefully distinguished to avoid delaying the patient’s condition. The manifestations of joint lesions in this case mainly include pain, swelling and morning stiffness, etc. The patient complained of a short duration of morning stiffness, while rheumatoid arthritis is mostly manifested as symmetrical polyarthritis, and the duration of morning stiffness is usually longer than one hour. In addition, SLE is usually accompanied by skin lesions, while rheumatoid arthritis generally has no skin lesion symptoms. Therefore, rheumatoid arthritis should be excluded and treated according to SLE.