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Abstract: Ms. Zhao, 29, has had a rash with fever for more than 10 years, which has been aggravated for 2 years. The rash is mostly located on the face and is accompanied by swelling of the lower limbs, joint pain, and weakness, which are symptoms of systemic lupus erythematosus. The cause of SLE is not clear, but may be related to genetics, ultraviolet radiation, food and medication, etc. It is a chronic disease.
Basic information】Female, 29 years old
Disease Type】Systemic lupus erythematosus
Hospital】The First Hospital of China Medical University
Date of consultation】June 2017
【Treatment plan】Medication (pantoprazole sodium for injection, prednisone acetate tablets, hydroxychloroquine sulfate tablets, calcium carbonate D3 chewable tablets, candesartanate tablets)
[Treatment Period] 5 days in hospital, 15 days after outpatient follow-up
Treatment effect】The disease was basically controlled, the fever disappeared, and the rash was relieved.
I. Initial interview
When we first saw the patient, we could find a red rash on the face, which was not accompanied by itching or pain, and a low fever of 38℃. He reported that the above symptoms had existed for more than 10 years, and his symptoms improved after he was given medication at the hospital. 2 years ago, he developed swelling and weakness in both lower limbs, and was diagnosed with lupus nephritis, and his symptoms decreased after he was given medication. He was diagnosed with lupus nephritis 2 years ago, and his symptoms decreased after medication. 1 week ago, he experienced increased weakness, mild swelling of both lower limbs, knee pain, and epigastric discomfort, and came to our hospital for further treatment. The physical examination showed a red rash on the face and mild depressed edema on both lower limbs, and the preliminary diagnosis was SLE with lupus nephritis.
II. Treatment history
Usually, based on the patient’s clinical manifestations, physical examination and the patient’s medical history, the patient was clearly diagnosed with SLE with lupus nephritis. Firstly, hormones and immunosuppressive drugs, i.e. prednisone acetate tablets and hydroxychloroquine sulfate tablets, were given to the patient to control the patient’s condition. The patient was also given pantoprazole sodium for injection to avoid drug damage to the gastric mucosa. The patient was given candesartanate tablets to control blood pressure and calcium carbonate D3 chewable tablets to prevent osteoporosis caused by long-term hormone use. After that, the patient was instructed to ensure adequate rest and also avoid ultraviolet radiation to reduce disease recurrence.
III. Treatment effect
After regular medication and general treatment, the patient’s condition was basically controlled, and the symptoms of joint pain and weakness disappeared, but the facial rash did not completely disappear. On the second day of admission, the patient’s fever disappeared, and the joint pain and swelling of both lower limbs decreased, but the facial erythema still existed. On the 5th day of admission, the patient’s joint pain, facial rash and swelling of both lower limbs were significantly improved and the condition was basically controlled.
IV. Precautions
Since SLE disease is relatively easy to recur, patients need to pay attention to taking drugs regularly under the guidance of doctors and avoid blindly stopping or reducing the dosage by themselves to avoid recurrence of the disease, and the disease may be stimulated by ultraviolet radiation, so patients need to avoid ultraviolet radiation when going out and can choose to wear long clothes and pants. In addition, patients need to ensure adequate rest and avoid overexertion during disease treatment or after hospitalization, and also need to pay attention to constant observation, and actively go to the hospital if symptoms of discomfort appear.
V. Personal insight
SLE is a chronic disease with a long duration and recurrent attacks, so patients should not stop taking medication but need to take medication regularly. Patients should not let down their vigilance for SLE, otherwise they may develop lupus nephritis like the patient in this case. We doctors should also pay attention to the various complications of SLE, take into account the adverse effects of long-term medication during the treatment process, and give corresponding medication to prevent them.