Abstract Inadequate Therapy of Systemic Lupus Erythematosus (SLE)?

Evriyanti T, Oktaviandani W, Antoni, Silahudin M, Almar A, Abidin AZ, Aliana R, Yuniza, Kurniati N, Salim EM* *Allergy and Immunology Division, Internal Medicine Departement of Hoesin M Hospital / Medical Faculty of Sriwijaya University, Palembang Preliminary : SLE is an autoimmune disease, characterized by the production of antibodies against components of the cell nucleus, associated with extensive clinical manifestations. SLE primarily affects young women, 15-40 years of age during the reproductive period with the ratio of women and men 5:1. Etiology of SLE is unclear, allegedly associated with gene-specific immune response in major histocompatibility complex class II HLA-DR2 and HLA-DR3. Case Report: A woman, Mrs. N, 31 years old, came to the Hoesin M Hospital with the chief complaint increasing joint pain since 2 days before admitted to the hospital. Another additional complaint was eyes appeared yellow since 1 week ago. Since 6 months ago, the patient complained joints pain, especially hands, feet and knees joints. There were also hair loss, mouth sores, fever which was not too high and red spots on the face, especially when exposed to sunlight. She was hospitalized and said having SLE. Then, she went home and got therapy methyl prednisolone, calcium carbonat, and omeprazole. She didnt controlled routinely at hospital. Since 1 month ago, she complained all of the signs and symptoms like 6 months ago, which was worse since 1 week ago. So that, she couldnt move her hands and feet. There were also yellowish eyes color, dark tea color urinating and nausea. On physical examination: CM, BP:100/70 mmHg, P:106 x/min, RR: 22x/min, T: 38.3C. Head: pale conjunctiva palpebra (+), jaundice sclerae (+), hair loss (+), malar rash (+), oral ulceration (+). Extremities: joint pain (+), edema of the dorsum pedis (+). Additional examination Hb 8.8 g/dl, leucocyte 6300/mm3, platelet 11.000/mm3, ureum 60 mg/dl, albumin 1.7 g/dl, sodium 126 mmol/l, calcium 1,45 mmol/l, total bilirubin 26.49 mg/l, direct bilirubin 5.04 mg/dl, indirect bilirubin 21.45 mg/dl, alkaline phosphatase 294 U/I, AST 196 U/I, ALT 66 U/I. Urinalysis: erythrocyte 2-3/LPB, blood (+), bilirubin 4.8. Thorax X-ray: cardiomegaly. Echocardiografi: minimal pericardial effusion. USG: hepatomegaly caused by hepatitis. Funduscopy: moderate vasculitis. HBsAg (-), AntiHCV (-), IgM antiHAV nonreactive, Coombs test (+), SMA (-), C3 20 (N:84-160 mg/dl), C4 5 (N:10-40 mg/dl), Anti dsDNA 786 (N<100 Iu/ml), ANA IF >1/1000 (N<1/100). ARA criteria: malar rash, mouth ulceration, arthritis, photosensitivity, serositis, hematology disorders, immunology disorders. Sledai criteria: vasculitis (8), arthritis (4), hematuria (4), new rash (2), alopecia (2), oral ulceration (2), pericarditis (2), fever (1), lowcomplement (2), trombositopenia (1). Total 28 (SLE flare up). Conclusion: Diagnosis: SLE flare up with AIHA and lupoid hepatitis. Patient was treated with methyl prednisolone injection 2x62,5mg, then switch to oral and tapering off, MMF 2x500 mg, folic acid 1x1 gr, omeperazole 1x20 mg, CaCO3 3x500mg, paracetamol 3 x500mg (prn), washed eriythrocyte transfusion and albumin infuse. Key Point : Systemic Lupus Erythematosus (SLE), Autoimmune Hemolytic Anemia (AIHA), Lupoid Hepatitis