关键词: class v lupus nephritis exudative pleural effusion lupus proteinuria systemic lupus erythematosus

来  源:   DOI:10.7759/cureus.62091   PDF(Pubmed)

Abstract:
Systemic lupus erythematosus (SLE) is an autoimmune condition more commonly observed in women of childbearing age. The most commonly reported initial presentations were fatigue, arthritis, and skin manifestations. However, due to the involvement of a variety of organs, diagnosis remains a challenge for physicians. Our patient is a 48-year-old lady who presented with severe bilateral lower extremity edema with non-resolving right lower lobe pneumonia and ipsilateral exudative pleural effusion. Her leg swelling was not responding to diuretics, and her pneumonia was not improving following a course of antibiotics. This unusual presentation prompted an autoimmune workup, which later revealed a diagnosis of SLE with class 5 lupus nephritis. Pleuritis, exudative pleural effusion, and lupus nephritis have been associated with autoimmune disorders in the literature, but this is an uncommon initial presentation in SLE without other clinical manifestations. Our case report highlights the challenges in the diagnosis of an atypical case of SLE and the need to maintain high clinical suspicion for SLE, especially in female patients with multiorgan involvement.
摘要:
系统性红斑狼疮(SLE)是一种在育龄妇女中更常见的自身免疫性疾病。最常见的初始报告是疲劳,关节炎,和皮肤表现。然而,由于各种器官的参与,诊断仍然是医生的挑战。我们的患者是一名48岁的女士,患有严重的双侧下肢水肿,并伴有无法解决的右下叶肺炎和同侧渗出性胸腔积液。她的腿部肿胀对利尿剂没有反应,经过一个疗程的抗生素治疗后,她的肺炎没有改善。这种不寻常的表现促使了自身免疫检查,后来诊断为SLE伴5类狼疮性肾炎。胸膜炎,渗出性胸腔积液,文献中狼疮肾炎与自身免疫性疾病有关,但这是SLE中罕见的初始表现,没有其他临床表现。我们的病例报告强调了在SLE非典型病例的诊断方面的挑战,以及维持SLE的高度临床怀疑的必要性。尤其是多器官受累的女性患者。
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