Case Studies

 Case 10.9 Mild systemic lupus erythematosus

A 32-year-old woman presented to the dermatology clinic with a facial rash but without other symptoms or signs. Antinuclear antibody and dsDNA-binding tests were negative and complement and immunoglobulin levels were normal. She was an epileptic who had been on phenytoin for 6 years. The dermatologist reduced the dose and later changed to another antiepileptic drug, but the rash remained. Ten years after presentation, she developed acute pleurisy. At this time, she had a positive ANA (titre 1/80), dsDNA binding of 80% and a low C4 of 0.16g/l (NR 0.2-0.4). A diagnosis of SLE was made and she was treated with a low dose of prednisolone with resolution of the pleurisy. The prednisolone was gradually discontinued; she has not required further treatment in the intervening 5 years.