Case StudyKelly Morris

Consider the following patient:

A female patient, age 25, comes into your office. She is 5’8 and 160 lbs, African-American, and is generally in good physical condition. However, after a recent trip from her North Dakota home to beautiful, sunny Florida, she is experiencing joint stiffness and fatigue. She has shortness of breath and a rash in the shape of a butterfly has formed over her nose and cheeks.

What is your initial diagnosis for this patient? What tests would you run to confirm your hypothesis?

Tests used to diagnose the patient

Complete Blood Count Erythrocyte sedimentation rate Kidney and liver assessment Urinalysis Antinuclear antibody (ANA) test Chest X-ray Echocardiogram Biopsy of kidney tissue

So, what is it?

Although it is hard to diagnose due to the wide range of signs and symptoms and the fact that there is no definitive test for lupus, you believe that your patient has lupus. The characteristic butterfly rash on her face due to so much sunlight exposure on her recent trip to Florida support your hypothesis.

“Lupus is a chronic inflammatory disease that occurs when your body's immune system attacks your own tissues and organs. Inflammation caused by lupus can affect many different body systems — including your joints, skin, kidneys, blood cells, brain, heart and lungs.Lupus can be difficult to diagnose because its signs and symptoms often mimic those of other ailments. The most distinctive sign of lupus — a facial rash that resembles the wings of a butterfly unfolding across both cheeks — occurs in many but not all cases of lupus.Some people are born with a tendency toward developing lupus, which may be triggered by infections, certain drugs or even sunlight. While there's no cure for lupus, treatments can help control symptoms.” (Mayo Clinic)

You prescribe belimumab (lymphoStat-B) to decrease inflammation Full-human monoclonal antibody Selectively targets and inhibits solube bLyS

Controls differentiation, proliferation and survival of B-cells Inhibition of BLyS can result in autoreactive B-cell apoptosis “Benlysta® (belimumab, formerly called LymphoStat-B™) was

developed to disrupt activation of B lymphocytes by interfering with BLyS, a protein required for B cell activity. Benlysta is the first and only drug specifically developed for and approved to treat lupus.” (Lupus Foundation)

Other medications prescribed to help manage lupus There is no treatment to cure lupus, but these medications help manage

the symptoms: Aspirin Acetaminophen NSAIDs Corticosteroids Antimalarials Immunosuppressives Anticoagulants Monoclonal antibodies (belimubab) Repository Corticotropin Injection

References

http://www.mayoclinic.org/diseases-conditions/lupus/basics/risk-factors/con-20019676

http://www.mollysfund.org/2013/01/lupus-symptoms-and-signs/ https://lupusadventurebetweenthelines.wordpress.com/2013/08/ http://www.lupus.org/answers/entry/medications-to-treat-lupus