The Butterfly Rash, many have heard of it as a presentation of a chronic autoimmune disease. Yes, I am talking about Lupus. May marks the beginning of Lupus Awareness Month. This month is meant to raise awareness, educate others, and learn more about this autoimmune disease. As medical students, we have learned about Lupus in our Immunology, Pathology, and Medical Microbiology classes. However, this disease is known to still present with many unanswered questions in the medical field. Today, I am going to provide my readers with a minimal explanation and a case for your basic understanding of Lupus.
Lupus as I said is an inflammatory autoimmune disease which presents with a variety of clinical presentations and can stem from one organ to multiple organs being affected (Maidhof and Hilas, 2012). There are 4 types of lupus: neonatal and pediatric lupus erythematosus (NLE), discoid lupus erythematosus (DLE), drug-induced lupus (DIL), and the most common one is systemic lupus erythematosus, (Maidhof and Hilas, 2012). For a clinician, it can be extremely difficult to come up with an accurate diagnosis of lupus since there are many clinical presentations which could relate to other illness and diseases. Let’s look at a case to help us better understand it.
Case: A 50 year old Asian Female who works as a teacher comes into the ED with a six-month history of generalized weakness, weight loss, and fever.
- Integumentary observation: skin Rash; “butterfly rash”
- Palpitation: palpable lymph nodes with possible lymphadenopathy
- Cardiovascular: decreased breath sounds
- ROM: painful joints especially elbows and knees with general weakness
Clinically looking at this case, it clearly presents with signs of acute systemic lupus erythematosus. However, many patients might come in with mild presentations of lupus so further testing should be done (Justiz, et. al., 2020). This could include a WBC, ANA testing, Autoantibody Testing, Complete Metabolic Profile and Urinalysis. All of these tests should be performed to completely rule out any other diagnosis (Maidhof and Hilas, 2012).
Many physicians will provide approach differently to Lupus depending on the severity of the disease. However, general recommendation tends to be sun protection, proper diet, exercise, and prescription of NSAIDS or Corticosteroids (Maidhof and Hilas, 2012). Although there is no cure for Lupus, further research is looking to provide a better outcome for the patients suffering from Lupus (Maidhof and Hilas, 2012).
As a chronic disease, it is noted that the patient and provider should keep a close and clear communication so that long-term quality of life can be maintained until a cure for Lupus is discovered. Raising awareness, more research, and education about Lupus are the building blocks to finding a cure to this chronic disease.
Ali, A., Sayyed, Z., Ameer, M. A., Arif, A. W., Kiran, F., Iftikhar, A., Iftikhar, W., Ahmad, M. Q., Malik, M. B., Kumar, V., Dass, A., Sami, S. A., Sapna, F., & Waqas, N. (2018). Systemic Lupus Erythematosus: An Overview of the Disease Pathology and Its Management. Cureus, 10(9), e3288. https://doi.org/10.7759/cureus.3288 (Retraction published Cureus. 2019 Apr 16;11(4):r13)
Justiz Vaillant AA, Goyal A, Bansal P, et al. Systemic Lupus Erythematosus. [Updated 2020 Dec 30]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK535405/
Maidhof, W., & Hilas, O. (2012). Lupus: an overview of the disease and management options. P & T : a peer-reviewed journal for formulary management, 37(4), 240–249.