Friday, January 18, 2013

Fever in a patient with SLE

Today we heard about a patient with a history of SLE presenting with cough and fever

1) The key question in these cases is always this one: is this an INFECTION or an SLE flare?
Clues here are the CBC: leukocytosis is suggestive of infection, whereas leukopenia and lymphopenia is seen in lupus flare (note that some infections, including sepsis in the elderly, can also produce this pattern).

Other clues: if your patient is known to have a rise in anti-dsDNA or drop in complement during previous flares, these changes would suggest that this may be occurring again.

If you are uncertain, cover with antibiotics while you figure it out.

2) We talked about the lung complications associated with SLE:
- pleurisy: note that this can be from costochondritis and/or serositis
- interstitial lung disease
- pulmonary hypertension
- acute lupus pneumonitis
- pulmonary hemorrhage
- shrinking/vanishing lung syndrome: progressively decreasing lung volumes, elevated diaphragms

Check out this review of SLE