Abstract
BackgroundSystemic lupus erythematosus (SLE) is a multi-system autoimmune disease which most commonly presents in women of reproductive age. It takes a relapsing-remitting course and may manifest as a variety of clinical symptoms, making it difficult to diagnose at first presentation, particularly in the emergency department (ED) setting. In active SLE, rhabdomyolysis has, thus far, not been reported as the sole initial presentation.Case presentationA 28-year-old presented to the ED with bilateral proximal arm swelling and pain. She had a previous history of Raynaud’s disease. Creatine kinase was > 13,000 units/l (normal range 25–200), but renal function was preserved. She did not require hospital admission so was encouraged to take oral fluids and discontinue the combined oral contraceptive pill. Antinuclear antibody and anti-double-stranded DNA titres were highly elevated with low complement demonstrated. She was diagnosed with SLE and treated with an oral prednisolone course. Antibody titres remained high 6 months later, provoking the initiation of hydroxychloroquine therapy.ConclusionsWe report with a view to recommend autoimmune screening in young patients for whom a cause of rhabdomyolysis is not clearly identified.
Highlights
Systemic lupus erythematosus (SLE) is a multi-system autoimmune disease which most commonly presents in women of reproductive age
We report with a view to recommend autoimmune screening in young patients for whom a cause of rhabdomyolysis is not clearly identified
creatine kinase (CK) improved but 6 months later, SLE disease activity remained significant according to biochemical markers such as anti-Double-stranded DNA (dsDNA), erythrocyte sedimentation rate (ESR) and complement
Summary
Systemic lupus erythematosus (SLE) is a multi-system autoimmune disease which most commonly presents in women of reproductive age. Conclusions: We report with a view to recommend autoimmune screening in young patients for whom a cause of rhabdomyolysis is not clearly identified. Acute presentations of SLE to the emergency department are more readily identified in patients with a pre-existing diagnosis.
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