CASE STUDY

PRESENTED BY
Ms. DANY SEBASTIAN
PHARM D III
ROLL NO : 12
A 41year old female patient was admitted to
the hospital with c/o maculopapular rash on
sun exposed areas since 2 months. The rash
first appeared on the cheeks and nasal bridge
and later on hands , neck and sun exposed
areas of back. She complained of burning
sensation with occasional itching for the past 2
weeks. No h/o DM , HTN or Asthma.
DEMOGRAPHIC DETAILS
Name : Latha Karthikeyan

Age : 41

Sex : Female

DOA : 26 Dec 2014

DOD : 29 Dec 2014

SOAP ANALYSIS
SUBJECTIVE
Presenting Complaints
Rashes on the sun exposed areas of the body for the
past 2 months. Rashes first appeared on the cheeks and
nasal bridge later on the hands and neck. Burning
sensation with occasional itching present.

Past Medical History

H/O IUD 5 years back at the 8th month of gestation and
it followed cerebral vein thrombosis No history of DM
Asthma .
Past Medication History
The patient is on anticoagulant therapy. Also
taking topical and oral drugs with sunscreen.

Family History
No h/o DM , HTN or such illness.

Dietary History
Mixed diet.
Immunization History
No recent h/o of any immunization.

Social Economic History

Middle class family.
No exposure to passive smoking
OBJECTIVE
O/E THE PATIENT IS CONSCIOUS
AND ORIENTED.
General Examination
Pulse : 70/min
RR : 16/min
Temp : Afebrile
BP : 120/80mmHg

P/A
Soft , non tender
No organomegaly
BS +
RS
B/L air entry equal
NVBS +
CVS
S1 S2 +
No murmur
CNS
HMF normal
Plantar normal

Musculoskeletal system
No joint pain , swelling or tenderness
 LOCAL EXAMINATION
 Maculopapular rash , pink coloured on cheeks
nasal bridge , hands , neck and on the sun exposed
areas of back.
 Scaling and tenderness is present in some lesions.

 Hyperpigmented patches over forehead and

upper chest.
 No alopecia.
HEMATOLOGY
TEST VALUE REFERENCE INFERENCE
Hb %gm 10.1 12 – 14g% Low
PCV 33.7 35 – 45 % Slightly low
Platelets lakhs 2 1 – 4 lakh Normal
ESR mm/hr 40 <20 mm/hr Very high
WBC 4500 5,000-11000 Low
neuto 50 54%-62% Low

lym 10 25%-30% Very low

esino 1 1%-3% Normal

mono 3 0%-9% Normal
Blood sugar RBS 106 70 -120 Normal

Blood urea 15 <40 Normal

Creatinine 0.55 0.5 – 1.4 Normal

Na 142 135 - 145 Normal

K 4.1 3.5 – 4.5 Normal

URINE ANALYSIS
•Albumin : nil
•Sugar : nil
•Cast , crystals : nil
•Epicells : 1-2
•WBC :12-15
•RBC : nil
•Acidic reaction
ASSESSMENT
SYSTEMIC LUPUS ERYTHEMATOSUS
Systemic lupus erythematosus (SLE) is an autoimmune disease in
which the body's immune system mistakenly attacks healthy tissue.
It can affect the skin, joints, kidneys, brain, and other organs.

The underlying cause of autoimmune diseases is not fully known.

SLE is much more common in women than men. It may occur at
any age, but appears most often in people between the ages of
10 and 50. African Americans and Asians are affected more
often than people from other races.

SLE may also be caused by certain drugs like procainamide ,

hydralazine , quinidine.
 TREATMENT
•Wear protective clothing, sunglasses, and sunscreen when in the sun
•Get preventive heart care
•Stay up-to-date with immunizations
•Have tests to screen for thinning of the bones (osteoporosis)

•NSAIDs for joint symptoms after talking with your doctor

•Corticosteroid creams for skin rashes
• Hydroxychloroquine and low-dose corticosteroids

Treatments for more severe SLE may include:

•High-dose corticosteroids
•Cytotoxic drugs (drugs that block cell growth or drugs which dampen
or suppress the immune system): These medicines are used if you do
not get better with corticosteroids, or if your symptoms get worse .
Side effects from these drugs can be severe, so you need to be
monitored.
DRUG DETAILS
BRAND GENERIC NAME INDICATIONS ADR INTERACTIONS
DRUG /CLASS
INJ.DEXAMET DEXAMETHASO Corticosteroid Headache , menstrual
HASONE NE disturbances, wt gain,
INJ CYCLOPHOSPA Cytotoxic Bone marrow Altered blood levels
.ENDOXAN MIDE drug suppression with warfarin

T .HCQS HYDROXYCHLO Antimalarial Blurred vision , hair

ROQUINE for SLE loss ,photosensitivity

CAP. VITAMIN B Vitamin

BECOSULES COMPLEX supplement

T. ECOSPIRIN ASPIRIN Antiplatelet , Hemorrhage

NSAID

T. WARF WARFARIN Anticoagulant Bleeding , nausea Altered blood levels

,vomiting with steroid drugs
T PREDNISOLONE Corticosteroid Peptic ulcer , increased Increased risk of GI
.WYSOLONE appetite bleeding with
NSAIDs
SUNCROS OCTINIXATE,OX Sunscreen ,
AQUA GEL YBENZONE, Skin protective
TREATMENT CHART
BRAND NAME GENERIC NAME DOSE FREQUEN DA DA DA DA
CY Y1 Y2 Y3 Y4

INJ.DEXAMETHASON DEXAMETHASONE 100mg Slow IV in √ √ √ √

E NS

INJ.ENDOXAN CYCLOPHOSPHAMIDE 500mg Slow IV in √ √ √

Dextrose
_

T. HCQS HYDROXYCHLOROQUI 200mg 1-0-0 √ √ √ √

NE

CAP. BECOSULES Z VITAMIN B COMPLEX OD √ √ √ √

T. ECOSPIRIN ASPIRIN 75mg 1-0-0 √ √ √ √

T.WARFARIN WARFARIN 10mg 0-0-1 √ √ √ √ √

DISCHARGE MEDICATION
T . HCQS 200mg 1-0-0

CAP. BECOSULES OD

T. ECOSPIRIN 75mg 1-0-0

2 weeks*
T. WARFARIN

T. WYSOLONE 7.5mg 1-0-0

SUNCROS AQUA GEL LA

T. ENDOXAN 50mg OD
*review after 2 weeks
 ON DISCHARGE
Vitals were stable with no
fresh complaints.
PLAN
Follow the therapeutic regimen properly.

Get regular checkups with your opthamologist in every 3 months and WBC and platelets should
be checked regularly..

Avoid the sun. If you must be in the sun, cover your arms and legs, wear a hat, and apply broad-
spectrum sunscreen with a high sun protection factor (such as SPF 50) to protect skin.

Good self-care is essential to managing lupus. It can improve your quality of life. Good self-care
also helps decrease the risk of heart attack and stroke.Self-care includes getting regular
exercise and eating a healthy diet.

Stress may trigger lupus symptoms.

Exercise regularly. A daily walk, for example, can reduce stress, clear your head, improve your
mood, and help fight fatigue.
Use relaxation techniques such as meditation ,and yoga to calm your body
and mind.

Fatigue is common in people with lupus. To fight fatigue:

Get plenty of rest. Some people with lupus need up to
12 hours of sleep every night.
A well-balanced diet is one that is low in fat; high in fruits, vegetables, and whole
grains; and contains a moderate amount of meat, poultry, and fish is essential for these
patients.

Vaccines to prevent pneumonia and the flu are recommended for people with lupus.

Prednisone increase appetite, potentially causing you to gain a lot of weight. Try to
control your appetite and to stay active. Weigh yourself daily while taking prednisone.
Also the drug should not be stopped abruptly.

Steroid medication can weaken your immune system, making it easier for you to get an
infection or worsening an infection you already have. So avoid being near people who
are sick or have infections.

Drink plenty of liquids while you are using cyclophosphamide, to prevent harmful effects
on your bladder.

Consult your doctor if you notice any changes in your vision while taking
hydroxyquine.

While taking warfarin vitamin K containing food should be avoided also

care should be given while handling sharp objects to avoid injury.
Taking care of your skin and health
Ask your doctor about the use of corticosteroid creams to relieve
skin symptoms. If you are bothered by the way a lupus rash looks
on your face or if you have scars from lupus, you can try makeup,
such as Covermark, to cover the rash or scars.

UV light triggers lupus. Exposure to ultraviolet light, as from

sunlight, can trigger or start skin rash, joint pain, or fatigue or it can
make these symptoms worse.

Avoid the sun. If you must be in the sun, cover your arms and legs,
wear a hat, and apply broad-spectrum sunscreen.

Avoid going out when the sun's rays are the strongest. In most
areas, this is between the hours of 10 a.m. and 4 p.m., especially
during the summer.
P H A M A S I S T’S I N T E R V E N S I O N
Antinuclear antibodies (ANA) were not checked which
is a major diagnostic tool.
Co-administration of prednisolone with NSAIDs like
aspirin cause an increased risk of GI bleeding and
ulceration.
PPI should be prescribed with Aspirin.
Cyclophosphamide will cause bone marrow suppression
and may further decrease the blood counts.

Clotting time and bleeding time should be checked.

REFERENCES

CIMS
www.drugs.com
www.webmd.com
www.patient.co.uk