Rhabdomyolysis as an initial presentation of systemic lupus erythematosus: a case report.
Myopathy
Oral contraceptive
Rhabdomyolysis
Systemic lupus erythematosus
Journal
International journal of emergency medicine
ISSN: 1865-1372
Titre abrégé: Int J Emerg Med
Pays: England
ID NLM: 101469435
Informations de publication
Date de publication:
08 Nov 2019
08 Nov 2019
Historique:
received:
21
09
2019
accepted:
23
10
2019
entrez:
10
11
2019
pubmed:
11
11
2019
medline:
11
11
2019
Statut:
epublish
Résumé
Systemic 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. A 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. We report with a view to recommend autoimmune screening in young patients for whom a cause of rhabdomyolysis is not clearly identified.
Sections du résumé
BACKGROUND
BACKGROUND
Systemic 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 PRESENTATION
METHODS
A 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.
CONCLUSIONS
CONCLUSIONS
We report with a view to recommend autoimmune screening in young patients for whom a cause of rhabdomyolysis is not clearly identified.
Identifiants
pubmed: 31703554
doi: 10.1186/s12245-019-0251-x
pii: 10.1186/s12245-019-0251-x
pmc: PMC6842242
doi:
Types de publication
Journal Article
Langues
eng
Pagination
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