病案讨论-Systemic Lupus Erythematosus.ppt

病案討論-Systemic Lupus Erythematosus 曾素卿 2006/09 The case General patient informationName:林×× Age:40Gender:femaleEducation: high Marital status: married Occupation: office ladyAdmission date:94/04/22Discharge date:94/04/25Chart NoChief complaint Progressive lower limb edema and gain of body weight for about 10 days Present illness (Ι) A 40-year-old woman was a case of SLE and diagnosed at 南門醫院 at age 19. She was under treatment at 東元醫院 and had received several cycles of pulse therapy. She had operation history of endometriosis s/p on MMH in 1994 and pregnancy with abortion (due to fever) for two times and an episode of interauterine death, followed by acute renal failure s/p hemodialysis for 3 months. Present illness (Ⅱ) She sustained from repeated cystitis and PIP in 2001/10 and followed by HPV infected vaginitis in 2002/7. Type Ⅳ lupus nephritis was told from renal biopsy at 台大醫院. Mrs.Lin appeared to our clinic in 2004/2/6 with severe Raynaud’s phenomenom and digital vasculitic purpura which were also present over elbows, lower limbs and pretibial area.  Present illness (Ⅲ) She was admitted to received pulse therapy and cystitis with vaginitis treatment during 93/05/14-93/05/20. She was admitted twice to our hospital due to finger and toe tips vasculitis and malar rash (2004/5, 2004/7) and herbal medicine induce flare. Present illness (Ⅳ) Due to her eager for baby, she refused treatments as pulse and cytotoxics. However, recurrent lower limb edema with heavy proteinuria despite prednisolone and azathiprine. Hydroxychloroquine was withheld due to patient’s fear of skin hyperpigmentation. Present illness (Ⅴ) Her laboratory tests resulted in dsDNA=31.94295626185031003222356178 44.514410.940 C3/C4=25/1026 ESR=41759183725351575049 alb=2.72.53.52.0 Uprotein=2.772.055.444.7g/day Present illness (Ⅵ) aCLIgG=7.817.3GPL/ml(N10), aCLIgM=3.29.8MPL/ml(7) within 4