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Description : lupus

Tags : lupus dermatology

Published on : Feb 13, 2020 | Views : 2105 | Downloads : 0

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CASE REPORT
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A previously healthy 8 year old girl with a lesion to the side of the face for 9 months. Lesion was unresponsive to hydrocortisone and clotrimazole after being seen by the pcp for multiple visits. Parents note that the lesion began as a small pink papule and grew in size. Increased itching to the area over the last 3 days. No other new or constitutional symptoms. PRESENTATION
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Family had dermatology appointment scheduled at LBJ, but family wanted to be seen at TCH. Differential included discoid lupus versus partially treated tinea corporis Fungal culture obtained and sent. Discussed with family that it was a very slow growing test. Prescribed topical ketoconazole Discharged home with dermatology appointment in 3 days ER EVALUATION
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Visit #1 Suspect discoid lupus Punch biopsy needed for confirmation Patient was very tearful during discussion of biopsy so recommend biopsy in OR 11 days later parents declined biopsy due to significant skin improvement Trial of topical clobetasol prescribed Visit #2 referred to rheumatology and ophthalmology DERMATOLOGY EVALUATION
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Told derm that she was being followed by Harris Co. hepatology Labs sent and prescribed Plaquenil/hydrochloroquine orally
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2 months of initial ER visit –returned for vomiting/fever/LUQ pain Received (2) 20 ml/kg NS boluses for tachycardia/SIRS and ceftriaxone Abnormal labs including elevated liver enzymes, ANC=960, lipase=586 +SSA and ANA 1:320 Admitted to rheumatology for 6 days for pancreatitis 6 days stay with clinical improvement Discharged home on Plaquenil and steroids BACK TO THE ER
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Completed ophthalmology appointment with normal exam/no uveitis Wean steroids, continue Plaquenil and PPI Begin Imuran/Azathioprine Continue dermatology follow up RHEUMATOLOGY CLINIC
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Seen in dermatology clinic and doing well. Questions? LAST FOLLOW UP