Case history / examination
A 16-year-old female has presented to our accidents and emergency
department complaining of fever and coughing of blood for 3 days. Her
condition started three days prior to admission with a gradual-onset,
high-grade fever that was associated with rigors. She also had a
productive cough of red bloody sputum. There was no associated chest
pain, shortness of breath, syncopal attack nor lower limb edema.
On review of her systems including GI, GU and CNS, she reported burning
epigastric pain with no abdominal distension, nausea, vomiting, diarrhea
or constipation. There was no weight loss nor change in her appetite.
When it comes to her past medical history, she reported that she had
been diagnosed with systemic lupus erythematosus (SLE) 5 months ago when
she sought medical advice regarding recurrent facial rashes and small
joints pain. Her SLE has been immunologically confirmed using
anti-double stranded DNA antibodies (100 IU/mL) and ANA factor (400
IU/mL) for which she currently takes prednisone 5 mg once daily and
hydroxychloroquine tabs 200 mg tabs twice daily with good adherence to
treatment and regular follow-up since then. Apart from SLE, she reported
no DM, HTN or any other coagulation or autoimmune diseases and she has
never been hospitalized before. Her family history is unremarkable.
Her examination revealed a tachypneic drowsy patient with a Glasgow coma
scale (GCS) of 8. There was a photosensitive malar rash over her cheeks.
Cardiac examination was normal with no murmurs and her lung auscultation
revealed no abnormalities. Abdominal examination was normal and her
musculoskeletal system examination was completely normal with no joints
swellings or deformities. Her vitals at time of admission were as
follows: PR: 110 bpm, RR: 24, BP: 80/50 mmHg and SaO2 of 81% on Room
Air.