Reference no: EM133656635
K.M. is a married 35-year-old white female homemaker with three children and a 10-year medical history of systemic lupus erythematosus (SLE). She has no known allergies. K.M. occasionally takes naproxen for joint pain and antacid for heartburn but no other prescription or OTC medications. She neither smokes nor drinks alcohol. Except for lupus and an episode of bronchitis at age 30, her medical history is unremarkable. She is 5'5 and weighs 112 lbs which is 23 lbs less than her last physical exam a year ago. She has four brothers and three sisters. An older sister has rheumatoid arthritis, an aunt has pernicious anemia, and her deceased mother suffered from Graves' disease.
Ten years ago, when she was first diagnosed, she saw her PCP for multiple rashes that developed on her arms and legs whenever she went out into the son. She also complained of several small patches of hair loss on her head that she attributed to stress from an airplane trip that she took three months previously because flying terrifies her. In addition, she mentioned that she lacked energy, became tired very easily, and always needed to take at least one nap each day. She also suffered from mild arthritic pain in her fingers and elbows but attributed those symptoms to age. After being on prednisone for two months, all symptoms resolved.
Today, K.M. presents to her PCP after complaints of fatigue, anorexia, weight loss, and significant swelling within the abdomen, face, and ankles. Her PCP notes that a "butterfly-shaped" rash is present across the bridge of her nose and cheeks. Blood tests reveal a productive cough, intermittent joint pain in the hands and feet, and mild jaundice.
Questions
1. What is the significance of the patient's family history?
2. Suggest one reasonable explanation for an association between systemic swelling and anorexia/weight loss.
3. Why should patients with SLE receive an influenza vaccine every year?