Case history
Case history #1
A 16-year-old black female presents to her general practitioner with symptoms of fatigue, musculoskeletal pain, and a facial rash. On examination she is noted to be thin with malar skin changes. No other abnormality is found.
Case history #2
A 38-year-old white woman presents to the accident and emergency department with 24 hours of dyspnoea and pleuritic chest pain. On further questioning, she reports a 3-year history of Raynaud's disease, polyarthralgia, and intermittent migraine. Physical examination reveals hypoxia, tachycardia, and normal blood pressure. Ventilation perfusion scanning confirms a pulmonary thromboembolism.
Other presentations
Most patients present with symptoms of fatigue, typical rash and/or musculoskeletal symptoms. Other symptoms and signs at presentation may include headaches or lymphadenopathy (cervical or axillary). Patients may present with pleuritis or pericardial effusions. Uncommon presentations include severe serositis or organ manifestations such as nephritis, possibly following triggers such as sun exposure or infection.
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