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CHAPTER V
DISCUSSION
RN, a 14 years old girl, with 36 kg of body weight and 155 cm of body
height, came to RSUP Haji Adam Malik Medan on 10thDecember. His main
complaint is to continue the chemotherapy. Patient was registered as allergic
and immunologic division’s patient in Adam Malik Hospital diagnosed with
Systemic Lupus Erythematosus. She was primarily diagnosed with Systemic
Lupus Erythematosus on April 2015.
Pain on joints was not complain by the patient. History of joint pain has
been complained since September 2015. This is the main complaint of patients
before being diagnosed with SLE this is consistent with the theory that states
arthralgia is the a most complaint felt by patients with SLE.3 . The complaint
was detected especially on feet joints and getting worse during patient on
walking. This is also consistent with theory that states arthritis in usually
primarily affecting the small joints of the hands, wrists, and knees.3
Another Clinical Manifestations in this patient which has been
identified are classic lupus butterfly rash in malar distribution and precipitated
by unlight exposure and alopecia. This is also consistent with theory that states
The classic lupus ‘butterfly’ rash is common presents acutely as an
erythematous, elevated lesion, pruritic or painful, in a malar distribution,
commonly recipitated by exposure to sunlight in SLE patient. Alopecia
defined as exaggerated hair loss occurs in most SLE patients. It may involve
the scalp, eyebrows, eyelashes, beard, and body hair. 3
during childhood and tends to be more severe with faster and more severe
damage accrual.4 In this case patient is a 14 years old girl.
Several risk factors for SLE are genetic factor, hormonal factor and
environmental factor. There is no family history of SLE in this case. There is
no history of consuming oral contraceptive drug and hormonal replacement
theraphy. Environmental triggers of SLE include ultraviolet light,
demethylating drugs, and infectious or endogenous viruses or viral-like
elements. Sunlight is the most obvious environmental factors that may
exacerbate SLE. It is well established that induced Certain drugs
autoantibodies in a significant number of Patients. Over 100 drugs have been
Reported to cause drug-induced lupus (DIL), Including a number of the newer
biologics and antiviral agents. In this case, Patients has history of consuming
anti-tuberculosis drugs in which one of the components of the drug, isoniazid
can induce SLE. However, the possibility of isoniazid causing SLE reported is
very low. Anti histones can be used as a guide if SLE occurs due to drug
induction or not.3
SLE is classified into 3 namely mild (kaegori I), moderate (category II)
and severe (category III). Category I (Mild SLE) is Characterized by arthritis,
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