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.