Pramanik Bimalendu
Department of Medicine, Patwary General Hospital, Banpara Bazaar, Haroa, Post Code 6430, Natore, Bangladesh.
Curr Rheumatol Rev. 2014;10(2):81-6. doi: 10.2174/1573397111999150128103237.
Systemic Lupus Erythematosus (SLE) is a multisystem autoimmune disease affecting millions of people worldwide. It can affect any organ systems of the body. However, all systems may not be involved initially rather than they may be affected gradually, sometimes over years. Diagnosis depends on characteristic clinical features and laboratory test results. Some features such as skin rash, joint symptoms and oral ulcers are common in SLE. But initial presentation of many patients is unusual because either they do not have these common features of the disease or the presentation mimics other illnesses. As a result, delayed diagnosis and misdiagnosis are common. Therefore, high index of initial suspicion of SLE is critical. In clinical practice, SLE should be suspected in any patient presenting with an unexplained disease process involving two or more organ systems. To make a diagnosis in an unusual presentation, thorough clinical evaluation with details history of both present and past illnesses as well as laboratory tests for SLE should be performed. Usually primary-care physicians first evaluate SLE patients; but there is no single article, where all the information on when to suspect SLE in an unusual presentation, is available in an integrated form. In this article, a list of conditions, when SLE should be suspected in an unusual presentation, has been given and some relatively common areas with diagnostic challenges of SLE have been briefly described. To prepare this manuscript, most articles have been identified through 'Pubmed' search using keywords-atypical/ unusual presentation of SLE, case reports on SLE, gastrointestinal manifestations of SLE, neuropsychiatric SLE, diagnostic challenges with SLE, etc. Selected most articles are from currently medline-indexed journals.
系统性红斑狼疮（SLE）是一种多系统自身免疫性疾病，全球有数百万人受其影响。它可累及身体的任何器官系统。然而，所有系统最初可能并不都会受累，而是可能逐渐受到影响，有时会历经数年。诊断取决于特征性的临床特征和实验室检查结果。一些特征，如皮疹、关节症状和口腔溃疡，在SLE中很常见。但许多患者的初始表现并不寻常，因为他们要么没有这些疾病的常见特征，要么其表现类似于其他疾病。因此，诊断延迟和误诊很常见。所以，对SLE保持高度的初始怀疑至关重要。在临床实践中，任何出现涉及两个或更多器官系统的不明原因疾病过程的患者都应怀疑患有SLE。对于不寻常的表现进行诊断时，应进行全面的临床评估，包括详细的现病史和既往史，以及针对SLE的实验室检查。通常，初级保健医生首先对SLE患者进行评估；但没有哪一篇文章以综合的形式提供了关于在不寻常表现时何时怀疑SLE的所有信息。在本文中，给出了一份在不寻常表现时应怀疑SLE的情况清单，并简要描述了SLE一些相对常见的具有诊断挑战性的领域。为撰写本手稿，大多数文章是通过使用关键词“非典型/不寻常的SLE表现”“SLE的病例报告”“SLE的胃肠道表现”“神经精神性SLE”“SLE的诊断挑战”等在“Pubmed”上搜索确定的。所选的大多数文章来自当前被Medline索引的期刊。
