title: Diagnosis of systemic lupus erythematosus in an unusual presentation: what a primary care physician should know.
abstract: 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.
authors.affiliation: Department of Medicine, Patwary General Hospital, Banpara Bazaar, Haroa, Post Code 6430, Natore, Bangladesh. bimalendup@hotmail.com.
authors.forename: Bimalendu
authors.initials: B
authors.lastname: Pramanik
mesh_terms: D000974:Antibodies, Antinuclear; D001168:Arthritis / Q000150:complications; D003937:Diagnosis, Differential; D005076:Exanthema / Q000150:complications; D006402:Hematologic Diseases / Q000150:complications; D006801:Humans; D007154:Immune System Diseases / Q000150:complications; D007674:Kidney Diseases / Q000150:complications; D008180:Lupus Erythematosus, Systemic / Q000150:complications / Q000175:diagnosis*; D009422:Nervous System Diseases / Q000150:complications; D019226:Oral Ulcer / Q000150:complications; D010787:Photosensitivity Disorders / Q000150:complications; D012700:Serositis / Q000150:complications
chemical_list: D000974:Antibodies, Antinuclear