DEATH CASE REPORT

Tuesday, November 12th 2019

 Summary of Database
Ms. E/ 19 y.o/w.29
Admission: 06/11/2019 (13.00) Died: 11/11/2019 (18.30)
Autoanamnesis and Heteroanamnesis from her parents
Chief Complaint: Cough
History of Present Illness:
• Cough was felt since one week before admission, cough was accompanied with productive
yellowish sputum. This happened intermittently and it mainly experienced at night
accompanied with shortness of breath.
• Fever was experienced since one week before admission, intermittent, it happened in the
morning and especially at night.
• She also encountered body’s weakness since two weeks before admission, which was getting
worse within five days before admission, she was observed more fatigue and looked pale.
• She also felt bloating sensation at stomach and felt nausea and she vomited all residues of
food every time she was eating.
• She had been diagnosed with SLE (systemic lupus erythematous) since August 2019.
 Summary of Database
Past Medical History:
Patient in healthy condition before

Family History:
There is no family had this condition

Social History:
She lived with her parents
She was a college student in university at Pasuruan
In the last 2 month her daily activity was normal
She never use tobacco, alcohol, and drugs

Review of System:
General: fatigue (+)
Skin: within normal limit
Head and neck: within normal limit
Respiratory: dyspneu with cough accompanied with yellowish sputum
Gastrointestinal: within normal limit
Extremitas: within normal limit
 Physical Examination
General appearance Sat O2 98% on Room Air (1st day)
GCS 456 , look moderately ill BMI: 18,2 kg/m
BP 103/81 mmHg (1st PR 88 bpm regular strong RR 27 tpm Tax 36.7 oC
day)
Head Konjungtiva Anemia (+), moon face
Neck Within normal limit
Chest Lung Sonor | Sonor Vesicular | Vesicular Rhonkhi : - | - Wheezing : -|-
Sonor | Sonor Vesicular | Vesicular
-
|- -|-
Sonor | Sonor Vesicular | Vesicular
+| - -|-
Cardio Within normal limit

Abdomen Within normal limit

Extremities Within normal limit

 Laboratory Findings (2/11/19)
LAB VALUE NORMAL LAB VALUE NORMAL

Leucocyte 3.190 4.700 – 11.300 /µL Anti ds-DNA total 137,6 <25 U/mL

Hemoglobine 10,6 11,4 - 15,1 g/dl

PCV 30,2 38 - 42%

Thrombocyte 179.000 142.000 – 424.000 /µL

MCV 98,4 80-93 fl

MCH 34,5 27-31 pg

Eo/Bas/Neu/ 0,0/0,0/81,5/ 0-4/0-1/51-67/

Limf/Mon /3,7 25-33/2-5
 Urinalysis (2/11/19)

LAB VALUE NORMAL LAB VALUE NORMAL

Turbidity Clear 10 x
Color Yellow Epithelia 3,7 ≤1
pH 7,0 4.5 – 8.0 Cylinder -
1.005 –
1.010
SG 1.030
Glucose - negative
Protein +1 negative
Keton - negative
Bilirubin - negative 40 x
Urobilinogen 33 negative Erythrocyte 2,6 ≤3
Nitrite - negative Leukocyte 7,1 ≤5
Leukocyte Trace negative Crystal -
Erythrocyte - negative Bacteria 668.600 ≤23 x 103/ml
 Laboratory Findings (6/11/19)
LAB VALUE NORMAL LAB VALUE NORMAL

Leucocyte 270 4.700 – 11.300 /µL Ureum 42,9 20-40 mg/dL

Hemoglobine 7,0 11,4 - 15,1 g/dl Creatinine 1,48 <1,2 mg/dL

PCV 20,7 38 - 42%

Thrombocyte 52.000 142.000 – 424.000 /µL Natrium 123 136-145 mmol/L

MCV 96,3 80-93 fl Kalium 3,74 3,5-5,0 mmol/L

MCH 32,6 27-31 pg Chlorida 91 98-106 mmol/L

Eo/Bas/Neu/ 0,0/0,0/22,2/ 0-4/0-1/51-67/ RBS 133 < 200 mg/dl

Limf/Mon 74,1/3,7 25-33/2-5
SGOT 71 0-40 U/L

SGPT 16 0-41 U/L

Albumin 3,38 3.5-5.5 g/dL

 Urinalysis (6/11/19)

LAB VALUE NORMAL LAB VALUE NORMAL

Turbidity Clear 10 x
Color Yellow Epithelia 2,6 ≤1
pH 7,0 4.5 – 8.0 Cylinder -
1.005 –
1.010
SG 1.030
Glucose - negative
Protein +3 negative
Keton - negative
Bilirubin - negative 40 x
Urobilinogen 33 negative Erythrocyte 2,6 ≤3
Nitrite - negative Leukocyte 7,1 ≤5
Leukocyte Trace negative Crystal -
Erythrocyte - negative Bacteria 98.900 ≤23 x 103/ml
 Blood Gas Analysis (7/10/19)

With Normal
pH 7,42 7.35-7.45
pCO2 23,6 35 – 45 mmHg
pO2 186,4 80 – 100 mmHg
HCO3 15,3 21 – 28 m mol/L
O2 saturation 99,3 > 95 %
BE -9,5 (-3) - (+3) m mol/L
Temperature 37,0
Hb 5,0
Conclusion: metabolic acidosis fully compensated
Laboratory Findings (9/11/19)
LAB VALUE NORMAL

Leucocyte 50 4.700 – 11.300 /µL

Hemoglobine 5,3 11,4 - 15,1 g/dl

PCV 15,4 38 - 42%

Thrombocyte 8.000 142.000 – 424.000 /µL

MCV 93,9 80-93 fl

MCH 32,3 27-31 pg

Eo/Bas/Neu/ 0,0/0,0/40/40 0-4/0-1/51-67/

Limf/Mon /20 25-33/2-5
 Urinalysis (9/11/19)

LAB VALUE NORMAL LAB VALUE NORMAL

Turbidity Clear 10 x
Color Yellow Epithelia 15,0 ≤1
pH 7,0 4.5 – 8.0 Cylinder +
1.005 –
1.015
SG 1.030
Glucose - negative
Protein +2 negative
Keton - negative
Bilirubin - negative 40 x
Urobilinogen 3,2 negative Erythrocyte 1,7 ≤3
Nitrite - negative Leukocyte 5,0 ≤5
Leukocyte - negative Crystal -
Erythrocyte - negative Bacteria 250,9 ≤23 x 103/ml
Laboratory Findings (10/11/19)

LAB VALUE NORMAL

Leucocyte 60 4.700 – 11.300 /µL

Hemoglobine 7,5 11,4 - 15,1 g/dl

PCV 20,9 38 - 42%

Thrombocyte 6.000 142.000 – 424.000 /µL

MCV 86 80-93 fl

MCH 30,9 27-31 pg

Eo/Bas/Neu/ 0,0/0,0/33,3/ 0-4/0-1/51-67/

Limf/Mon 50/16,7 25-33/2-5
Blood Gas Analysis (11/11/19)

With Normal
pH 7,36 7.35-7.45
pCO2 27,0 35 – 45 mmHg
pO2 101,5 80 – 100 mmHg
HCO3 15,3 21 – 28 m mol/L
O2 saturation 99,9 > 95 %
BE -10,4 (-3) - (+3) m mol/L
Temperature 37,0
Hb 6,2 g/dL
True O2 21.5
Conclusion: metabolic acidosis fully compensated, severe
hypoxemia
Electrocardiography (06/10/19)
Electrocardiography (06/10/19)

• Sinus rhythm, HR 86 bpm

• Frontal Axis : Normo Axis
• Horizontal Axis : Normo axis
• P wave : 0,08
• PR interval : 0,12
• QRS complex : 0.06
• ST segment : iso electric
• QT interval : 0, 18
• T wave : normal T wave

Conclusion : Sinus Rhythm with HR 86 bpm

Chest X-Ray (8/11/19)
 Chest X-Ray (06/10/19)

• AP position, asymmetric, enough KV, enough inspiration

• Soft tissue was thin and bone was normal
• Trachea in the middle
• Hemidiaphragm D was slightly flattening, S was hard to evaluate
• Phrenico-costalis angle D was sharp, S was hard to evaluate
• Pulmo: infiltrate in the medial and basal lung bilateral +
hyperairated lung bilateral
• Cor: site N, size CTR 55%, shape N, elongation aorta (-), cardiac
waist (+)

Conclusion: Suspect TB Millier

MEX-SLEDAI (06/11/2019)

Leucopenia 1
Fatigue 1
Thrombocytopenia 4
Hemolysis 4
Oral ulcer 4
Renal disorder 6
Lymphopenia 1
Total 21
POMR (Problem Oriented Medical Record)
CUE AND CLUE PL DDx PDx PTx PMo&Ed

1. Respiratory 1.1. CAP - Non pharmacology PMo :

Ms E /19 yo/Ward 29
failure type I 1.2. TB - Bedrest Vital sign, serial
with BGA
Subjective
secondary Pharmacology
Last day in hospital she felt
infection - O2 15 lpm on Jackson PEd :
shortness of breath
Reece Worsening
Objective - Consult to Anestesi condition,
for ICU care and Planning therapy
RR 36 x/min
ventilator Prognosis
Sat O2 67% on NRBM 12 lpm
Rhonki : mediobasal D, Basal
S

Laboratory
BGA
PH 7,36/ pCO2 27,0 / pO2
101,5 / HCO3 15,3/ BE -
10,4/ sat O2 99,9%
True O2 : 21.5 mmHg

CXR:
TB millier
POMR (Problem Oriented Medical Record)
CUE AND CLUE PL DDx PDx PTx PMo&Ed

Mrs. E/ 19 yo/ Ward 29 2. SLE Severe - - - Bed rest Pmo : S, VS,

Subjective MEX-Sledai - IVFD NS 0,9% MEX-SLEDAI,
Fever since 1 week ago 21 1500cc/24 hours Ur/Cr, OT/PT, SE,
General weakness 2 weeks ago - Soft diet HCHP 2100 Albumin
Diagnosed SLE in august 2019 kkal/day
Objective - Pulse Methyl Ped : possibility
Conj Anemic (+) Prednisolone 500 mg cause of the
Laboratory for 3 days disease,
Hb 7 g/dl - PO Azathioprine 2x50 routinely
MCV/MCH : 96,2/32 mg consume the
PLT 52.000 - PO Chloroquine 2x250 drug to control
TLC 200 mg the disease
Urinalysis :
Protein 3+
Sylinder +
Erythrocyte 2.6 HPF
Leucocyte 5 HPF
Anti ds-DNA : 137.6 U/ml
MEX SLEDAI : 21
Leucopenia, Fever, Fatigue,
Thrombocytopenia, Hemolysis,
Renal Disturbance, Lymphopenia
POMR (Problem Oriented Medical Record)
CUE AND CLUE PL DDx PDx PTx PMo&Ed

Mrs. E/ 19 yo/ Ward 29 3. SOB + 3.1. CAP Sputum - Bed rest Pmo :
Subjective Cough + 3.2. TB with culture - O2 15 lpm on CBC after 3 days of
Cough 1 week ago, white Fever secondary and drug Jackson Reece antibiotic
phlegm infection sensitivit - IVFD NaCl 0,9% administrations
Objective 3.3. Interstisial y test 1500cc/24 hours
RR 24 tpm Lung Disease - Fluid balance Ped : possibility
Rh +/+ Sputum - Soft diet HCHP cause of the
Laboratory GenXpert 2100 kkal/day disease
CXR TB Millier - PO NAC 3x200 mg
Sputum - IV ceftriaxone 2 x
culture in 1 gram
LJ media
Pulmology
Department :
- Combivent
nebulization/8
hours
- Pulmicort
nebulization/8
hours
- Plan to give OAT
Category 1 if TB
confimerd
POMR (Problem Oriented Medical Record)
CUE AND CLUE PL IDx PDx PTx PMo&Ed
Mrs. E/ 19 yo/ Ward 29 4. - Renal - Bed rest Pmo : S, VS,
Subjective Nephritic biopsy - Equal fluid balance Ur/Cr,
Diagnosed SLE in august Lupus - PO Chloroquine 1x250
2019 Class III Ur/Cr mg Ped : possibility
Objective - Diagnosis confirmation cause of the
- Albumin disease,
Laboratory and protein routinely
Urinalysis : creatinine consume the
Protein 3+ ratio drug to control
Cylinder + the disease,
Erythrocyte 2.6 HPF control fluid
Leucocyte 5 HPF intake
Anti ds-DNA : 137.6 U/ml
POMR (Problem Oriented Medical Record)
CUE AND CLUE PL DDx PDx PTx PMo&Ed
Mrs. E/ 19 yo/ Ward 29 5. - - - Bed rest Pmo : S, VS
Subjective Pancytopenia - IVFD NaCl 0,9%
Diagnosed SLE in august dt SLE 1500cc/24 hours Ped :
2019 - Equal Fluid balance possibility
Objective - Soft diet HCHP 2100 cause of
Epigastric tenderrness kkal/day the disease
Laboratory - Pulse Methyl
Hb 7 g/dl Prednisolone 500 mg
MCV/MCH : 96,2/32 for 3 days
PLT 52.000 - PO Azathioprine 2x50
WBC 270 mg
- PO Chloroquine 2x250
Anti ds-DNA : 137.6 U/ml mg
MEX SLEDAI : 21 - Considering
Leucopenia, Fever, Fatigue, Azathioprine
Thrombocytopenia, replacement
Hemolysis, Renal
Disturbance, Lymphopenia
POMR (Problem Oriented Medical Record)
CUE AND CLUE PL DDx PDx PTx PMo&Ed
Mrs. E/ 19 yo/ Ward 29 6. Swallowing 6.1. KOH Swab - IV Fluconazole Pmo : VAS
Subjective pain Candidiasis 1x200mg Score
Swallowing pain (+) oroesophageal
Diagnosed with SLE since Ped : keep
August 2019 the oral
Consumed hygiene
Metylprednisolon 1x4mg,
Azathioprine 2x50mg,
Cloroquine 1x250mg

Objective
Oral thrush (+) on Palatum
Mole
VAS Score 3/10
 PROGRESS NOTE
6 November 2019 7 November 2019

SUBJECTIVE: Pulde Methylprednisolon 500mg in 100cc Ns

Batuk (+), Lemas (+) mual berkurang,
nyeri te Pmo
OBJECTIVE: S, VS, GDS pre and post pulse
18.00 90/60 116 22 97 % 38,1 GCS :
BP : 111/72 mmHg
methylprednisolone, VS/15 minute every
time durante pulse.
HR : 92 x/min
18.15 100/7 118 20 98 % 38 RR : 28 x/min
Tax : 36.7 C
0 SaO2 : 99 % on NRBM 8 lpm
Konjungtiva anemis (+), oral thrush
18.30 95/72 121 20 97 % 38,2 (+)
Nyeri Epigastrik (+)
18.45 90/70 139 20 98 % 38 ASSESSMENT:
1. SLE severe mex sledai 18
2. Lupus Nefritis class III
19.00 90/70 121 20 97 % 28,2 3. Anemia Makrositik
1. dt SLE
2. Folic acid defisiensi
4. Nausea vomiting
1. Gastritis induced steroid
2. PUD
5. Pansitopenia dt SLE
6. Acute cough+Fever
1. Bronchitis Acute
2. CAP
Ptx
Bed rest
O2 Nasal Canul 2-4lpm
Soft Diet High Calorie high protein
2100 kkal/day
IVFD NaCl 1500cc/24hr
IV lansoprazole 1x30mg
PO Paracetamol 3x500mg
PO Folic Acid 1x3mg
PO B12 tab 3x1tab
PO Chloroquin 1x200mg
Imuran  postponed
 PROGRESS NOTE
7 November 2019 8 November 2019

SUBJECTIVE: IV lansoprazole 1x30mg

Batuk (+), Lemas (+) mual IV Fluconazole 1x200mg
berkurang, nyeri te IV Ceftriaxon 2x1gr
OBJECTIVE: PO Paracetamol 3x500mg
20.00 92/58 109 28 38,7 94% GCS : PO Folic Acid 1x3mg
BP : 100/76 mmHg PO B12 tab 3x1tab
HR : 92 x/min PO Chloroquin 1x200mg
20.15 86/49 105 32 36,4 92% RR : 28 x/min Pulde Methylprednisolon 500mg in 100cc Ns
Tax : 36.7 C
SaO2 : 99 % on NRBM 8 lpm Pmo
20.30 88/51 103 36 36,2 98% on S, VS, GDS pre and post pulse
4lpm Konjungtiva anemis (+), oral thrush methylprednisolone, VS/15 minute every time
(+) durante pulse.
Nyeri Epigastrik (+)
20.45 91/49 98 24 36,1 98% on
ASSESSMENT:
4lpm 1. SLE severe mex sledai 18
2. Lupus Nefritis class III
21.00 93/56 99 28 36,1 99% on 3. Anemia Makrositik
1. dt SLE
4lpm 2. Folic acid defisiensi
4. Nausea vomiting (improved)
1. Gastritis induced steroid
2. PUD
5. Pansitopenia dt SLE
6. Acute cough+Fever
1. Bronchitis Acute
2. CAP
7. Swallow pain+oral thrush
7.1 Candidiasis oro esophageal
Pdx
Sputum culture+antibiotic
sensitivity
Ptx
Bed rest
O2 Nasal Canul 2-4lpm
Soft Diet High Calorie high protein
2100 kkal/day
IVFD NaCl 1500cc/24hr
 PROGRESS NOTE
8 November 2019 9 November 2019

SUBJECTIVE: IV lansoprazole 1x30mg

Batuk (+), Lemas (+) mual IV Fluconazole 1x200mg
berkurang, nyeri te IV Ceftriaxon 2x1gr
OBJECTIVE: PO Paracetamol 3x500mg
18.00 100/60 102 28 35,0 97% on GCS : PO Folic Acid 1x3mg
BP : 102/76 mmHg PO B12 tab 3x1tab
x/m 4lpm HR : 92 x/min PO Chloroquin 1x200mg
RR : 28 x/min Pulde Methylprednisolon 500mg in 100cc Ns
18.15 95/60 96 x/m 24 36,1 98% on Tax : 36.7 C
SaO2 : 99 % on NRBM 8 lpm Pmo
4lpm S, VS, GDS pre and post pulse
Konjungtiva anemis (+), oral thrush methylprednisolone, VS/15 minute every time
18.30 100/70 98 x/m 22 36 97% on (+)
Nyeri Epigastrik (+)
durante pulse.
4lpm
ASSESSMENT:
18.45 100/68 104x/ 22 36,1 99% on 1. SLE severe mex sledai 18
2. Lupus Nefritis class III
4lpm 3. Anemia Makrositik
1. dt SLE
2. Folic acid defisiensi
19.00 98/67 98 x/m 24,5 36,4 99% on 4. Nausea vomiting (improved)
4lpm 1. Gastritis induced steroid
2. PUD
5. Pansitopenia dt SLE
6. Acute cough+Fever
1. Bronchitis Acute
2. CAP
7. Swallow pain+oral thrush
7.1 Candidiasis oro esophageal
Pdx
Sputum culture+antibiotic
sensitivity
Ptx
Bed rest
O2 Nasal Canul 2-4lpm
Soft Diet High Calorie high protein
2100 kkal/day
IVFD NaCl 1500cc/24hr
 PROGRESS NOTE
11 November 2019 11 November 2019 15.00
SUBJECTIVE: IV lansoprazole 1x30mg SUBJECTIVE: IV lansoprazole 1x30mg
Batuk (+), Lemas (+) mual berkurang, IV Fluconazole 1x200mg Batuk (+), Sesak (+) IV Fluconazole 1x200mg
nyeri te IV Ceftriaxon 2x1gr OBJECTIVE: IV Ceftriaxon 2x1gr
OBJECTIVE: PO Paracetamol 3x500mg GCS : IV methylprdnisolon 1x5mg
GCS : PO Folic Acid 1x3mg BP : 102/76 mmHg PO Paracetamol 3x500mg
BP : 102/76 mmHg PO B12 tab 3x1tab HR : 92 x/min PO Folic Acid 1x3mg
HR : 92 x/min PO Chloroquin 1x200mg RR : 28 x/min PO B12 tab 3x1tab
RR : 28 x/min Blood Tranfusin PRC Tax : 36.7 C PO Chloroquin 1x200mg
Tax : 36.7 C SaO2 : 99 % on NRBM 8 lpm
SaO2 : 99 % on NRBM 8 lpm *from Pulmo Departmnt *from Pulmo Departmnt
Sputum Test Konjungtiva anemis (+), oral thrush (+) Sputum Test
Konjungtiva anemis (+), oral thrush (+) PO NAC 3x100mg Nyeri Epigastrik (+) PO NAC 3x100mg
Nyeri Epigastrik (+) Nebul Combivent 3x1amp Nebul Combivent 3x1amp
Ronkhi Pulmo bilateral +/+ Nebul Pulmicort 3x1amp Mex SLEDAI 17 Nebul Pulmicort 3x1amp
OAT Kategor 1 OAT Kategor 1
ASSESSMENT: ASSESSMENT:
1. SLE severe mex sledai 18 Pmo 1. SLE severe mex sledai 17 Pmo
2. Lupus Nefritis class III S, VS, 2. Lupus Nefritis class III S, VS,
3. Anemia Makrositik 3. Anemia Makrositik
1. dt SLE 1. dt SLE
2. Folic acid defisiensi 2. Folic acid defisiensi
4. Nausea vomiting (improved) 4. Nausea vomiting (improved)
1. Gastritis induced steroid 1. Gastritis induced steroid
2. PUD 2. PUD
5. Pansitopenia dt SLE 5. Pansitopenia dt SLE
6. Acute cough+Fever 6. Acute cough+Fever
1. Bronchitis Acute 1. Bronchitis Acute
2. CAP 2. CAP
7. Swallow pain+oral thrush 7. Swallow pain+oral thrush
7.1 Candidiasis oro esophageal 7.1 Candidiasis oro esophageal
8. Neutropenia
Pdx
Pdx Sputum culture+antibiotic sensitivity
Sputum culture+antibiotic sensitivity Ptx
Ptx Bed rest
Bed rest O2 Nasal Canul 2-4lpm
O2 Nasal Canul 2-4lpm Soft Diet High Calorie high protein 2100
Soft Diet High Calorie high protein 2100 kkal/day
kkal/day IVFD NaCl 1500cc/24hr
IVFD NaCl 1500cc/24hr
 PROGRESS NOTE
11 November 2019 16.00 18.30
SUBJECTIVE: SUBJECTIVE:
- Shortness of breath getting - Apneu
worst, patient sometimes release
the oxygen mask OBJECTIVE:
GCS : 111
OBJECTIVE: BP : undetected
GCS : 4/5/6 HR : undetected
BP : 140/80 mmHg RR : undetected
HR : 148x/m Tax : -
RR : 42x/m SaO2 : undetected
Tax : 37,4
SpO2 80% on NRBM 12lpm - Family refused to performed the
CPR
Ronkhi at both of lung - Patient passed away at 18.16 with
causa mortis respiratory failure dt
*Assesment* pneumonia dd Asma late onset dd
1. SOB COPD dd ACO
2. SLE severe mex sledai 20
3. Lupus nefritis
4. Anemia Makrositer
5. Neutropenia

Ptx
Bed rest
O2 Jackson reece 15 lpm
Soft Diet High Calorie high protein 2100
kkal/day
IVFD NaCl 1500cc/24hr
 Problem Analysis

Macrocytic Anemia

Haematological Nausea Vomitting

Nephritic Lupus Manifestation??
B12 Deficiency?
Folic Acid Steroid Treatment
Deficiency??

SLE

ILD??
Caused by SLE??
Azathioprine Induced ??? Pancytopenia

Acute Cough+Fever Immunocompromised

 Risk Factors Analysis

Problem Theory Patient

SLE Female sex Female, Young Age
Age 15 to 45 years
Sun exposure
Family history of SLE
Tobacco smoking
Drug
Race

Epocrates.com
 MANAGEMENT
ANALYSIS
PROBLEM THEORY FACTUAL

Foundation of SLE Treatment

On This Patient :
• Education and Counseling - Bed rest
• Rehabilitation Program : the purpose is rest, - O2 2-4 lpm NC
physical therapeutic, modality therapies, ortothic, - IVFD NS 0,9% 1500cc/24
Systemic etc hours
• Medicamentosa Treatment : - Soft diet HCHP 2100
Lupus kkal/day
o OAINS
Erythematosus o Antimalaria - Pulse Methyl Prednisolone
o Steroid 500 mg for 3 days
o Immunosupressan/ Cytotoxic - PO Azathioprine 2x50 mg –
o Other treatment consider to replace
- PO Chloroquine 1x250 mg

Lupus Recommendation Guideline

 MANAGEMENT
PROBLEM ANALYSIS
THEORY FACTUAL

Management of LSE based on

The Degree of SLE

On This Patient :

Systemic
- Pulse Methyl
Lupus
Prednisolone 500 mg for
Erythematosus 3 days
- PO Azathioprine 2x50 mg
– consider to replace
- PO Chloroquine 1x250 mg

Perhimpunan Reumatologi Indonesia, 2019

Key Message Pathophysiology

Curr Opin Immunol. 2012 December

Key Message Diagnosis
Key Message Diagnosis
Key Message Management

Perhimpunan Reumatologi Indonesia, 2019

Key Message Management
 Key Message Social

• Family support is needed to achieve good

compliance and better control of the SLE in the
future
• Educate the patient to join and active the Lupus
Support Group