Diagnostic Challenge of Lupus with Overlap Syndrome in an Adolescent: A Case Report

Anu Suria Ganason; Mohd Radzniwan A. Rashid; Fathima Begum Syed Mohideen; Sharifah Najwa Syed Mohamad; Nurul Hayati Chamhuri

doi:10.33102/mjosht.v10i2.407

Authors

Anu Suria Ganason Department of Primary Healthcare, Faculty of Medicine and Health Sciences, Universiti Sains Islam Malaysia, Persiaran Ilmu, Putra Nilai, 71800 Nilai, Negeri Sembilan, Malaysia. https://orcid.org/0000-0003-1057-7332
Mohd Radzniwan A. Rashid Department of Primary Healthcare, Faculty of Medicine and Health Sciences, Universiti Sains Islam Malaysia, Persiaran Ilmu, Putra Nilai, 71800 Nilai, Negeri Sembilan, Malaysia. https://orcid.org/0000-0002-6981-9431
Fathima Begum Syed Mohideen Department of Primary Healthcare, Faculty of Medicine and Health Sciences, Universiti Sains Islam Malaysia, Persiaran Ilmu, Putra Nilai, 71800 Nilai, Negeri Sembilan, Malaysia. https://orcid.org/0000-0002-2774-681X
Sharifah Najwa Syed Mohamad Department of Primary Healthcare, Faculty of Medicine and Health Sciences, Universiti Sains Islam Malaysia, Persiaran Ilmu, Putra Nilai, 71800 Nilai, Negeri Sembilan, Malaysia
Nurul Hayati Chamhuri Department of Primary Healthcare, Faculty of Medicine and Health Sciences, Universiti Sains Islam Malaysia, Persiaran Ilmu, Putra Nilai, 71800 Nilai, Negeri Sembilan, Malaysia. https://orcid.org/0000-0003-1608-7158

DOI:

https://doi.org/10.33102/mjosht.v10i2.407

Keywords:

autoimmune disease, eczema, lupus erythematosus, case report

Abstract

Lupus with overlap syndrome is an uncommon autoimmune disease that typically affects teenage females. It can present as various symptoms affecting multiple organs. Delay in the diagnosis of lupus will lead to deleterious effects on the implicated adolescents’ health. The case report aims to describe the diagnostic challenge of a refractory skin disease leading to a delay in diagnosis and highlight its psychosocial impact. Here, we describe a case of a teenager who presented with poorly controlled chronic dermatitis. The chronic dermatitis was refractory to the first-line therapy of topical steroids and emollients. She was finally diagnosed with lupus and overlap syndrome, confirmed by a skin biopsy. In conclusion, any chronic refractory skin diseases warrant further referral and investigation at the tertiary centre. Assessment of psychosocial in managing chronic skin disease in adolescent is essential as it could implicate their mental health further.

Downloads

Download data is not yet available.

References

Alharbi, S., Ahmad, Z., Bookman, A. A., Touma, Z., Sanchez-Guerrero, J., Mitsakakis, N., & Johnson, S. R. (2018). Epidemiology and Survival of Systemic Sclerosis-Systemic Lupus Erythematosus Overlap Syndrome. The Journal of rheumatology, 45(10), 1406–1410. https://doi.org/10.3899/jrheum.170953.

Levy, D. M., & Kamphuis, S. (2012). Systemic lupus erythematosus in children and adolescents. Pediatric clinics of North America, 59(2), 345–364. https://doi.org/10.1016/j.pcl.2012.03.007

Tang, S. P., Lim, S. C., & Arkachaisri, T. (2021). Childhood-Onset Systemic Lupus Erythematosus: Southeast Asian Perspectives. Journal of clinical medicine, 10(4), 559. https://doi.org/10.3390/jcm10040559

Kernder, A., Richter, J. G., Fischer-Betz, R., Winkler-Rohlfing, B., Brinks, R., Aringer, M., Schneider, M., & Chehab, G. (2021). Delayed diagnosis adversely affects outcome in systemic lupus erythematosus: Cross sectional analysis of the LuLa cohort. Lupus, 30(3), 431–438. https://doi.org/10.1177/0961203320983445

Rubinstein, T. B., Mowrey, W. B., Ilowite, N. T., Wahezi, D. M., & Childhood Arthritis and Rheumatology Research Alliance Investigators (2018). Delays to Care in Pediatric Lupus Patients: Data From the Childhood Arthritis and Rheumatology Research Alliance Legacy Registry. Arthritis care & research, 70(3), 420–427. https://doi.org/10.1002/acr.23285

Hussain, A., Maheshwari, M. V., Khalid, N., Patel, P. D., & Alghareeb, R. (2022). Diagnostic Delays and Psychosocial Outcomes of Childhood-Onset Systemic Lupus Erythematosus. Cureus, 14(6), e26244. https://doi.org/10.7759/cureus.26244

Ponvilawan, B., Charoenngam, N., Wongtrakul, W., & Ungprasert, P. (2021). Association of atopic dermatitis with an increased risk of systemic lupus erythematosus: A systematic review and meta-analysis. Journal of postgraduate medicine, 67(3), 139–145. https://doi.org/10.4103/jpgm.JPGM_1270_20

Hsiao, Y. P., Tsai, J. D., Muo, C. H., Tsai, C. H., Sung, F. C., Liao, Y. T., Chang, Y. J., & Yang, J. H. (2014). Atopic diseases and systemic lupus erythematosus: an epidemiological study of the risks and correlations. International journal of environmental research and public health, 11(8), 8112–8122. https://doi.org/10.3390/ijerph110808112

Williams, T. S., Aranow, C., Ross, G. S., Barsdorf, A., Imundo, L. F., Eichenfield, A. H., Kahn, P. J., Diamond, B., & Levy, D. M. (2011). Neurocognitive impairment in childhood-onset systemic lupus erythematosus: measurement issues in diagnosis. Arthritis care & research, 63(8), 1178–1187. https://doi.org/10.1002/acr.20489

Holmes, J., Fairclough, L. C., & Todd, I. (2019). Atopic dermatitis and autoimmunity: the occurrence of autoantibodies and their association with disease severity. Archives of dermatological research, 311(3), 141–162. https://doi.org/10.1007/s00403-019-01890-4

National Academies of Sciences, Engineering, and Medicine; Health and Medicine Division; Board on Health Care Services; Committee on Selected Immune Disorders and Disability. (2022). Selected Immune Disorders and Disability. National Academies Press (US).