A 30-year old female with periorbital edemapresented to my clinic for echocardiography due to apparent cardiomegaly on chest x ray . The echo findings showed moderate pericardial effusion and severe mitral regurgitation which was minimally thickened .During the study , the patient developed a tonic-colonic seizure , after which she was transferred to the ICU.
How would you like to proceed with this case ?
What is the likely diagnosis ?
The constellation of such different symptoms denotes multisystem affection
Periorbital edema : points to Nephrotic syndrome to be confirmed by UA & dipstick for protein + quantitative test for protein in urine
Pericardial effusion and mitral regurge
Points to serositis plus valvular pathology
tonic clonic fits with rapid deterioration
Points to CNS affection
All such aformentioned features in female of childbearing period Points strongly to
SLE ( Systemic lupus erythromatosis )
Renal + serositis + CNS affection
This patient needs much more assessment of other features ( skin, hematological , joints etc )
And specific labs ( ANA, antidsDNA, C3&C4, )
To fulfil ACR ( american college of Rheumatology ) diagnostic criteria )
≥ 4 out of 11
Or
Preferrably
New SLICC ( systemic lupus international collaborative clinic ) criteria
≥ 4 out of 18 ( at least one clinical and one lab)