JPSIM Journal of Pakistan Society of Internal Medicine J Pak Soc Intern Med 2709-8729 2710-0804 Pakistan Society of Internal Medicine 10.70302/jpsim.v4i3.2348 jpsim.v4i3.2348 Case Report Systemic Lupus Erythematosus and Overlap Qaisar Wafa wafa.qaisar04@gmail.com * Waseem Tariq Baloch Muhammad Awais wafa.qaisar04@gmail.com *Correspondence: Wafa Qaisar (wafa.qaisar04@gmail.com) 25 09 2023 2023 4 3 237 239 18 06 2023 31 07 2023 Copyright © 2023 The Author(s) 2023 The Author(s) https://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Connective tissue diseases are autoimmune in nature and have a predominance in younger to middle aged women. Symptoms sometimes can be so vague and ill-defined that it may take a while before they are correctly diagnosed and treatment offered Systemic Lupus Erythematosus (SLE) can have a very diverse clinical manifestation and may present without the typical history of a photosensitive rash, alopecia or oral ulcers. A 40-year-old lady presented to the outpatient department with complaints of joint pains, stiffness and unintentional weight loss of 6kgs. Complete blood picture showed pancytopenia but examination was unremarkable for lymphadenopathy and visceromegaly. A detailed assessment revealed hypothyroidism (TSH >100) along with a positive ENA profile with presence of Anti Ro/La, anti U1-RNP and Anti-Smith antibodies but no specific features of Mixed Connective Tissue Disorder. With low complement levels and positive Anti-DS-DNA antibodies she was labelled as SLE with Overlap and started on Replacement Thyroxine, Steroids and Disease Modifying Anti-Rheumatic Drugs (DMARDS). She showed significant improvement after 3 days of Pulse Therapy with Methylprednisolone and was discharged after 5 days of treatment with a follow up planned both with the Internist as well as the Rheumatologist.

 References Shah S, Chengappa KG, Negi VS. Systemic lupus erythematosus and overlap: A clinician perspective. Clin Dermatol Rev. 2019;3(1):12-7. Brasington R. Mixed connective tissue disease, overlap syndromes, and undifferentiated connective tissue disease. Rheumatology Secrets E-Book. 2019;33(67):185. Handa R, Handa R. Undifferentiated Connective Tissue Disease, Mixed Connective Tissue Disease, and the Overlap Syndromes. Clin Rheumatol. First Edition. 2021: p.143-5. Maikap D, Deosale S, Singh P, Panda SS, Padhan P. A comparative study of mixed connective tissue disease and overlap syndromes–A single-center study from India. Indian J Rheumatol. 2023:10(1):4103 Alekperov RT. Mixed connective tissue disease, undifferentiated connective tissue disease and overlap syndromes. Almanac Clin Med. 2019;47(5):435-44. Liu YC, Lin WY, Tsai MC, Fu LS. Systemic lupus erythematosus and thyroid disease–Experience in a single medical center in Taiwan. J Microbiol Immunol Infec. 2019;52(3):480-6. Shah S, Chengappa KG, Negi VS. Systemic lupus erythematosus and overlap: A clinician perspective. Clin Dermatol Rev. 2019;3(1):12-7. Lockshin MD, Levine AB, Erkan D. Patients with overlap autoimmune disease differ from those with ‘pure’disease. Lupus Sci Med. 2015;2(1):e000084. Raissi TC, Hewson C, Pope JE. Repeat testing of antibodies and complements in systemic lupus erythematosus: when is it enough?. J Rheumatol. 2018;45(6):827-34. Mohamed A, Chen Y, Wu H, Liao J, Cheng B, Lu Q. Therapeutic advances in the treatment of SLE. Int Immunopharmacol. 2019;72(7):218-23. Saeed M, Pasha A, Rizvi SH, Munawar M, Elias ZA, Shafi MI, Gazdar T, Lakhdir MP. Remission and clinical patterns of systemic lupus erythematosus (SLE) in Pakistan: a retrospective cohort study. medRxiv. 2022:2022-11. Athanassiou P, Athanassiou L, Mavroudi M, Tsakiridis P, Koukosias N, Kostoglou-Athanassiou I. PO. 4.89 Hashimoto’s thyroiditis in systemic lupus erythematosus patients. Bibi H, Raza AB, Naz F. Occurrence of Autoimmune Thyroid Dysfunction in Juvenile SLE. Pak J Med Health Sci. 2022 Jul 8;16(06):229. Fang K, Orr-Skirvin JA. Systemic lupus erythematosus, its treatment, and future directions. US Pharm. 2019;44(8):3-7.