Thread by @shakiratgold

#Dermatologyteaching
This one is going to be really long. It's like a story because that's the typical way it happens around here. Where a lot of happenings are attached to the supernatural.
Have you ever heard of the hydraheaded disease called Systemic Lupus Erythematosus?

She was the life of the party. Beauty and brains combined. Beautiful in soul and looks. At 19, she had already completed her first degree at the prestigious 'better by far' university in Nigeria. Her parents had just two of them. And they were as different as night and day.

While Bimpe was kind and loving, Bayo was cruel at heart. While her parents could go to sleep with their two eyes closed when Bimpe was out, it was always fasting and prayers when Bayo was around as he always had calamity following him.

From drinking heavily, to smoking like a chimney, to different women weekly, and even to drugs, he had all the vices.

Mama Bimpe had always been a woman who believed in actions and prayers. One without the other was incomplete.

And she always told her friends who cared to listen that going to any mountain or prayer summit wasn't going to solve any problems. Pray to God in your house, be kind to one another, help people in need and work hard to succeed. That was their mantra in the Onalaja home.

They couldn't understand why Bayo turned out the way he did. He wasn't overtly spoiled or given privileges. They didn't even have that luxury to do that. It was a personal decision to have just two kids...to be able to provide for them in the best way possible.

Luckily, God's plans for them was exactly what they prayed for. They had Bimpe five years after Bayo.

Bimpe was to go for her masters in the UK. She had gotten a scholarship at the University of Manchester.

She even had to defer the admission for a year as she wanted to finish the mandatory one year service before leaving.

It all started with joint pains, recurrent ulcers in the mouth while in Edo state where she was posted to.

She had treated 'malaria and typhoid' four times in the last two months. She had lost a lost of weight and going out in the sun was a problem as she had developed some 'rashes' on her face that was associated with intense burning while out in the sun.

As she had been going to the hospital for treatment and she seemed to improve after each time, she didn't inform her parents. The last episode was so bad that it was the hospital that called her parents.

She had become a shadow of herself that her parents almost didn't recognize again.
They took her back to Lagos with them and it was then the back and forth started. By this time she had developed several other skin rashes, recurrent cough and had been given blood thrice.

Suggestions came from friends and family members. 'This thing is not ordinary eye, they got to you through Bayo before and now they want to take your shining star. The devil is a liar. She needs prayers and fasting, and you need cleansing in this family.

Don't let them get you like this. This 'malaria and typhoid' would soon be a thing of the past.'

They had gone to several hospitals and prayer houses by then and had even seen some of the worshippers of the sea as they couldn't seem to understand this illness

It wasn't until her mother met one of her friends whom she had lost touch that convinced her to go to a teaching hospital.'Teaching hospital? With all their stress? And they'll now finish my daughter?..I don't think we can do that. Her friend finally convinced her to go there.

They met with several doctors who asked about her history and carried out several investigations on her. Bimpe's parents were made to understand that she had the 'chameleon disease' called systemic lupus erythematosus.. SLE for short. They had never heard of it...

SLE is an autoimmune disease that can affect any and every organ. The typical response of the body to something considered foreign like an infection is to fight against it and form antibodies to it.

In autoimmune diseases however, the body fails to recognize itself again and now starts fighting against 'itself' with formation of autoantibodies. This happens in SLE with involvement of any system. It is about 9 times more common in young women than men.

It presents with symptoms such as the ones highlighted in Bimpe. In our environment, most cases would have been misdiagnosed with the 'malaria typhoid' syndrome for several months or years before the diagnosis. Sadly, complications may have set in before the diagnosis is made.

The most feared complications of lupus are related to the kidneys and neurological system.

Bimpe is one of the lucky cases that a correct diagnosis was finally made. Sadly, we have also lost one too many cases due to delay in diagnosis.

It is a disease that is manageable but not exactly curable. Remission can be achieved with the use of drugs called disease modifying antirheumatic drugs (DMARDs). Patients can have a normal quality of life with correct management.

This disease is not an 'attack from home or enemies' neither is it malaria and typhoid syndrome. Reject every diagnosis of 'malaria typhoid'...there's nothing like that.

We have over 200 cases of lupus patients being managed in my unit who are doing well.

For my colleagues, the ACR criteria which has been existence for over 25 years is still very useful. Just to remind us.

SLE is also not the only autoimmune disease. Several others exist. Read, understand and educate. Try to read this to the end please😊

All names in this write up are not real and just a figment of the writer's overactive imagination and experience over the years. Any relation to persons dead or alive is a coincidence.
Popular people with SLE include Seal, Toni Braxton and Selena Gomez.

Malar rash of SLE

Discoid and malar rash in SLE

Discoid rash on the scalp.
All pictures from Google images.
Any questions?
As usual...ask me any question on the thread. I'll respond. If you're a doctor and you need further clarity, please send a DM.