Rhupus Syndrome Presenting as Interstitial Lung Disease: A Case Report
Published: February 1, 2021 | DOI: https://doi.org/10.7860/JCDR/2021/46873.14558
Vishal Venugopal, Srujan Sriram Yelamanchi, Vrinda Vijayakumari, VR Mohan Rao
1. Postgraduate, Department of General Medicine, Chettinad Hospital and Research Institute, Chennai, Tamil Nadu, India.
2. Postgraduate, Department of General Medicine, Chettinad Hospital and Research Institute, Chennai, Tamil Nadu, India.
3. Assistant Professor, Department of General Medicine, Chettinad Hospital and Research Institute, Chennai, Tamil Nadu, India.
4. Professor and Head, Department of General Medicine, Chettinad Hospital and Research Institute, Chennai, Tamil Nadu, India.
Correspondence
Srujan Sriram Yelamanchi,
Chettinad Hospital and Research Institute, SH 49A, Kelambakkam,
Chennai-603103, Tamil Nadu, India.
E-mail: srujanyalamanchi@gmail.com
Systemic Lupus Erythematosus (SLE) and Rheumatoid Arthritis (RA) are characterised by two distinct immunopathological activities, the T-helper 2 cells play a vital role in pathogenesis of SLE while T-helper 1 cells play an important role in RA. Organ involvement in Rhupus syndrome is relatively rare. Here, authors present a case of 59-year-old female who came with complaints of multiple joint pain (involving small and large joints) for a year and dyspnoea for 6 months without co-morbidities, on examination she had pallor, impaired percussion note and velcro crepitations in bilateral infrascapular region, her Pulmonary function test revealed a restrictive pattern and High-Resolution CT (HRCT) chest revealed sub-pleural reticulations involving lower lobes, she was diagnosed as RA with Interstitial Lung Disease (ILD) and started on hydroxycholoroquine, sulfasalazine and prednisolone. During follow-up after 6 months she developed a hyperpigmented rash over cheeks and bridge of nose, non-painful oral ulcers with Anti-Nuclear Antibodies (ANA) showing speckled positivity and Extractable Nuclear Antigen (ENA) panel showing positive anti-ds DNA and negative anti-histone, here with, we present a case of Rhupus syndrome presented with ILD. Recognising this condition is important as treatment varies between Rhupus syndrome and SLE or RA.
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