Butterfly Bella — Systemic Lupus Erythematosus
Butterfly rash, joint pain, photosensitivity — protect skin, watch the kidneys
Bella noticed a red rash spreading across her cheeks and nose after a weekend at the beach, along with swollen, painful finger joints. She's also been exhausted and running low-grade fevers for weeks.
Bella is a 28-year-old woman with joint pain, fatigue, and a red rash across her cheeks and nose that flares after sun exposure. Systemic lupus erythematosus (SLE) is an autoimmune disease where the body attacks its own tissue, causing widespread inflammation that can affect the skin, joints, kidneys, heart, and brain. The malar (butterfly) rash and photosensitivity are hallmark skin findings, but the kidneys are the organ that determines long-term prognosis — lupus nephritis is monitored closely with urinalysis and renal function tests.
Read Butterfly Bella's full story →The story arc
The setup
Bella, otherwise healthy, develops vague joint pain and fatigue that she attributes to overwork and stress.
The turn
After a sunny weekend, a red, raised rash spreads across her cheeks and the bridge of her nose, sparing the nasolabial folds.
The crisis
Her joints are now swollen and stiff in the mornings, she has intermittent chest pain with breathing, and her urine appears foamy. Urinalysis shows proteinuria, and anti-dsDNA antibodies are strongly positive.
The save
Bella starts corticosteroids and hydroxychloroquine to control inflammation, is taught strict sun protection with SPF 30+ and protective clothing, and begins regular monitoring of renal function and urine protein to catch nephritis early.
NCLEX study section — Systemic Lupus Erythematosus
What this chapter is testing: the recognition cues, the numbers and the priority action.
Study section: Health Assessment
Take this chapter into practice questions on the same topic.