26th February 2025

You are the SHO covering rheumatology and have been called to the day ward to see a febrile patient.

You are the SHO covering rheumatology and have been called to the day ward to see a febrile patient. The patient in question is a 26-year-old female with known SLE who is attending for an infusion of Belimumab, however, has not received this yet, as the nurses were concerned. She has spiked a temperature of 37.7 degrees Celsius. On questioning, she tells you that she has been having intermittent fevers for the past few weeks and is feeling increasingly tired. She denies any cough, shortness of breath or coryzal symptoms. She denies any lower urinary tract symptoms. She tells you that she has had some mouth ulcers, joint pains and diffuse hair loss over the past few months and has not been feeling well in herself.

On examination there is a prominent butterfly rash across the face, sparing the nasolabial folds. Her chest sounds clear with normal heart sounds, and her abdomen is soft and non-tender. There is no peripheral oedema or lymphadenopathy.

Observations are HR 84 bpm, RR 16/minute, O2 saturations 98% on room air, BP 115/86 mmHg, temperature 37.7 degrees Celsius.

Urinalysis: Blood 1+, protein 1+, leucocytes negative, nitrites, negative

You check her routine bloods from today, which show:

What is the most likely cause for her presentation?

Select the SINGLE most appropriate option from the list below. Select ONE option only.