Follow up on April 24

th
,2014:
S : Low back pain (+), fever (-)
O: Sens: Compos mentis, Temp: 37.!C , "# :3$ k%, "&: '(3cm
&ea) *+es: ,i%-t ref,e.: +/+, isocoric p0pi,, pa,e of con10nctiva pa,pebra inferior (-),
*ar/nose/mo0t-: norma,/norma,/ T'-T', -+peremic (+)
2ace 3oon face (+), "0tterf,+ ras- (+), 4cne on bot- c-eeks (+)
5eck *n,ar%ement of ,+mp- no)es (-)
T-ora. Simetrica, f0siform, 6etraction (-)
&6: '77 bpm, re%0,ar, m0rm0r (-)
66: 8 rpm, re%0,ar, ronc-i (-/-)
"ack 3i,iar+ spots (+), "r0ises (-)
4b)omen Soepe,, perista,tic (+) 5, ,iver/sp,een: not pa,pab,e

9e,vic Costo-vertebra, an%,e (C:4) ten)erness (-)
*.tremities 90,se '77 bpm, re%0,ar, press0re an) vo,0me were a)e;0ate, warm e.termities (+),
C6T<3==
Working Diagnosis: Low back pain e.c Seere S!ste"ic Lupus #r!the"atosus $ Lupus %ephritis
$ Secon&ar! A"enorrhea
'anage"ent :
3et-+,pre)niso,one 3-3-3
&+)ro.+c-,oro;0ine . > tab,et
?b0profen 3 @ 877 m%
Aiet common foo) 'BB7 kka, wit- 7B %ram of protein
Follow up on April 2(
th
,2014:
S : Low back pain (+), fever (-)
O: Sens: Compos mentis, Temp: 37.!C, "#:3$ k%, "&: '(3cm, "9: '7/B7 mm&%
&ea) *+es: ,i%-t ref,e.: +/+, isocoric p0pi,, pa,e of con10nctiva pa,pebra inferior (-),
*ar/nose/mo0t-: norma,/norma,/ -+peremic (+)
2ace 3oon face (+), "0tterf,+ ras-, 4cne on bot- c-eeks (+)
5eck *n,ar%ement of ,+mp- no)es (-)
T-ora. Simetrica, f0siform, 6etraction (-)
&6: '77 bpm, re%0,ar, m0rm0r (-)
66: 7 rpm, re%0,ar, ronc-i (-/-)
"ack 3i,iar+ spots (+), "r0ises:(-)
4b)omen Soepe,, perista,tic (+) 5orma,, ,iver/sp,een: not pa,pab,e
9e,vic C:4 ten)erness (-)
*.tremities 90,se '77 bpm, re%0,ar, press0re an) vo,0me were a)e;0ate, warm e.termities (+),
C6T<3==
Working Diagnosis: Low back pain e.c Seere S!ste"ic Lupus #r!the"atosus $ Lupus %ephritis
$ Secon&ar! A"enorrhea
'anage"ent :
3et-+,pre)niso,one 3-3-3
&+)ro.+c-,oro;0ine . > tab,et ( . (7m%)
?b0profen 3 @ 877 m%
Follow up on April 2)
th
,2014:
S : Low back pain (+), fever (-)
O: Sens: C3, Temp: 37.3!C, "#:3$ k%, "&: '(3cm, "9: '7/B7 mm&%
&ea) *+es: ,i%-t ref,e.: +/+, isocoric p0pi,, pa,e of con10nctiva pa,pebra inferior (-),
*ar/nose/mo0t-: norma,/norma,/ -+peremic (+)
2ace 3oon face (+), "0tterf,+ ras- (+), 4cne at bot- c-eeks (+)
5eck *n,ar%ement of ,+mp- no)es (-)
T-ora. Simetrica, f0siform, retraction (-)
&6: '77 bpm, re%0,ar, m0rm0r (-)
66: 7 rpm, re%0,ar, ronc-i (-/-)
4b)omen Soepe,, perista,tic (+) 5, ,iver/sp,een: not pa,pab,e
"ack 3i,iar+ spots (+)
*.tremities 90,se '77 bpm, re%0,ar, press0re an) vo,0me were a)e;0ate, warm e.termities (+),
C6T<3==
Working Diagnosis: Low back pain e.c Seere S!ste"ic Lupus #r!the"atosus $ Lupus %ephritis
$ Secon&ar! A"enorrhea
'anage"ent :
3et-+,pre)niso,one 3-3-3
&+)ro.+c-,oro;0ine . > tab,et
?b0profen 3 @ 877 m%
*onsultation results +ro" &er"atolog! &epart"ent on 'arch 2)
th
2014:
Aia%nosis : 2o,,ic0,itis
4)vice : 4pp,+ C,in)am+cin cream . ' per )a+
Laborator! +in&ings on April 2)
th
2014:
,""unoserolog!
-or"one .nit /esult /e+erence
FS- n%/mL (.$
L- 0%/L 7.B$
#stra&iol p%/)L (
/heu"atoi& Factor 0/F1
2-3/4,D
2otal 25 n%/mL 7.8B 7.B-
2otal 24 0%/)L 7.(C (.7-'8
2S- 0/D/mL 7.CC 7.7-8.
A.24,''.%#
A%A 2est ($ <7
Anti &s6D%A B'7 7-77
*/7 kualitati+
*arboh!&rate
'etabolis"
/an&o" 8loo& 9lucose m%/)L B'.8 <77
/enal
.reu" m%/)L 8.' <(7
*reatinin m%/)L 7.8( 7,(7-7,B7
#lectrol!te
%atriu" m*;/)L '3 '3( E '((
:aliu" m*;/)L .7 3,C E (,(
*lori&e m*;/)L '7B $C E '7C
7hosphor m*;/)L 3.' 3,8-C,
'agnesiu" m*;/)L .3$ ',3-',B
Follow up on April 2;
th
2014:
S : Low back pain (-), fever (-)
O: Sens: C3, Temp: 3C.B!C, "#:3$ k%, "&: '(3cm, "9: '7/B7 mm&%
&ea) *+es: ,i%-t ref,e.: +/+, isocoric p0pi,, pa,e of con10nctiva pa,pebra inferior (-),
*ar/nose/mo0t-: norma,/norma,/norma,
2ace 3oon face: (+), 4cne at bot- c-eeks (+), "0tterf,+ ras- (+)
5eck *n,ar%ement of ,+mp- no)es (-)
T-ora. Simetrica, f0siform, 6etraction (-)
&6: $B bpm, re%0,ar, m0rm0r (-)
66: 8 rpm, re%0,ar, ronc-i (-/-)
"ack 3i,iar+ spots (+), "r0ises: (-)
4b)omen Soepe,, perista,tic (+) 5, ,iver/sp,een: not pa,pab,e
*.tremities 90,se $B bpm, re%0,ar, press0re an) vo,0me were a)e;0ate, warm e.termities (+),
C6T<3==
Working Diagnosis: Low back pain e.c Seere S!ste"ic Lupus #r!the"atosus $ Lupus %ephritis
$ Secon&ar! A"enorrhea
'anage"ent :
3et-+,pre)niso,one 3-3-3
&+)ro.+c-,oro;0ine . > tab,et
?b0profen 3 @ 877 m%
Follow up on April 2<
th
,2014:
S : Low back pain (-), fever (-)
O: Sens: Compos 3entis, Temp: 37.3!C, "#:3$ k%, "&: '(3cm, "9: '7/B7 mm&%
&ea) 3oon face: (+), 4cne at bot- c-eeks (+)
*+es: ,i%-t ref,e.: +/+, isocoric p0pi,, pa,e of con10nctiva pa,pebra inferior (-),
*ar/nose/mo0t-: norma,/norma,/norma,
2ace 3oon face: (+), 4cne at bot- c-eeks (+), "0tterf,+ ras- (+)
5eck *n,ar%ement of ,+mp- no)es (-)
T-ora. Simetrica, f0siform, 6etraction (-)
&6: $ bpm, re%0,ar, m0rm0r (-)
66: 8 rpm, re%0,ar, ronc-i (-/-)
"ack 3i,iar+ spots (+)
4b)omen Soepe,, perista,tic (+) 5, ,iver/sp,een: not pa,pab,e
*.tremities 90,se $B bpm, re%0,ar, press0re an) vo,0me were a)e;0ate, warm e.termities (+),
C6T<3==
Working Diagnosis: Low back pain e.c Seere S!ste"ic Lupus #r!the"atosus $ Lupus %ephritis
$ Secon&ar! A"enorrhea
'anage"ent :
3et-+,pre)niso,one 3-3-
&+)ro.+c-,oro;0ine . > tab,et
?b0profen 3 @ 877 m%
Follow up on April 2=
th
,2014:
S : Low back pain (+), fever (-), :omit (-)
O: Sens: C3, Temp: 37.3!C, "#:3$ k%, "&: '(3cm, "9: '7/B7 mm&%
&ea) *+es: ,i%-t ref,e.: +/+, isocoric p0pi,, pa,e of con10nctiva pa,pebra inferior (-),
*ar/nose/mo0t-: norma,/norma,/norma,
2ace 3oon face: (+), 4cne at bot- c-eeks (+), "0tterf,+ ras- (+)
5eck *n,ar%ement of ,+mp- no)es (-)
T-ora. Simetrica, f0siform, 6etraction (-)
&6: '77 bpm, re%0,ar, m0rm0r (-)
66: 7 rpm, re%0,ar, ronc-i (-/-)
"ack 3i,iar+ spots (+)
4b)omen Soepe,, perista,tic (+) 5, ,iver/sp,een: not pa,pab,e
*.tremities 90,se '77 bpm, re%0,ar, press0re an) vo,0me were a)e;0ate, warm e.termities (+),
C6T<==
Working Diagnosis: Low back pain e.c> Seere S!ste"ic Lupus #r!the"atosus $ Lupus
%ephritis $ Secon&ar! A"enorrhea
'anage"ent :
3et-+,pre)niso,one 3-3-
&+)ro.+c-,oro;0ine . > tab,et
?b0profen 3 @ 877 m%
Aiet common foo) 'B77 kca, + 7B %ram 9rotein
7lanning:
Cons0,t Ort-ope)ics
Follow up on April 50
th
,2014:
S : Low back pain (+), fever (-), :omit (-)
O: Sens: C3, Temp: 37.!C, "#:3$ k%, "&: '(3cm, "9: '7/B7 mm&%
&ea) *+es: ,i%-t ref,e.: +/+, isocoric p0pi,, pa,e of con10nctiva pa,pebra inferior (-),
*ar/nose/mo0t-: norma,/norma,/norma,
2ace 3oon face (+), 4cne at bot- c-eeks (+), "0tterf,+ ras- (+)
5eck *n,ar%ement of ,+mp- no)es (-)
T-ora. Simetrica, f0siform, 6etraction (-)
&6: $7 bpm, re%0,ar, m0rm0r (-)
66: 8 rpm, re%0,ar, ronc-i (-/-)
"ack 3i,iar+ spots (+)
4b)omen Soepe,, perista,tic (+) 5, ,iver/sp,een: not pa,pab,e
*.tremities 90,se $7 bpm, re%0,ar, press0re an) vo,0me were a)e;0ate, warm e.termities (+),
C6T<3=
Working Diagnosis: Seere S!ste"ic Lupus #r!the"atosus $ Lupus %ephritis $ Secon&ar!
A"enorrhea
'anage"ent :
3et-+,pre)niso,one 3-3-3
&+)ro.+c-,oro;0ine . > tab,et
?b0profen 3 @ 877 m%
Aiet common foo) 'B77 kca, + 7B %ram 9rotein
9-+siot-erap+
Follow up on 'a! 1
st,
2014
S : Low back pain (+), fever (-)
O: Sens: C3, Temp: 37.!C "#:3$ k%, "&: '(3cm
&ea) *+es: ,i%-t ref,e.: +/+, isocoric p0pi,, pa,e of con10nctiva pa,pebra inferior (+/+),
*ar/nose/mo0t-: norma,/norma,/norma,
2ace 3oon face (+), "0tterf,+ ras- (+), 4cne on bot- c-eeks (+)
5eck *n,ar%ement of ,+mp- no)es (-)
T-ora. Simetrica, f0siform, 6etraction (-)
&6: $8 bpm, re%0,ar, m0rm0r (-)
66: 8 rpm, re%0,ar, ronc-i (-/-)
"ack 3i,iar+ spots (+)
4b)omen Soepe,, perista,tic (+) 5orma,, ,iver/sp,een: not pa,pab,e
*.tremities 90,se $8 bpm, re%0,ar, press0re an) vo,0me were a)e;0ate, warm e.termities (+),
C6T<==
Working Diagnosis: Seere S!ste"ic Lupus #r!the"atosus $ Lupus %ephritis $ Secon&ar!
A"enorrhea
'anage"ent :
3et-+,pre)niso,one 8m% 3-3-3
&+)ro.+c-,oro;0ine . > tab,et
?b0profen 3 @ 877 m%
Aiet common foo) 'B77 kca, + 7B %ram 9rotein
Follow up on 'a! 2
n&
,2014:
S : Low back pain (+), fever (-)
O: Sens: Compos 3entis, Temp: 3C.7!C, "#:3$ k%, "&: '(3cm
&ea) *+es: ,i%-t ref,e.: +/+, isocoric p0pi,, pa,e of con10nctiva pa,pebra inferior (-/-),
*ar/nose/mo0t-: norma,/norma,/norma,
2ace 3oon face: (+), 4cne at bot- c-eeks (+), "0tterf,+ ras- (+)
5eck *n,ar%ement of ,+mp- no)es (-)
T-ora. Simetrica, f0siform, 6etraction (-)
&6: $C bpm, re%0,ar, m0rm0r (-)
66: B rpm, re%0,ar, ronc-i (-/-)
"ack 3i,iar+ spots (+)
4b)omen Soepe,, perista,tic (+) 5, ,iver/sp,een: not pa,pab,e
*.tremities 90,se $C bpm, re%0,ar, press0re an) vo,0me were a)e;0ate, warm e.termities (+),
C6T<3==
Working Diagnosis: Seere S!ste"ic Lupus #r!the"atosus $ Lupus %ephritis $ Secon&ar!
A"enorrhea $ Folliculitis $ Lu"bar spon&!litis
'anage"ent :
3et-+,pre)niso,one 8m% 3-3-3
&+)ro.+c-,oro;0ine . > tab,et
?b0profen 3 @ 877 m%
Aiet common foo) 'B77 kca, + 7B %ram 9rotein
Follow up on 'a! 5
r&
2014:
S : Low back pain (+)
O: Sens: C3, Temp: 37.!C, "#:3$ k%, "&: '(3cm
&ea) *+es: ,i%-t ref,e.: +/+, isocoric p0pi,, pa,e of con10nctiva pa,pebra inferior (-),
*ar/nose/mo0t-: norma,/norma,/norma,
2ace 3oon face: (+), 4cne at bot- c-eeks (+), "0tterf,+ ras- (+)
5eck *n,ar%ement of ,+mp- no)es (-)
T-ora. Simetrica, f0siform, 6etraction (-)
&6: ''7 bpm, re%0,ar, m0rm0r (-)
66: 8 rpm, re%0,ar, ronc-i (-/-)
"ack 3i,iar+ spots (+)
4b)omen Soepe,, perista,tic (+) 5, ,iver/sp,een: not pa,pab,e
*.tremities 90,se ''7 bpm, re%0,ar, press0re an) vo,0me were a)e;0ate, warm e.termities (+)
Working Diagnosis: Seere S!ste"ic Lupus #r!the"atosus $ Lupus %ephritis $ Secon&ar!
A"enorrhea $ Folliculitis $ Lu"bal spon&!litis
'anage"ent :
3et-+,pre)niso,one 3-3-3
&+)ro.+c-,oro;0ine . > tab,et
?b0profen 3 @ 877 m%
Aiet common foo) 'B77 kca, + 7B %ram 9rotein
Aipstick 0rine/C -o0r
Le0 5it Dro 9ro p& "LO SF Get "i, F,0
+- + 3,( - ( '737 - - - -
Follow up on 'a! 4
th
2014:
S : Low back pain (+)
O: Sens: C3, Temp: 37, "#:3$k%, "&: '(3cm, "9: '7/B7 mm&%
&ea) *+es: ,i%-t ref,e.: +/+, isocoric p0pi,, pa,e of con10nctiva pa,pebra inferior (-),
*ar/nose/mo0t-: norma,/norma,/norma,
2ace 3oon face (+), 4cne at bot- c-eeks (+), "0tterf,+ ras- (+)
5eck *n,ar%ement of ,+mp- no)es (-)
T-ora. Simetrica, f0siform, 6etraction (-)
&6: $ bpm, re%0,ar, m0rm0r (-)
66: rpm, re%0,ar, ronc-i (-/-)
"ack 3i,iar+ spots (+)
4b)omen Soepe,, perista,tic (+) 5, ,iver/sp,een: not pa,pab,e
*.tremities 90,se $ bpm, re%0,ar, press0re an) vo,0me were a)e;0ate, warm e.termities (+),
C6T<3==
Working Diagnosis: Seere S!ste"ic Lupus #r!the"atosus $ Lupus %ephritis $ Secon&ar!
A"enorrhea $ Folliculitis $ Lu"bal spon&!litis
'anage"ent :
T-ree wa+
3et-+,pre)niso,on ?n1ection '777m%/?: ( 2or 3 )a+s)- A'
3et-+,pre)niso,one 3-3-3
&+)ro.+c-,oro;0ine . > tab,et
?b0profen 3 @ 877 m%
Aiet common foo) 'B77 kca, + 7B %ram 9rotein
Follow up on 'a! (
th
2014:
S : Low back pain (+), fever (-), pa,e (-)
O: Sens: C3, Temp: 37.!C "#:3$ k%, "&: '(3cm,
&ea) *+es: ,i%-t ref,e.: +/+, isocoric p0pi,, pa,e of con10nctiva pa,pebra inferior (-),
*ar/nose/mo0t-: norma,/norma,/norma,
2ace 3oon face (+), 4cne at bot- c-eeks (+) "0tterf,+ ras- (+)
5eck *n,ar%ement of ,+mp- no)es (-)
T-ora. Simetrica, f0siform, 6etraction (-)
&6: ''7 bpm, re%0,ar, m0rm0r (-)
66: C rpm, re%0,ar, ronc-i (-/-)
4b)omen Soepe,, perista,tic (+) 5, ,iver/sp,een: not pa,pab,e
"ack 3i,iar+ spots (+)
*.tremities 90,se ''7 bpm, re%0,ar, press0re an) vo,0me were a)e;0ate, warm e.termities (+),
C6T<==
Working Diagnosis: Seere S!ste"ic Lupus #r!the"atosus $ Lupus %ephritis $ Secon&ar!
A"enorrhea $ Folliculitis $ Lu"bal spon&!litis
'anage"ent :
T-ree wa+
3et-+,pre)niso,on ?n1ection '777m%/?: ( 2or 3 )a+s)- A
3et-+,pre)niso,one 3-3-3
&+)ro.+c-,oro;0ine . > tab,et
?b0profen 3 @ 877 m%
Aiet common foo) 'B77 kca, + 7B %ram 9rotein
*onsultation results +ro" #n&ocrinolog! &epart"ent on 'a! (
th
2014:
Aia%nosis : Secon)ar+ 4menorr-ea
4)vice :-6ecommen) cortiso, test on mornin% an) )a+
-Treat 0n)er,+in% )isease
Follow up on 'a! )
th
2014:
S : Low back pain (+), fever (-), pa,e (+)
O: Sens: C3, Temp: 37, "#:3$ k%, "&: '(3cm,
&ea) *+es: ,i%-t ref,e.: +/+, isocoric p0pi,, pa,e of con10nctiva pa,pebra inferior (-),
*ar/nose/mo0t-: norma,/norma,/norma,
2ace 3oon face: (+), 4cne at bot- c-eeks (+), "0tterf,+ ras- (+)
5eck *n,ar%ement of ,+mp- no)es (-)
T-ora. Simetrica, f0siform, 6etraction (-)
&6: '77 bpm, re%0,ar, m0rm0r (-)
66: C rpm, re%0,ar, ronc-i (-/-)
4b)omen Soepe,, perista,tic (+) 5, ,iver/sp,een: not pa,pab,e
"ack 3i,iar+ spots (+)
*.tremities 90,se '77 bpm, re%0,ar, press0re an) vo,0me were a)e;0ate, warm e.termities (+),
C6T<3==
Working Diagnosis: Seere S!ste"ic Lupus #r!the"atosus $ Lupus %ephritis $ Secon&ar!
A"enorrhea $ Folliculitis $ Lu"bal spon&!litis
'anage"ent :
T-ree wa+
3et-+,pre)niso,one 3-3-3
&+)ro.+c-,oro;0ine . > tab,et
?b0profen 3 @ 877 m%
Aiet common foo) 'B77 kca, + 7B %ram 9rotein
Dipstick .rine?) hour:
Le0 5it Dro 9ro p& "LO SF Get "i, F,0
+- + 3,( +++ C - '7(7 - - -
7lanning:6 Fiven 3et-+,pre)niso,on ?n1ection '777m%/?:-A3
-Cons0,tation res0,t from Ort-ope)ic S0r%er+ Aepartment sti,, pen)in%
-C-eck C"C, L2T, 62T, 454 Test, anti )s-A54
Laborator! +in&ing on 'a! )
th
2014:
*o"plete 8loo&
*ount
-e"atolog! .nit /esult /e+erence
-e"oglobin 0-981 %H '8.8 '.7-'8.8
#r!throc!te 0/8*1 '7
C
/mm
3
8.(( 8.7-8.B7
Leucoc!te 0W8*1 '7
3
/mm
3
'3.7$ 8.(-''.7
-e"atocrite H 8' 3B-88
2hro"boc!te 07L21 '7
3
/mm
3
8' '(7-8(7
'*@ f, $7.' B(-$(
'*- p% 3'.C B-3
'*-* %H 3(.' 33-3(
/DW H '3.$ ''.C-'8.B
'7@ f, 7.B 7.7-'7.
7*2 H 7.'$
7DW f, B.'
#S/ mm/-o0r '' <7
Di++tel *ount
%eutrophil H BC.B 37-B7
L!"phoc!te H 7 7-87
'onoc!te H C -B
#osinophil H 7 '-C
8asophil H 7. 7-'
%eutrophil Absolute '7
3
/IL ''.3( .7-C.(
L!"phoc!te Absolute '7
3
/IL 7.$ '.(-3.7
'onoc!te Absolute '7
3
/IL 7.7$ 7.-7.8
#osinophil Absolute '7
3
/IL 7 7-7.'
8asophil Absolute '7
3
/IL 7.73 7-7.'
Lier
Albu"in %/)L 3.8 3. - 8.(
2otal 8ilirubin m%/)L 7.3$ <'
Direct 8ilirubin m%/)L 7.' 7-7.
AS2?S942 D/L C <3
AL2?S972 D/L 83 <3'
/enal
.reu" m%/)L 83 <(7
*reatinin m%/)L 7.38 7,(7-7,B7
.ric aci& m%/)L . <(.7
Follow up on 'a! ;
th
2014:
S : Low back pain (+), fever (-), pa,e (-)
O: Sens: Compos 3entis, Temp: 37!C "#:3$ k%, "&: '(3cm,
&ea) *+es: ,i%-t ref,e.: +/+, isocoric p0pi,, pa,e of con10nctiva pa,pebra inferior (-),
*ar/nose/mo0t-: norma,/norma,/norma,
2ace 3oon face: (+), 4cne at bot- c-eeks (+), "0tterf,+ ras- (+)
5eck *n,ar%ement of ,+mp- no)es (-)
T-ora. Simetrica, f0siform, 6etraction (-)
&6: '77 bpm, re%0,ar, m0rm0r (-)
66: C rpm, re%0,ar, ronc-i (-/-)
"ack 3i,iar+ spots (+)
4b)omen Soepe,, perista,tic (+) 5, ,iver/sp,een: not pa,pab,e
*.tremities 90,se '77 bpm, re%0,ar, press0re an) vo,0me were a)e;0ate, warm e.termities (+),
C6T<3==
Working Diagnosis: Seere S!ste"ic Lupus #r!the"atosus $ Lupus %ephritis $ Secon&ar!
A"enorrhea $ Folliculitis $ Lu"bal spon&!litis
'anage"ent :
3et-+,pre)niso,one 3-3-3
&+)ro.+c-,oro;0ine . > tab,et
?b0profen 3 @ 877 m%
Aiet common foo) 'B77 kca, + 7B %ram 9rotein
Dipstick .rine?) hour:
Le0 5it Dro 9ro p& "LO SF Get "i, F,0
+- + (,( +- ( - '77 +- - -
7lanning:6 Five C+c,op-osp-ami)e (77-'777 m%/m wit- "icnat C7H

Follow up on 'a! <
th
2014:
S : Low back pain (+), fever (-), pa,e (-)
O: Sens: Compos 3entis, Temp: 37!C "#:3$ k%, "&: '(3cm,
&ea) *+es: ,i%-t ref,e.: +/+, isocoric p0pi,, pa,e of con10nctiva pa,pebra inferior (-),
*ar/nose/mo0t-: norma,/norma,/norma,
2ace 3oon face: (+), 4cne at bot- c-eeks (+), "0tterf,+ ras- (+)
5eck *n,ar%ement of ,+mp- no)es (-)
T-ora. Simetrica, f0siform, 6etraction (-)
&6: '77 bpm, re%0,ar, m0rm0r (-)
66: C rpm, re%0,ar, ronc-i (-/-)
"ack 3i,iar+ spots (+)
4b)omen Soepe,, perista,tic (+) 5, ,iver/sp,een: not pa,pab,e
*.tremities 90,se '77 bpm, re%0,ar, press0re an) vo,0me were a)e;0ate, warm e.termities (+),
C6T<3==
Working Diagnosis: Seere S!ste"ic Lupus #r!the"atosus $ Lupus %ephritis $ Secon&ar!
A"enorrhea $ Folliculitis $ Lu"bal spon&!litis
'anage"ent :
3et-+,pre)niso,one 3-3-3
&+)ro.+c-,oro;0ine . > tab,et
?b0profen 3 @ 877 m%
Aiet common foo) 'B77 kca, + 7B %ram 9rotein
7lanning:6 Five C+c,op-osp-ami)e (77-'777 m%/m wit- "icnat C7H
-Cons0,tation res0,t from Ort-ope)ic S0r%er+ Aepartment sti,, pen)in%
- 454 Test an) anti )s-A54 are sti,, pen)in%
Dipstick .rine?) hour:
Le0 5it Dro 9ro p& "LO SF Get "i, F,0
+- + + '( C - '77 - - -
Follow up on 'a! =
th
2014:
S : Low back pain (+), fever (-)
O: Sens: Compos 3entis, Temp: 37.!C, "# :3$ k%.
&ea) *+es: ,i%-t ref,e.: +/+, isocoric p0pi,, pa,e of con10nctiva pa,pebra inferior (-),
*ar/nose/mo0t-: norma,/norma,/ norma,
2ace 3oon face (+), "0tterf,+ ras- (+), 4cne on bot- c-eeks (+)
5eck *n,ar%ement of ,+mp- no)es (-)
T-ora. Simetrica, f0siform, 6etraction (-)
&6: ''7 bpm, re%0,ar, m0rm0r (-)
66: 8 rpm, re%0,ar, ronc-i (-/-)
"ack 3i,iar+ spots (+), "r0ises (-)
4b)omen Soepe,, perista,tic (+) 5, ,iver/sp,een: not pa,pab,e

*.tremities 90,se ''7 bpm, re%0,ar, press0re an) vo,0me were a)e;0ate, warm e.termities (+),
C6T<3==
Working Diagnosis: Seere S!ste"ic Lupus #r!the"atosus $ Lupus %ephritis $ Secon&ar!
A"enorrhea $ Folliculitis $ Lu"bal spon&!litis
'anage"ent :
T-ree wa+
3et-+,pre)niso,one 3-3-3
&+)ro.+c-,oro;0ine . > tab,et
?b0profen 3 @ 877 m%
Aiet common foo) 'BB7 kka, wit- 7B %ram of protein
7lanning: -Cons0,tation res0,t from Ort-ope)ic S0r%er+ Aepartment sti,, pen)in%
- C-est @-ra+ p-oto is sti,, pen)in%
- T-ir) c-emot-erap+ C94 wit- "icnat in an -o0r
Follow up on 'a! 10
th
2014:
S : Low back pain (+), fever (-)
O: Sens: Compos 3entis, Temp: 37.!C "# :3$ k%.
&ea) *+es: ,i%-t ref,e.: +/+, isocoric p0pi,, pa,e of con10nctiva pa,pebra inferior (-),
*ar/nose/mo0t-: norma,/norma,/ norma,
2ace 3oon face (+), "0tterf,+ ras- (+), 4cne on bot- c-eeks (+)
5eck *n,ar%ement of ,+mp- no)es (-)
T-ora. Simetrica, f0siform, 6etraction (-)
&6: ''7 bpm, re%0,ar, m0rm0r (-)
66: B rpm, re%0,ar, ronc-i (-/-)
"ack 3i,iar+ spots (+), "r0ises (-)
4b)omen Soepe,, perista,tic (+) 5, ,iver/sp,een: not pa,pab,e

*.tremities 90,se ''7 bpm, re%0,ar, press0re an) vo,0me were a)e;0ate, warm e.termities (+),
C6T<3==
Working Diagnosis: Seere S!ste"ic Lupus #r!the"atosus $ Lupus %ephritis $ Secon&ar!
A"enorrhea $ Folliculitis $ Lu"bal spon&!litis
'anage"ent :
T-ree wa+
3et-+,pre)niso,one 3-3-
&+)ro.+c-,oro;0ine . > tab,et
?b0profen 3 @ 877 m%
Aiet common foo) 'BB7 kka, wit- 7B %ram of protein
Dipstick .rine?) hour:
Le0 5it Dro 9ro p& "LO SF Get "i, F,0
+- + + + C - '77 - - -
*onsultation results +ro" /a&iolog! &epart"ent on 'a! 10
th
2014:
Aia%nosis : "ronc-opne0monia
*onsultation results +ro" 4rthope&ics &epart"ent on 'a! (
th
2014:
Aia%nosis: Spon)i,itis -T-e manifestation of m0sc0,oske,eta, from SL* is t-e spine osteopenia
Follow up on 'a! 11
th
2014:
S : Low back pain (+), fever (-)
O: Sens: Compos 3entis, Temp: 37.!C "# :3$ k%.
&ea) *+es: ,i%-t ref,e.: +/+, isocoric p0pi,, pa,e of con10nctiva pa,pebra inferior (-),
*ar/nose/mo0t-: norma,/norma,/ norma,
2ace 3oon face (+), "0tterf,+ ras- (+), 4cne on bot- c-eeks (+)
5eck *n,ar%ement of ,+mp- no)es (-)
T-ora. Simetrica, f0siform, 6etraction (-)
&6: $B bpm, re%0,ar, m0rm0r (-)
66: 8 rpm, re%0,ar, ronc-i (-/-)
"ack 3i,iar+ spots (+), "r0ises (-)
4b)omen Soepe,, perista,tic (+) 5, ,iver/sp,een: not pa,pab,e

*.tremities 90,se $B bpm, re%0,ar, press0re an) vo,0me were a)e;0ate, warm e.termities (+),
C6T<3==
Working Diagnosis: Seere S!ste"ic Lupus #r!the"atosus $ Lupus %ephritis $ Secon&ar!
A"enorrhea $ Folliculitis $ Lu"bal spon&!litis
'anage"ent :
T-ree wa+
3et-+,pre)niso,one 3-3-
&+)ro.+c-,oro;0ine . > tab,et
?b0profen 3 @ 877 m%
Aiet common foo) 'BB7 kka, wit- 7B %ram of protein