Case presentation A 25-year-old secretary presents with joint pains, lethargy, and a rash. She has no significant past medical history. She first noticed the rash one month ago, which she thought was sunburn. This rash persisted, mainly on her arms, neck, upper chest, and cheeks. She has also had four or five mouth ulcers during this period, which is unusual for her. There is no history of genital ulceration.
She is otherwise fit and healthy and has never had any similar episodes previously. Her only medication is the oral contraceptive pill which she has been taking for the past six years, and she has never been pregnant or had a miscarriage. She is a non-smoker and denies the use of any recreational drugs. She does have a family history of autoimmune disease in that her maternal grandmother had rheumatoid arthritis. The patient has pale conjunctivae and palmar creases. Her temperature…
