A 14-year-old female presents with a 6-week history of fatigue and facial rash. Her rash seems to be exacerbated by sun exposure. She has recently developed pain and swelling in her fingers and wrists. She has no significant past illnesses. Family history is significant for an aunt with lupus and a grandmother with thyroid disease. Examination: VS T 37.8, P 88, R 20, BP 110/66.
Height and weight are at the 20th percentile. She is alert and cooperative. She has thinning hair over her front scalp with some fine short hairs. She has an erythematous maculopapular rash over her malar areas spanning the bridge of her nose, erythema of the hard palate and a few shallow gingival ulcers. Joint exam reveals mild swelling and tenderness to palpation and range of motion in the proximal interphalangeal joints of several of her fingers and both wrists. Heart, lung, abdomen, back and neurological…
