BIOPSYCHOSOCIAL HISTORY OF 25/F PRESENTED WITH FEVER AND MULTIPLE SKIN LESIONS

BIOPSYCHOSOCIAL HISTORY OF A 25 F PRESENTED WITH FEVER AND MULTIPLE SKIN LESIONS OVER BOTH LEGS  WITH  SUSPECTED  SYSTEMIC LUPUS ERYTHEMATOSUS

Case blog link : https://asjad24.blogspot.com/2023/10/a-case-of-sle-presented-in-october-2023.html

PSYCHOLOGICAL HISTORY :

Before Disease : Patient was brought up in a rural background with her father working as a stone cutter. Due to financial constraints and social backwardness she couldn't even attain the primary education. Although her family had financial crisis, there was no stress in the family. 

She got married at an early age of 17 years(2015) and two children at 20(2018) and 23(2021) respectively which overburdened her shoulder with responsibilities at an early age. After that she started working as a daily wage worker with her husband. 

During her second pregnancy she got rashes over her both the cheeks but she wasn't  worried about that and after labour she didn't even pay heed to it. She had cheerful marital life. 

No h/o any family stress or any stressful events. 

After disease 

Since July 2023 she has been having continuous high grade fever with multiple skin lesions that made her apprehensive. She started getting multiple joint pains that  deprived her from working 

She began feeling low due to pain and skin lesions. She has been experiencing mood swings with irritability and frustration due to pain. 

Before she used to watch television for recreation but now she stopped all her recreational activities which makes her feel depressed 

Before the disease she used to keep herself busy in her work and household chores but due to pain and extreme weakness she is unable to do normal activities like taking bath and changing clothes which makes her feel  dependent. 

She is  worried about her  children as no one is there to look after them. 

She talks in a low voice with a fatigued look also keeps crying in between and is emotionally weak. 

She prefers social seclusion. 

Coping Strategies : She prefers company of her husband, children and her parents. 

Mental State : Cooperative 

Speech : Decrease rate and volume 

Quality of life has significantly decreased and her social participation has been limited due to continuous pain and profound fatigue. 

No h/o alcohol intake, smoking and substance abuse

No signs of perceptual disturbances. 

No suicidal thoughts

No h/o medication for psychological disorders. 

BIOLOGICAL HISTORY 

Family history : No h/o similar complaints in other family members . 

Diet: Before Disease - appetite was normal 

After disease - appetite is significantly reduced

She takes small quantity of rice with some amount of daal in all her 3 meals. Her calorie requirement per day - 1500kcal

She eats 1 and 1/2 cup rice and 1 bowl of daal in a day 

Her daily calorie intake = 400 kcal

Calorie deficit = 1100 kcal 

Required protein per day = 56 gm

Amount consumed 10gms 

Protein deficit = 46gms

Status : Severely undernourished

Sleep : Before disease : 8 hours continuous sound sleep during night (from 9pm to 5am)

After disease - She is getting up during night 4-5 times for using the washroom. 

Even after getting up in the morning she stays on the bed and after taking tea  she sleeps again 

Due to extreme weakness she prefers staying on bed and takes intermittent naps. 

Physical traumas - No h/o significant accidents or trauma. But minor skin abrasions are common in her stone  carrying occupation.

Lifestyle : Before Disease - She used to wake up at 5 am then freshen up. 

At 6am she used to do her household chores. 

At 7am she used to have a cup of tea with her husband and then prepare both breakfast and lunch(she packs it to work) for herself and her family. By 8 they leave her son at school and they both go to work. 

At 2pm she used to have lunch at her workplace. 

And by evening 4 they return home and after doing household chores she used to sleep by 9pm.

After Disease : No fixed time of getting up in the morning as she doesn't have to go for work. 

Not doing any house hold chores.

She is mostly lying on bed. 

She needs support from her husband for taking bath and changing dress. 

SOCIAL HISTORY 

Living situation : She lives with her husband and 2 children 

Nuclear family 

Occupation : Daily wager but not going for work since 3 months because of pain. 

Occupational hazards : Continuous exposure to silica dust due to stone carrying activities.

"Silica exposure is a known risk factor for SLE" https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9282083/#:~:text=Several%20epidemiological%20studies%20have%20shown,have%20not%20been%20well%20studied

Prone to minor abrasions

No educational history 

Socio economic status : Upper lower Class (IV) according to kuppuswamy scale 2018

Kutcha house with only a room without separate kitchen. 

She uses woods and coal for cooking food. 

Filter water for drinking. 

No toilet and bathroom (open defecation) 

Overcrowding is present 

No proper ventilation and hygiene 

Support system : stable family support from husband, children and her parents. 

Stressor and life events : painful ulceration since 3 months which deprived her from carrying out normal daily activities.