History:

This 25-year-old woman presented with 3 year history (soon after her marriage) of developing a photosensitive red malar rash and arthralgia associated with mouth and palate ulcers.  Her symptoms worsened over time and she developed a red macular eruption on the face, upper chest, hands and feet, low grade fever, multiple joint pains, nause, diarrhea and episodes of crampy abdominal pain related with ingestion of food.  She also developed Raynaud's phenomenon. Her lab investigations including ANA and anti ds DNA are pending. 

(Hb 7.9 g/dl Platelet count 297x10^9/l WBC count 5.2x109/L ESR 110 mm/1st hour

Anti dsDNA  strongly positive  (319 IU/ml)

 She was clinically diagnosed as a case of active SLE two years earlier and prescibed oral prednisolone and hydroxychloroquin to which she always responded dramatically and her symptoms improved.  At the time of presentation she was off her medication for at least one month.