Rhupus Syndrome Presenting as Interstitial Lung Disease: A Case Report

• Main Authors: Vishal Venugopal, Srujan Sriram Yelamanchi, Vrinda Vijayakumari, VR Mohan Rao
• Format: Article
• Language: English
• Published: JCDR Research and Publications Private Limited 2021-02-01
• Series: Journal of Clinical and Diagnostic Research
• Subjects: cyclosporin; rheumatoid arthritis; systemic lupus erythematosus
• Online Access: https://www.jcdr.net/articles/PDF/14558/46873_CE[Ra1]_F(KM)_PF1(SK1_KM)_PFA(OM)_PN(SHU).pdf

Systemic Lupus Erythematosus (SLE) and Rheumatoid Arthritis (RA) are characterised by two distinct immunopathological activities, the T-helper 2 cells play a vital role in pathogenesis of SLE while T-helper 1 cells play an important role in RA. Organ involvement in Rhupus syndrome is relatively rare. Here, authors present a case of 59-year-old female who came with complaints of multiple joint pain (involving small and large joints) for a year and dyspnoea for 6 months without co-morbidities, on examination she had pallor, impaired percussion note and velcro crepitations in bilateral infrascapular region, her Pulmonary function test revealed a restrictive pattern and High-Resolution CT (HRCT) chest revealed sub-pleural reticulations involving lower lobes, she was diagnosed as RA with Interstitial Lung Disease (ILD) and started on hydroxycholoroquine, sulfasalazine and prednisolone. During follow-up after 6 months she developed a hyperpigmented rash over cheeks and bridge of nose, non-painful oral ulcers with Anti-Nuclear Antibodies (ANA) showing speckled positivity and Extractable Nuclear Antigen (ENA) panel showing positive anti-ds DNA and negative anti-histone, here with, we present a case of Rhupus syndrome presented with ILD. Recognising this condition is important as treatment varies between Rhupus syndrome and SLE or RA.