From the Guidelines
The most relevant additional history to obtain in this patient is regarding her current disease activity, medication regimen, and any recent changes or stressors that may have triggered her symptoms, as well as screening for infections such as HIV, HCV, HBV, and tuberculosis, according to her risk factors 1. Given the patient's symptoms of fever, headache, photophobia, and limited neck mobility, along with the cerebrospinal fluid analysis showing neutrophilic pleocytosis and increased protein concentration, it is essential to consider the possibility of a neuropsychiatric manifestation of systemic lupus erythematosus (NPSLE) or an infection. The European League Against Rheumatism (EULAR) recommendations for monitoring patients with SLE emphasize the importance of assessing disease activity, organ damage, and comorbidities, as well as screening for infections 1. In patients with SLE, neuropsychiatric manifestations can be a significant concern, and the EULAR recommendations for the management of NPSLE suggest that these manifestations should be evaluated and treated as in patients without SLE, and secondarily attributed to SLE and treated accordingly 1. Some key points to consider in the history include:
- Current medication regimen, including any immunosuppressive therapy
- Recent changes or stressors that may have triggered her symptoms
- Screening for infections such as HIV, HCV, HBV, and tuberculosis, according to her risk factors
- Assessment of disease activity using a validated index
- Evaluation of organ damage and comorbidities
- History of previous neuropsychiatric manifestations or other SLE-related complications By obtaining a thorough history, the clinician can better understand the patient's condition and develop an appropriate treatment plan, which may include glucocorticoids, immunosuppressive therapy, or antiplatelet/anticoagulation therapy, depending on the underlying cause of her symptoms 1.
From the Research
Relevant History
To determine the most relevant additional history for a 36-year-old woman with systemic lupus erythematosus (SLE) and symptoms of fever, headache, photophobia, and limited neck mobility, with cerebrospinal fluid analysis showing neutrophilic pleocytosis and increased protein concentration, the following points should be considered:
- The patient's past and current context, including any previous infections or exposures that may be relevant to the current symptoms 2
- A thorough history of present illness, including the onset and duration of symptoms, as well as any factors that exacerbate or relieve them 3, 4
- The use of digital tools to obtain the history of present illness may be beneficial in improving efficiency and quality of care, although the outcomes measured have been inconsistent 5
Additional Considerations
In patients with sepsis, timely delivery of appropriate antibiotic therapy is crucial in reducing length of stay in the ICU and hospital 6
- It is essential to consider the patient's medical history, including any previous diagnoses or treatments that may be relevant to the current symptoms
- A comprehensive patient history should include information about the patient's symptoms, medical history, and any factors that may be contributing to the current condition
Key Points to Consider
- Take a thorough and structured history of present illness
- Consider using digital tools to improve efficiency and quality of care
- Timely delivery of appropriate antibiotic therapy is crucial in patients with sepsis
- The patient's past and current context, including any previous infections or exposures, should be taken into account
- A comprehensive patient history should include information about the patient's symptoms, medical history, and any factors that may be contributing to the current condition 2, 3, 4, 5, 6