Dr. Gersh: A 36-year-old housewife was admitted to Tripler Army Medical Center because of increasing shortness of breath over a period of three months.
Six months before admission she had noted pain and swelling in her wrists, elbows, shoulders, and knees, as well as in the small joints of her hands. At the same time, a nonpruritic, erythematous rash spread over her face and trunk.
Of 11 brothers and sisters, one had died of lupus erythematosus; a son had died of a cerebral neoplasm. Otherwise, the family history was unremarkable.
Positive findings were limited to the following: fine basilar rales in both lungs; a palpable spleen edge; tenderness and minimal synovial thickening over the metacarpophalangeal and proximal interphalangeal joints, shoulders, and elbows; marked synovial thickening over knees and wrists; patchy erythema over the lower portion of the face, the trunk, and fingers; violaceous periorbital edema; decreased muscle strength,