Introduction:

Systemic lupus erythematosus (SLE) is a chronic autoimmune inflammatory disease of unknown cause with multisystemic involvement. In Portugal, it is estimated that 0.07% of the population has this diagnosis, with the first symptoms manifesting in the age group of 16 to 49 years old in 75% of the cases. The clinical manifestations of SLE are multiple and are related to the multisystemic character of this pathology. The heterogeneity of the clinical presentation extends from mild mucocutaneous or joint changes (90%) to impaired renal, pulmonary, cardiac, hematological, or neuropsychiatric function.

Case description:

Woman, 18 years old, with a history of SLE, went to an open consultation at her family doctor due to complaints of insidious onset of sternal thoracalgia, aggravated by deep inspiration and relief with anterior flexion of the chest, with the notion of dyspnea, irritating cough, and associated fever.

Comment:

SLE due to its multisystemic and chronic nature, is responsible for a wide range of clinical manifestations, being considered by many ‘one of the greatest imitators’. In the current epidemiological context, the presence of symptoms such as fever, chest pain, and cough immediately suggest the diagnostic hypothesis of the disease COVID-19, which, undoubtedly, should be excluded. However, the role of the family doctor, as a privileged expert on the patient’s personal history, namely on their chronic illnesses and their follow-up, as well as on the clinical manifestations associated with the disease’s recurrence or exacerbation, allows him to have a supported diagnostic suspicion.

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