A possible case of systemic lupus erythematosus presenting with generalised oedema.

Systemic lupus erythematosus (SLE) is an autoimmune disease of unknown aetiology affecting various systems within the body. We report the case of a patient with generalised subcutaneous oedema as the only presenting feature, which led to the possible diagnosis of SLE without a specific cause. The patient presented to the Sultan Qaboos University Hospital in Muscat, Oman, in April 2013. The oedema had been present for two years before admission. Other potential causes of oedema in patients with SLE were excluded, including SLE of renal origin and SLE due to protein-losing enteropathy or drugs. This was confirmed by the patient's normal serum albumin level and negative proteinuria. Laboratory investigations showed high levels of positive antinuclear antibodies (>1:640), positive anti-double-stranded deoxyribonucleic acid results, high levels of anti-β2-glycoprotein 1 and immunoglobulin M and low levels of both complement components 3 and 4. The oedema improved immediately in response to steroids and immunosuppressive medications. Physicians should be aware that generalised subcutaneous oedema can be the only manifestation of SLE.