FROM PRESSURE INJURY TO FEMUR FRACTURE: CHALLENGES AND STRATEGIES IN AN IMMUNOSUPPRESSED PATIENT WITH SYSTEMIC LUPUS ERYTHEMATOSUS AND PARAPLEGIA, A CASE REPORT

Abstract

Introduction: Systemic Lupus Erythematosus (SLE) is a multisystem autoimmune disease with a multifactorial etiology. It presents manifestations related to the nervous system, such as paraplegia, and also has consequences from the use of medications for treatment, such as osteoporosis. Objective: To report the challenges faced by a socially and professionally active patient regarding SLE and its complications, as well as the strategies adopted to overcome them. Case Description: A 57-year-old female patient has had SLE since childhood and, as a result, became paraplegic at the age of 14. In addition, she has a medical history significant for fibromyalgia, systemic arterial hypertension, and osteoporosis. Immunosuppression due to SLE treatment and paraplegia led to complications such as sacral pressure ulcers, followed by hospitalization, sepsis, and respiratory system complications. Two months after hospital discharge due to sepsis, she suffered a femur fracture from exhaustion. There were disagreements regarding the appropriate treatment, and ultimately, surgery for pseudoarthrosis was chosen. However, due to delays in performing the procedure, the patient developed a bone callus. Later, she had to be admitted to the intensive care unit due to sepsis triggered by a pressure ulcer in the sacral region. She underwent treatment and was discharged upon request after 16 days of hospitalization. Conclusion: Collaborative care was necessary, and effective communication among healthcare professionals proved essential to prevent or minimize complications.