27yrs old woman with SLE
Left side chest pain since 15days....pain during breathing....
Swelling on face, feet , fingers leg abdomen since 6month...
Pain in finger and leg and knee join....
Weakness

Past/history ___
Before 1 1/2 yrs...
After delivery.......
Fever since 8days....and after few time patient complaining small pox...since 4_5days ... then...pain in leg and hand...
And then start kidney problem and treatment continue....

Personal/history __not significant
Family /history ___ not significant

Mentrual /history ___ Marriage _8yrs
Menarche__ 15yrs of age
Amenorrhoea_ 1 1/2 yrs....After delivery

Obs/history. .. p3 L3
2male child 1female child...
All delivery are normal...
Last child birth..1 1/2 yrs
During last pregnancy..swelling on whole body and pain in rt side abdomen....
P/A ___ soft tenderness  in hypochondriac region. .
Bp_ 120/80
Pulse_ 78/min
Urine_ normal
Motion _ normal
Skin..normal...swlling and dryness...

Investigation___
Echo...
Pericarditis with MR (moderate to severe) with mitral valve thickning..

Spot urine___ protien creat. 3.53
Hb_ 9.2
ESR__ 25
Usg_ done
Chest x_ray....done