She was brought into the Johns Hopkins University Hospital desperately ill, recalls her doctor, "acutely seriously and violently."
In addition to a high fever, rash, serious kidney problems and a low platelet count, "She was grossly, frankly psychotic, to such a degree that when we went in to see her she would slug us. And this went on for several weeks. Her husband, even the hospital staff, became very discouraged. . ."
That was 10 years ago.
The patient, in her early 30s and the mother of young children, was suffering from SLE, systematic lupus erythematosus. (Named "lupus" by 19th-century doctors who detected a similarity between the bite of a wolf and the shape and color of a skin lesion that may be a manifestation, the perferred term is now SLE.)
Even as recently as 15 or 20 years ago the woman's case would have been considered hopeless. And 10 years ago most physicians were convinced that once the brain was involved, as hers was, hope for recovery was nil.
Nevertheless, after a few weeks of intensive treatment by Dr. Lawrence E. Shulman, the woman recovered from that crisis. Today she leads a full, active normal life, on a minimum of medication.
She is not cured.
SLE is a chronic disorder that usually requires constant care in varying degrees of intensity. It is an illness known for "its ups and downs," says Dr. Shulman. It can be fatal, but with proper care, no longer need be (Author Flannery O'Connor died of SLE at the age of 39 in 1964 after 13 years of fighting its ravages.)
Shulman, associate director of the Arthritis, Musculoskeletal and Skin Diseases Program of the National Institute of Arthritis, Metabolism and Digestive Diseases, NIH, is one of the world's leading experts on SLE.
He speaks carefully. SLE is an illness that has been much misunderstood.
It has been feared, as it should not be, but sometimes has not been properly respected -- as it should be.
Shulman doesn't like to speak in absolute numbers because there may be as many as a million victims in this country -- or as few as 100,000. There are estimates of 50,000 new cases each year.
Possibly 90 percent of its victims are women, mostly in late adolescence or early adulthood. According to a 1974 study, it may hit one person in a thousand, but strikes one adult woman in 700 and one adult black woman in 245.
Evidence from current research points to some role played by heredity. Research also is probing the apparent relationship between SLE and the sex hormones.
Other research has shown that it involves a malfunction in the body's immune system which, in a complex series of biochemical processes, leads to the production in the body of substances which attack the body's own tissue.
There are many symptoms that have been associated with SLE, but not all of them may be present at any given time.
"It expresses itself in varying combinations," says Shulman. "It may have an explosive onset, or it may come on more insidiously, but the most frequent initial manifestation is arthritis." (SLE has, in fact, been considered a form of arthritis, even though experts now realize that arthritis is but a symptom.)
Next most common symptoms are fever and the skin rash, which may or may not imply a sun sensitivity.
There may be inflammation of the lung lining or of the heart lining. In about half of SLE patients there is serious kidney involvement. Fewer than half have central nervous system symptoms, such as convulsions or psychoses. There also may be anemia, adnormalities in the urine.
No wonder it was thought of as dire, rare and fatal.
Today, however, says Shulman, "We have found the disease to be more frequent and, overall, not as serious as it was originally thought to be."
And with treatment using cortisone -- like drugs, principally Prednisone, often along with aspirin, most lupus patients can live relatively full and active lives. In the most serious flare-ups, potent anti-cancer immune system supressor agents have proven useful, although their often harsh side effects make them less satisfactory as maintenance drugs. In some milder cases, anti-malarial drugs have been helpful.
Recent breakthroughs in treatment now even permit some women with SLE to have normal pregnancies.
Finally, the most exciting news about SLE is in the prognosis for the individual patient. A 1955 project indicated that about 50 percent of SLE victims survived four years after diagnosis.
In 1976, there was a 92 percent survival rate after five years, and 84 percent after 10 years. The newest statistics, according to Shulman indicate that 10 years after diagnosis 90 percent of victims survive.