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Sin embargo dos meses despus del inicio de dichos sntomas la paciente presenta fiebre, malestar general, cansancio, dolor de cabeza, artralgias, rash malar (o alas de mariposa es una erupcin eritematosas plana o sobreelevada con leve descamacin que se localiza en las mejillas y el puente nasal, respetando el pliegue nasogeniano y de distribucin simtrica), dolor pectoral a nivel de la pleura y oligouria (disminucin de la produccin de orina) (13)

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