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Since how long she is experiencing these symptoms?
Have they checked the muscle enzymes?
Thanks for the information
I would suggest that she should have muscle enzymes if not done before
This could be a muscle inflammation or myositis
If the rash has appeared after taking the antibiotic the rash could be due to antibiotic
The rash on neck and feet does not seems the same as the one on the foot looks more like a bruise or hematoma which can signify an impaired clotting mechanism
Sometime if liver is having an advance damage the clotting can be impaired and thus a small bleeding under skin with minor trauma or spontaneously and that is what the foot rash looks like
She should have a clotting study as well to see if impaired problem is responsible for this or not
So two things one is myositis and other is a liver damage needs to be ruled out
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Yes the next thing to consider should be an autoimmune disorder like Lupus
I would suggest that other than steroids she should also get treatment with Hydroxychloroquin
She will start to improve within weeks
Usually in an acute flare of SLE with myositis she can be put on 1mg/kg body weight of prednisolone along with Hydroxychloroquin at a dose of 200-400 mg per day
Then after seeing the initial response steroids can be tapered after a couple of weeks
Asymptomatic heart murmur should not be a problem in getting this treatment
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Wishing your wife a speedy recovery
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I am a Consultant Rheumatologist and will try to guide you further if required