September 27, 2010

Woman with Shortness of Breath, Hematuria and Lymphadenopathy

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41-Year-Old Woman With Shortness of Breath, Hematuria, and Lymphadenopathy (see Original Question)

ANSWER
The constellation of serositis, hypertension, diffuse lymphadenopathy, azotemia, and proteinuria in this patient was highly suspicious for a systemic autoimmune disease. Further laboratory workup revealed a positive result for antinuclear antibodies (ANA) 1:640, including those against double-stranded DNA (ds-DNA); IgG titer of 300 IU/mL, and an anti-Smith finding (156 EU/mL) which, when correlated with the clinical picture, are consistent with a diagnosis of systemic lupus erythematosus.

September 26, 2010

A 41-Year-Old Woman With Shortness of Breath, Hematuria, and Lymphadenopathy

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Background
A 41-year-old black woman presents to the emergency department (ED) with a 5-day history of increasing shortness of breath along with a mild, nonproductive cough. She denies having any fever, chills, chest pain, or palpitations. No sick contacts are identified, and she denies any recent travel. On further questioning, the patient reports that she first experienced shortness of breath 1 year ago, and that it has been gradually progressive since then.