Rheumatology Quiz

Prepared by Ernest Raymund Vina, BS, Medical Student, Chicago Medical School, Finch University of Health Sciences,

North Chicago, Ill; Sandeep Dang, MD, Resident, Department of Medicine, Nina Trinh, MD, Fellow, Division of

Rheumatology, and Daniel G. Arkfeld, MD, Assistant Professor, Division of Rheumatology, Keck School of Medicine,

University of Southern California, Los Angeles, Calif

A24-year-old Vietnamese woman presented with a dry cough with left-sided pleuritic pain and a new rash. She had low-grade fever, and a malar rash and excoriations covered her anterior neck and sternal area (Figure). A chest x-ray revealed a rightsided pulmonary nodule, and the patient was started on presumptive tuberculosis therapy. Test results were: leucopenia and thrombocytopenia; antinuclear antibody (ANA) titer, 1:>1280; anti-DNA antibody titer, 1:320; and urine protein, >300 mg/dL. Three induced sputum samples for acid-fast bacillus stains and subsequent cultures were negative.

What's Your Diagnosis?

What's the Diagnosis?

• Systemic lupus erythematosus (SLE)
• SLE and coining
• SLE and dermatomyositis
• Tuberculosis

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