AAAAA
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A 33-year-old woman with a 10-year history of migraine headaches and systemic lupus erythematosus develops a fever of 38.3 °C (101 °F) and pleuritic chest pain of 1 day's duration. Her lupus manifestations include arthritis, livedo reticularis, and positive findings on antinuclear antibody and IgG-specific anticardiolipin antibody assays. For the past 8 months, her lupus had been well controlled with hydroxychloroquine and prednisone, 5 mg/d. Three weeks ago, she began taking an estrogen-containing oral contraceptive.
On physical examination, temperature is 38.1 °C (100.6 °F) and respiration rate is 18/min. On pulmonary examination, the lungs are clear to auscultation. Cardiac examination reveals tachycardia without murmur, rub, or extra sounds. There is a faint violaceous reticular rash on the arms and legs. On musculoskeletal examination, there is no sign of arthritis, tendonitis, or myofascial tenderness to palpation.
Laboratory Studies Hemoglobin 10.2 g/dL (102 g/L) Leukocyte count 13,500/µL (13.5 × 109/L) Platelet count 94,000/µL (94 × 109/L) Erythrocyte sedimentation rate 66 mm/h Activated partial thromboplastin time 41 s Creatinine 1.2 mg/dL (106.1 µmol/L)
Chest radiography is normal.
Which of the following is the most appropriate next step in this patient's management?
A Complement level and anti–double-stranded DNA antibody assay B Contrast-enhanced spiral CT of the chest C Antiplatelet antibody assay D Anticardiolipin antibody assay
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| whiterabbit
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A Complement level and anti–double-stranded DNA antibody assay
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| PGI2alpha
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why?
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| beefoxy
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C
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