new_n_lost
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A 33-year-old single mother of two young children visits her physician because of an oral ulcer. A review of systems is significant for fatigue, myalgia, and joint pain. Laboratory results demonstrate leukopenia, and a high-titered antinuclear antibody. A speckled staining pattern due to anti-Sm is seen with immunofluorescence; urinary protein is elevated.
Which of the following is the most likely diagnosis?
A. Generalized fatigue
B. Goodpasture's syndrome
C. Mixed connective tissue disease
D. Scleroderma
E. Systemic lupus erythematosus
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| silver
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E. SLE
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| tompat
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anti -smith 100% specific, anti nuclear 100% sensitive
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| jean robert
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E
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| drhouse
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E. SLE
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| drmohamed811
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E- SLE
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| sfk
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E.
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| tompat
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ok gimme something with ANA +ve and anti-sm(?) positive
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| new_n_lost
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tompat wrote:
ok gimme something with ANA +ve and anti-sm(?) positive
Well wht do u think the Answer shud be of ur own Question ??
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| SmokyWaters
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SLE
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| new_n_lost
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FORUM RULES-- Those who believe in telekinesis, raise my hand. I get enough exercise just by pushing my luck --P4U World.." The pure and simple truth is rarely pure and never simple."
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| new_n_lost
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The correct answer is E. Systemic lupus erythematosus (SLE) is a prototype connective tissue disease. The diagnosis requires four criteria to be met from a list of eleven possible criteria: malar rash, discoid rash, photosensitivity, oral ulcers, arthritis, serositis, renal disorder, neurologic disorder, hematologic disorder, immunologic disorder, and antinuclear antibody. This patient also has anti-Sm, which is pathognomonic for SLE, but is only found in 30% of the affected patients. Antinuclear antibodies (ANA) are present in 95-100% of cases of SLE; anti-double-stranded DNA is found in 70% of the cases.
Generalized fatigue (choice A) due to being a single working mother of two children could well be a possibility, but the presence of the other criteria make SLE more likely.
Goodpasture's syndrome (choice B) is characterized by linear disposition of immunoglobulin, and often C3, along the glomerular basement membrane (GBM). Glomerulonephritis, pulmonary hemorrhage, and occasionally idiopathic pulmonary hemosiderosis occur.
Mixed connective tissue disease (choice C) is an overlap syndrome characterized by a combination of clinical features similar to those of SLE, scleroderma, polymyositis, and rheumatoid arthritis. These patients generally have a positive ANA in virtually 100% of the cases. High titer anti-ribonucleoprotein (RNP) antibodies may be present, generating a speckled ANA pattern. Anti-RNP is not pathognomonic for mixed connective tissue disease, since it can be found in low titers in 30% of the patients with SLE.
Scleroderma (choice D) is characterized by thickening of the skin caused by swelling and thickening of fibrous tissue, with eventual atrophy of the epidermis. ANA are often associated with the disease, but the staining pattern is generally nucleolar.
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FORUM RULES-- Those who believe in telekinesis, raise my hand. I get enough exercise just by pushing my luck --P4U World.." The pure and simple truth is rarely pure and never simple."
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| tompat
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while reading this q , it occured to me what if they meant anti-sm as anti smooth muscle
hmm, but guess they wont.
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| Ig F
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good work nnl.......
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| 1.ammara
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let me add here in context of SLE.... its a connective tissue disorder that can involve any part of the human body except one i.e liver. as far i know, its rare for liver to be affected by it in the first place.
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