Block 2 Case 4 Answers

A 23 year old female presents to the office with a rash on her face, complains of muscle pain / weakness and fatigue.  A battery of tests are run and she tests positive for syphilis despite never having sex. It is also noted that she has  ANA and Anti-ds-DNA antibodies.

What kind of rash is this? Malar rash

Why did she have a false positive result for syphilis? The anti-phospholipid antibodies present in lupus can cause a false positive syphilis test. 

What is her diagnosis? SLE - lupus nephritis

What type of hypersensitivity reaction causes the tissue damage? Type III

Name 4 of the criteria for diagnosis:

1. malar rash
2. discoid rash
3. serositis
4. oral ulcers
5. arthritis
6. photosensitivity
7. hematologic disorder
8. renal disorder
9. ANA+
10. anti-ds DNA, antiphospholipid AB / false positive for syphilis
11. neuro disorder

If a biopsy of her kidney was taken it would show the following:

http://library.med.utah.edu/WebPath/RENAHTML/RENAL120.html

This patient has lupus nephritis - note the mesangial hypercellularity and "wire-looping." Wire looping refers to the thickened glomerular capilary loops. Note: the more immune complex deposition the more cellular proliferation and the worse the disease.