A Diagnostic Difficulty on ANA Negative/ Seronegative Systemic Lupus Erythematosus with Diffuse Alveolar Haemorrhage

P. Upadhya, A. Priya, M. Chari, P. Toi, G. Vishnukanth
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Abstract

A 45-year-old hypertensive woman had a dry cough, dyspnea, and a crusted nonhealing ulcer on her right ankle for one month. She was suffering from worsening anaemia, proteinuria, and thrombocytopenia. A CT pulmonary angiogram revealed pulmonary hypertension, a thrombus in the left internal jugular vein, and bilateral multilobar opacities. A Doppler USG revealed thrombus in the right popliteal and left jugular veins. Serology revealed a low C3, C4, negative ANA with antiphospholipid antibodies that were twice positive. Diffuse alveolar bleeding was confirmed by bronchoalveolar lavage (DAH). An ulcer biopsy revealed lymphocytic vasculitis, which is a sign of immune complex deposition disorder.ANA negative SLE with DAH was identified after meeting the clinical and immunological criteria of the Systemic Lupus International Collaborating Clinics (SLICC).
ANA阴性/血清阴性系统性红斑狼疮伴弥漫性肺泡出血的诊断困难
一位45岁的高血压女性,有干咳、呼吸困难和右脚踝结痂性溃疡一个月。她患有日益严重的贫血、蛋白尿和血小板减少症。CT肺血管造影显示肺动脉高压,左颈内静脉血栓,双侧多叶混浊。多普勒超声显示右腘静脉和左颈静脉有血栓。血清学显示低C3, C4,阴性ANA与抗磷脂抗体两次阳性。支气管肺泡灌洗(DAH)证实弥漫性肺泡出血。溃疡活检显示淋巴细胞性血管炎,这是免疫复合物沉积障碍的征兆。ANA阴性SLE合并DAH在符合系统性狼疮国际合作诊所(SLICC)的临床和免疫学标准后被确定。
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