Pagana: Mosby’s Manual of Diagnostic and Laboratory Tests

Pagana: Mosby’s Manual of Diagnostic and Laboratory Tests, 5th Edition

Systemic Lupus Erythematosus (SLE)

Case Studies

A 24-year-old woman had been complaining of multiple joint and muscular pains and stiffness in the morning. She also noted some hair loss and increased skin sensitivity to light. Her physical examination showed slight erythema around the cheek bones and some swelling in the joints of her hands.

Studies	Results
Routine laboratory work	Within normal limits (WNL), except for mild anemia
Urinalysis, p. 956	Profuse proteinuria and cellular casts
Antinuclear antibody (ANA), p. 88	1:256 (normal: <1:20)
Anti-DNA	398 units (normal: <70 units)
Anti-ENA	Positive (normal: negative)
Anticardiolipin antibody (ACA), p. 68
Immunoglobulin (Ig) G	96 g/L (normal: <23 g/L)
IgM	78 mg/L (normal: <11 mg/L)
Erythrocyte sedimentation rate (ESR), p. 221	75 mm/hour (normal: ≤20 mm/hour)
Immunoglobulin electrophoresis, p. 312
IgG	1910 mg/dL (normal: 565-1765 mg/dL)
IgA	450 mg/dL (normal: 85-385 mg/dL)
IgM	475 mg/dL (normal: 55-375 mg/dL)
Total complement assay, p. 172	22 hemolytic units/mL (normal: 41-90 hemolytic units/mL)

Diagnostic Analysis

The positive ANA and ACA tests strongly supported the diagnosis of systemic lupus erythematosus (SLE). The patient also had a facial rash suggestive of SLE. The elevated ESR indicated a systemic inflammatory process. The immunoelectrophoretic results were compatible with either RA or SLE; however, a decreased complement assay is commonly associated with SLE. The abnormal urinalysis indicated that the kidneys also were involved with the disease process. The patient was treated with steroids and did well for 7 years. Unfortunately, her renal function deteriorated, and she required chronic renal dialysis.

Critical Thinking Questions

1. Explain the significance of the urinalysis results as they relate to renal involvement with SLE.

2. Why is the ESR increased in inflammatory conditions?

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