SLE – vasculitis – cold hemagglutinin disease (CHAD)
Journal Title: Αρχεία Ελληνικής Ιατρικής - Year 2015, Vol 32, Issue 1
Abstract
Laboratory tests were as follows: Hct=21.3%, Hb=6.1 g/dL, WBC=2,800/μL (neutrophils 38%, lymphocytes 50%, monocytes 12%), reticulocytes=6.1% and platelets=144.000/μL. Peripheral blood smears is shown in figures 2 and 3. Blood chemistry was Glu=1.50 mg/dL, BUN=0.70 mg/dL, creatinine=0.9 mg/dL, Na+=135 mmol/L, K+=4.0 mmol/L, Ca++=4.6 mEq/L, SGOT=26 IU/L, SGPT=16 IU/L, bilirubin=2.52 mg/dL (indirect 1.8 mg/dL), ALP=105 IU/L, γGT=32 IU/Ι, uric acid=5.5 mg/dL, LDH=1,070 IU/L, CPK=10 IU/L. Total protein was 7.3 g/L (alb=3 g/L, α1-globulins=0.3,An 80-year-old man presented to the outpatient clinic with fatigue, difficulty in breathing, heartburn, chest pain and palpitations in effort, pain in fingers and toes during last week and α2-globulins=0.3, β-globulins=0.7 and γ-globulins=2.5 g/L). The coagulation tests were normal (PT=11 sec, APTT=30 sec, fibrinogen=230 mg/dL). Direct Coombs test was positive for ΙgG, ΙgA, ΙgM, and C3: indirect Coombs test was also positive. Antibodies for Mycoplasma, EBV and other viruses were negative. ANA, anti-DNA tests were positive. Urine chemistry and microscopy were normal. hemorrhagic dermal rash, especially in the lower extremities (fig. 1). There was a history of mild anemia and attacks of acrocyanosis (blue discoloration of fingers and toes following exposure in cold) for the last ten years. A chronic, non-paramorphotic arthritis of the hands was diagnosed ten years ago with mild cervical lympadenopathy and mild splenomegaly. No abnormal findings were detected in the CT of upper and lower abdomen, and of the chest. Physical examination revealed pallor, tachycardia, splenomegaly (2 cm below the left costal margin), and hepatomegaly (one centimeter below the right costal margin). Mild cervical and axillar lympadenopathy were detected. Physical examination was otherwise unremarkable.
Authors and Affiliations
J. ASIMAKOPOULOS, L. PAPAGEORGIOU, K. PETEVI, G. BOUTSIKAS, P. FLEVARI, E. KOUTSI, V. TELONIS, A. ZANNOU, T. VASSILAKOPOULOS, M. ANGELOPOULOU
Keywords
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