A 70 year old man presents with weakness, low grade fever, and tightening and redness of the skin on his arms and legs. Laboratory tests show normal CK, ANA, RF but elevated CRP and ESR. A CBC shows hemoglobin of 11.2 g/dl and increased monocytes and eosinophils. The most likely diagnosis is eosinophilic fascitis. A 32 year old pregnant woman with lupus presents with headache and high blood pressure. Tests show low hemoglobin, platelets, and elevated LDH, AST, ALT. The best test to determine the cause would be anti-Smith antibody. A 44 year old woman presents with arthritis, lung disease

1. CLINICAL CASES
CASOS CLÍNICOS
DR. JCDT
Dr. Juan Carlos Díaz Torre
Pediatra Neonatólogo
dr_diaz_torre@hotmail.com
(779) 100 - 40 - 26 1

2. Page 221
A 70 year old man presents with
weakness and low grade temperature for
a few months. He has no Rynaud´s. He
DR. JCDT
has tightening and erythema of the skin
of his upper arms and legs with
prominence along the course of the
superficial veins.
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3. There is considerable muscle weakness.
Laboratory testing reveals a normal CK
(Creatinine Kinase), ANA (Antinuclear Antibodies), RF (Reuhmatoid
Factor) and a significantly elevated CRP (C
DR. JCDT
Reactive Protein) and ESR (Erythrocite Sedimentation Rate). A
CBC (Complete Blood Count) reveals a hemoglobin of
11.2 g/dl with a moderate increase in
monocytes and eosinophils.
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4. Question:
Which of the following is the most likely
diagnosis?
DR. JCDT
Answers:
a) Parasitic involvment.
b) Occult neoplasm.
c) Alergic reaction.
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d) Eosinophilic fascitis.

5. Page 217
A 32 year old female with systemic lupus
erythematosus is 32 weeks preganant and
presents with a headache. Physical
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examination is remarkable for a blood
pressure of 200/110 mmHg.
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6. Laboratory studies show a hemoglobin of
8.0 g/dl, platelet count of 38,000, a low
haptoglobin level, and an elevated LDH
(Lactate Dehydrogenase), AST (Aspartate Aminotransferase)
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and ALT (Alanine Aminotransferase).
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7. Question:
What test would be best to determine
the cause of her problem?
Answers:
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a) Complement levels.
b) Erythrocyte sedimentation rate.
c) Anti-Smith antibody.
d) C- Reactive protein.
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8. Page 219
A 44 year old Hispanic female presents
with inflammatory arthritis of one of her
wrists and MCP´s interstitial lung
DR. JCDT
disease, a non specific rash, and
Raynaud´s phenomenon. Laboratory tests
reveal an elevated ANA (Antinuclear Antibody)
1:640, RF (Rheumatoid Factor) of 50 (normal
<14), and a normal anti-U1 RNP 8
(Ribonucleoprotein).

9. Question:
Which of the following is the diagnosis?
Answers:
DR. JCDT
a) Undifferentiated connective tissue
disease.
b) Mixed connective tissue disease.
c) Systemic lupus erythematosus.
d) Rheumatoid arthritis. 9

10. Gracias por su atención
DR. JCDT
Dr. Juan Carlos Díaz Torre
Pediatra Neonatólogo
dr_diaz_torre@hotmail.com
(779) 100 - 40 - 26
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