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How would you approach the work up of SLE in a patient over 80 years old?
How would you work up an elderly female with persistent anemia secondary to warm AIHA requiring almost monthly transfusion, with positive ANA,dsDNA (by ELISA), elevated inflammatory markers, and serum protein > 12, and reactive LAD. Negative bone marrow biopsy. Would you consider a new elderly onset of SLE or paraneoplastic syndrome? Any other differential diagnoses?
Answer from: at Community Practice
In summary, we have a woman in her 80's with AIHA, lymphadenopathy, and positive ANA/dsDNA/Coombs antibodies (I assume direct Coombs Ab is positive with her "warm" AIHA). You have done an excellent job of ruling out other common causes of AIHA (I'm sure you included checking for HIV, EBV, Hep C, and...
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at Hackensack University Medical Center
Thank you for this thoughtful answer. I would also...
Thank you for this thoughtful answer. I would also...
at UTMB Health
I agree completely with Dr. @Broder. I have been t...
I agree completely with Dr. @Broder. I have been t...
at Boston Medical Center
Thank you for the input. The patient is actually q...
Thank you for the input. The patient is actually q...
Answer from: at Academic Institution
Excellent responses to this question - wanted to add a comment to please consider other mimics of SLE in your differential as you work through the case, particularly given her advanced age. For example, lymphoproliferative disorders (such as Castleman's) and hematologic malignancy can be associated ...
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at Boston Medical Center
Hi @Mithu, Thank you for the answer. She actually...
Hi @Mithu, Thank you for the answer. She actually...
Thank you so much for the thoughtful advice. Her l...
@Hung - left a comment to also consider some SLE m...