A teenager with lupus – and more

SLE is suspected and tests are ordered. E/LFTs and FBC are normal. The ANA is strongly positive, and follow-up testing shows a positive ENA with Ro antibodies and a dsDNA antibody level of 50IU (<7).

After discussion with the local immunopathologist, further testing for anti-phospholipid antibodies with IgG anticardiolipin, IgG B2GP1, and lupus anticoagulant is performed. ACL and B2GP1 are both >100 units and the LAC is positive.

Before you can review the patient, she presents to the local hospital with a pulmonary embolus.