Question

a 36 - year - old female patient presents with fatigue, joint pain bilaterally and a butterfly rash across the face. lab report reveals a positive direct coombs test, positive sana and abnormal plasma proteins. which of the following is most likely diagnosis?
a) graves disease
b) cushings
c) scleroderma
d) systemic lupus erythematosus
e) hashimotos

Explanation:

• Systemic Lupus Erythematosus (SLE):
• Clinical Manifestations: Fatigue and joint pain are common non - specific symptoms in SLE. The butterfly rash (malar rash) is a classic cutaneous manifestation of SLE.
• Laboratory Findings: A positive direct Coombs' test can be seen in SLE - related autoimmune hemolytic anemia. Positive antinuclear antibodies (ANA, here referred to as SANA in a non - standard abbreviation) are highly associated with SLE. Abnormal plasma proteins (such as hypocomplementemia, hypergammaglobulinemia in some cases) can also be present in SLE.
• Other Options:
• Graves' disease: Mainly presents with hyperthyroidism symptoms (e.g., weight loss, palpitations, exophthalmos), not the described symptoms and laboratory findings.
• Cushing's syndrome: Characterized by features like central obesity, moon face, striae, hypertension, etc., which do not match the given case.
• Scleroderma: Has skin thickening (sclerodactyly, diffuse skin sclerosis) and internal organ fibrosis (e.g., pulmonary fibrosis) as prominent features, not the butterfly rash and the given laboratory profile.
• Hashimoto's thyroiditis: Usually presents with hypothyroidism symptoms (e.g., fatigue, weight gain, cold intolerance) and thyroid - specific antibody abnormalities (e.g., anti - thyroid peroxidase antibodies), not the described multi - system and laboratory findings.

Answer:

d) Systemic Lupus Erythematosus