Victoria, a 44-year-old Vietnamese woman presented with complaints…
Victoria, a 44-year-old Vietnamese woman presented with complaints… Victoria, a 44-year-old Vietnamese woman presented with complaints of fever for 2 weeks; pleuritic chest pain; and intermittent joint pain in her hands, feet, and knees. On examination, she was free of skin lesions. She had a pleural friction rub; a slightly swollen tender right knee; and enlarged axillary, cervical, and inguinal lymph nodes. A chest film showed a small right pleural effusion; joint films were normal except for a small amount of soft tissue swelling in the right knee. Hemoglobin was 10 g/dL, and urinalysis revealed 4+ proteinuria with white blood cells, red blood cells, and red cell casts in the urine sediment. A VDRL test was positive. A test for antitreponemal antibodies was negative. Blood urea nitrogen (BUN) and creatinine were slightly elevated, and moderate hypoalbuminemia and hypergammaglobulinemia were present. An ANA test was positive at a titer of 1:2560 and was reported as showing a speckled pattern. A dsDNA antibody determination by the Crithidia luciliae assay was positive at 1:320, and an extractable nuclear antigen (ENA) antibody determination was reported as RNP (U1-RNP) and Sm antibody present. A C4 level was less than 10 mg/dL (reference range 12-45 mg/dL) and a C3 level was less than 40 mg/dL (reference range 88-192 mg/dL). The patient was treated with prednisone, 60 mg/day. After 4 weeks, the urine protein was 2+, the sediment had cleared, and BUN and serum creatinine had returned toward normal. What is the inciting event leading to this proliferation? Health Science Science NursingNUR 3069Share QuestionEmailCopy link Comments (0)
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