A 20-year-old female with impending foot gangrene: How to interpret her laboratory results.

ABSTRACT

A 20-year-old female presented with multi-system involvement. At first, she had acute cholecystis and was treated by cholecystectomy. After the operation she had neurological symptoms and was diagnosed with herpes encephalitis, confirmed by CSF serology. One month later she developed left foot arterial occlusion. Autoimmune hemolytic anemia with immune thrombocytopenia (Evan’s syndrome) and myocarditis were also detected concurrently. Her primary disease was suspected to be systemic lupus erythematosus. However, her antinuclear antibody assayed by the enzyme-link immunoassay (ELISA) method was negative twice but became positive by indirect immunofluorescence method. Other positive laboratory results were lupus anticoagulant, antineutroplil cytoplasmic antibody (ANCA), and anti proteinase 3 (anti-PR3). Their relevance will be discussed in details. She was given steroids, anticoagulants and underwent a femerofemoral bypass. Her clinical status improved afterwards.