Secondary Evans Syndrome Presenting With Lupus Anticoagulant.

Evans syndrome (ES), characterized by autoimmune hemolytic anemia (AIHA) and immune thrombocytopenia (ITP), often poses diagnostic challenges due to its varied etiology and clinical presentation. We present a case of secondary ES in a 41-year-old male with a history of AIHA and ITP, who presented with lower extremity erythema, warmth, and sensation of chest pressure. Initial laboratory investigations revealed thrombocytopenia, mild anemia, and a prolonged activated partial thromboplastin time (aPTT), prompting further evaluation. Subsequent testing revealed positive lupus anticoagulant (LA), anti-cardiolipin antibodies, and anti-beta-2-glycoprotein 1 antibodies, along with lower extremity deep vein thrombosis (DVT) and bilateral pulmonary embolism (PE). Treatment with therapeutic anticoagulation led to clinical improvement, highlighting the importance of recognizing hypercoagulable states in ES patients. This case underscores the significance of comprehensive differential diagnosis and timely intervention in optimizing outcomes for patients with ES.

The Congregational Structure of Homonegativity: Why Place of Worship May Matter More than Frequency of Worship.

Using 239 congregants from 14 randomly selected places of worship in the Southern United States-and a mega-analysis of 577 congregants from 34 similarly-located places of worship-we examined the relationship between religiousness and homonegativity. Multilevel models examining the effects of religiousness on homonegativity indicated that service attendance was more strongly related to homonegativity as a congregation-level variable than as an individual-level variable. Interaction effects between service attendance and the affirmativeness of a congregation were not significant, suggesting that the frequency of participation with a homonegative congregation is not related to homonegativity. These findings imply that the religiousness of a congregation is more closely related to homonegativity than the religiousness of an individual and that individuals may select a congregation that matches their views on same-sex sexuality. Homonegativity may serve a signaling function, enabling congregants to affiliate with a congregation with attitudes toward same-sex sexuality similar to their own.