Aug 18 - Lupus Flare

Today's case was a patient with a known prior history of SLE that presented with multiple complications - including fevers, arthralgias and myalgias, and a rash on her face and abdomen.  Workup revealed evidence of multisystem disease, with elevated cardiac enzymes, hematuria, anemia, and thrombocytopenia.  Complicating her picture was a recent hospital stay where she rec'd heparin, and anti-heparin antibodies were positive. 

Peripheral blood smear revealed schistocytes:

Click this link for a nice review of mircoangiopathyc hemolytic anemia from the American Society of Hematology Image Bank

The working differential was HIT/HAT vs TTP vs other thrombotic microangiopathy.  TTP incidence is elevated in patients with SLE, and autoantibodies to ADAMTS-13 seem to play a role in pathogenesis.

Here is a link to another review of SLE pathogenesis in general from a recent NEJM article.