A 58 Year Old Woman with Vision Loss, Headaches, and Oral Ulcers.pdf


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Case Records of the Massachuset ts Gener al Hospital

Table 1. Laboratory Data.

Reference Range,
Adults*

21 Mo before
Admission,
Rheumatology
Clinic

Hematocrit (%)

36.0–46.0

43.2

44.7

Hemoglobin (g/dl)

12.0–16.0

14.0

15.7

4500–11,000

10,410

15,490

Neutrophils

40–70

89.7

88.0

Lymphocytes

22–44

7.9

3.8

Monocytes

4–11

1.4

6.8

Eosinophils

0–8

0

0

Variable

9 Days before
Admission,
Infusion
Clinic

On Admission,
This Hospital

Blood

White-cell count (per

mm3)

Differential count (%)

Basophils
Platelet count (per mm3)

0–3

0.1

0.1

150,000–400,000

276,000

248,000

Erythrocyte-sedimentation rate (mm/hr)

0–20

2

C-reactive protein (mg/liter)

<8.0

1.1

2
0.9

C3 (mg/dl)

81–157

127

C4 (mg/dl)

12–39

33

2.5

Urine
Color

Yellow

Yellow

Yellow

Clarity

Clear

Clear

Clear

Glucose

Negative

2+

Negative

Bilirubin

Negative

Negative

Negative

Ketones

Negative

Negative

1+

1.001–1.035

1.016

1.024

Negative

Negative

1+

5.0–9.0

7.0

5.0

Protein

Negative

Negative

Negative

Urobilinogen

Negative

Negative

Negative

Nitrite

Negative

Negative

Negative

Leukocyte esterase

Negative

Negative

Negative

0–2

0–2

5–10

Specific gravity
Blood
pH

Red cells (per high-power field)
White cells (per high-power field)
Mucin

0–2

0–2

0–2

None

None

Present

* Reference values are affected by many variables, including the patient population and the laboratory methods used. The
ranges used at Massachusetts General Hospital are for adults who are not pregnant and do not have medical conditions
that could affect the results. They may therefore not be appropriate for all patients.

nasal erosions. Blood levels of electrolytes, urea
nitrogen, creatinine, calcium, total protein, albumin, and globulin and results of liver-function
tests were normal. Tests for antinuclear antibodies, rheumatoid factor, antineutrophil cytoplasmic

antibodies, and anti–cyclic citrullinated peptide
were negative; other laboratory test results are
shown in Table 1.
Dr. Rif kin: One month later, the patient returned to the ophthalmology clinic for follow-up.

n engl j med 380;11 nejm.org  March 14, 2019

The New England Journal of Medicine
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