1991 Volume 28 Issue 6 Pages 817-822
An elderly case of systemic lupus erytematosus (SLE) with suspected hemolytic anemia was experienced. A 70 year-old female was admitted to our hospital on December 31 with complaints of herpetic eruption. She complained of arthralgia since 3 month prior to her admission. The positive findings on examination were skin eruption in the left chest, a systolic heart murmur and a palpable elastic hard liver. Laboratory data showed raised erythrocyte sedimentation rate of 149mm per hour, decreased Hb (10.1g/dl), decreased hematocrit (30.0%), increased reticulocytes (33‰), decreased thrombocytes (73, 000/mm3), increased γ-globulin (33%) and positive rheumatoid factor. During admission, she developed anemia. A stool test for occult blood was negative. The haptoglobin was 38.8mg/dl and bone marrow aspiration showed increased erythropoesis, suggesting features of immune hemolytic anemia, except she was negative on Coomb' test. Eye fundi were similar to case of typical bleeding observed in SLE. Concerning immunoglogical findings, the antinuclear factor was ×1280 and the anti-dsDNA antibody was ×80, on which a diagnosis of SLE was based. She experienced numbness of the left arm and developed left hemiparesis 2 days later. Therapy with 15mg/day prednisone obtained a good response and anemia, abnormal immunological findings and hemiparesis disappeared.
