A 26-year-old woman is being treated for glomerulonephritis, photosensitive skin rash, and arthralgias. Rapid plasma reagin (RPR) test is repeatedly positive in this patient despite negative Treponema pallidum enzyme immunoassay (TP-EIA) testing. Coagulation study results are as follows: This patient is at greatest risk for which of the following complications?

Question

A 26-year-old woman is being treated for glomerulonephritis, photosensitive skin rash, and arthralgias.  Rapid plasma reagin (RPR) test is repeatedly positive in this patient despite negative Treponema pallidum enzyme immunoassay (TP-EIA) testing.  Coagulation study results are as follows:  This patient is at greatest risk for which of the following complications?

Quizplus · Accepted Answer

11ec160b_396d_ef48_9249_7d02ee7c8099_MD0001_00 Glomerulonephritis, a photosensitive skin rash, and arthralgia in a young woman are suggestive of systemic lupus erythematosus (SLE). This patient's prolonged activated partial thromboplastin time (aPTT) and false-positive rapid plasma reagin (RPR) test further suggest the presence of circulating antiphospholipid antibodies. Although antiphospholipid antibodies cause aPTT prolongation in vitro, they act in vivo to produce a hypercoagulable state due to activation of phospholipid-dependent coagulation pathways. These antibodies can also cause false-positive results on nontreponemal serologic syphilis tests (eg, RPR and VDRL) by reacting with cardiolipin (the dominant antigen used in these tests). Antiphospholipid antibody syndrome (APS) is a disorder characterized by the presence of antiphospholipid antibodies in the setting of venous or arterial thromboembolism and/or recurrent pregnancy loss. APS may be a primary disorder or occur secondary to other autoimmune diseases such as SLE. Although antiphospholipid antibodies are present in 10%-30% of patients with SLE, not all exhibit the clinical syndrome. (Choices A and E) SLE is less likely than other connective tissue diseases such as scleroderma or mixed connective tissue disease to involve the esophagus. Sclerodactyly is also more typical of the CREST syndrome/scleroderma. (Choices B and C) Painful hemarthroses and/or menorrhagia would be indicative of a hypocoagulable state. Although antiphospholipid antibodies can prolong the aPTT (and sometimes prothrombin time), patients with APS experience thromboembolic events, not increased bleeding. (Choice F) Tabes dorsalis is a manifestation of tertiary syphilis that results in sensory ataxia. The inability to confirm syphilis screening tests with more specific treponemal tests such as Treponema pallidum enzyme immunoassay (TP-EIA) or fluorescent treponema antibody absorption test (FTA-ABS) argues against a diagnosis of syphilis. Educational objective: Glomerulonephritis, a photosensitive skin rash, and arthralgias in a young woman are suggestive of systemic lupus erythematosus (SLE). Up to 30% of patients with SLE have antiphospholipid antibodies, which can cause paradoxical aPTT prolongation and a false-positive RPR/VDRL. Patients with antiphospholipid antibodies are at risk for venous and arterial thromboembolism and unexplained, recurrent pregnancy loss.

A 26-Year-Old Woman Is Being Treated for Glomerulonephritis, Photosensitive Skin