ow-grade fevers, weight loss, malaise, nocturnal t - stefan78

[ArchivalUser]

A 31-year-old previously healthy man comes to your office because of a 2-week history of low-grade fevers, weight loss, malaise, nocturnal tightness in his chest, and shortness of breath. He also reports a small amount of leg swelling and scrotal swelling over this time. Prior to 2 weeks ago, he denies any recent illnesses, sick contacts, or travel. He also denies any hemoptysis or sinus infections. His temperature is 38.0 C (100.2 F), blood pressure is 170/95 mm Hg, pulse is 77/min, and respirations are 14/min. Physical examination shows trace bilateral lower extremity and scrotal edema. Bilateral wheezes are also appreciated. A chest x-ray is unremarkable. Laboratory studies show:
Sodium
141 mEq/dL

Potassium
5.1 mEq/dL

Chloride
98 mEq/dL

Bicarbonate
21 mEq/dL

Urea nitrogen, serum
21 mg/dL

Creatinine
2.5 mg/dL

Glucose
97 mg/dL

Serum eosinophils
mildly elevated

Urinalysis

Color
clear

Specific gravity
1.020

Osmolality
55 mOsmol/kg

Leukocyte esterase
negative

Nitrite
negative

Protein
2+

Blood
4+

Microscopic
many red cell casts.

24 hour urine protein collection
1900 mg

The laboratory finding that would support the most likely diagnosis is

A. anti-glomerular basement membrane antibody


B. antistreptolysin titer (ASO)


C. cANCA


D. elevated serum IgA levels


E. pANCA

[ArchivalUser]

ANSWER IS E

[ArchivalUser]

Dd

[ArchivalUser]

C----------

[ArchivalUser]

cc

[ArchivalUser]

Its a case of Nephritic syndrome with subnephrotic range proteinuria.Plus there is a h/o SOB with eosinophilia and no sinusitis or hemoptysis.
The proble is the MILD eosinophilia but otherwise its clearly a case of Churg Strauss Syndrome where there is pANCA positivity in 60% and cANCA positivity in 10% cases.

[ArchivalUser]

So E is the answer

[ArchivalUser]

ddddd

[ArchivalUser]

I am also agree with Churg Strauss Syndrome.
but not remember c or p ANCA.


agree its E.

[ArchivalUser]

E. pANCA