Systemic lupus erythematosus (SLE) Quiz: Ace Your Exams

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A 29-year-old woman comes to the office with joint pain and fatigue. For the past three months, she has felt excessive fatigue with normal activity, associated with poor appetite, and a 5 lb (2.3 kg) weight loss. The joint pain is characterized by stiffness in her fingers and wrists that lasts an hour after waking up and usually improves throughout the day. She has no significant past medical history. The patient’s temperature is 38.0°C (100.4°F), pulse is 77/min, respirations are 18/min, and blood pressure is 115/76 mmHg. She appears tired. Physical examination shows symmetrically swollen and tender wrists bilaterally, and abdominal examination shows splenomegaly. Examination of the patient’s face is shown below:


Reproduced from: Wikimedia commons    

Follow-up laboratory studies show the following:  
 
Laboratory value  Result 
 Hemoglobin  9.0 g/dL 
 Leukocyte count  3,800/mm3 
 Platelet count  125,000/mm3 
Which of the following is the most likely cause of this patient’s laboratory findings?

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