Systemic lupus erythematosus Quiz: Ace Your Exams

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A 38-year-old woman presents to the emergency department with chest pain for the past two days. The pain started gradually and is located in the center of her chest. It is slightly better when she sits up straight, and it is not affected by exertion or rest. The patient also reports feeling fatigued, achy, and feverish for the past few months. She takes no medications, and family history is non-contributory. The patient does not drink alcohol or smoke cigarettes. The patient’s temperature is 38.6°C (101.5°F), pulse is 104/min, respirations are 22/min, and blood pressure is 153/97 mmHg. She appears anxious and uncomfortable. Physical examination shows conjunctival pallor and bilateral pitting ankle edema, and a scratching extra heart sound between the apex and sternum is heard on auscultation. Laboratory studies show the following:  
 
 Laboratory value  Result 
 Sodium   132 mEq/L 
 Potassium   4.2 mEq/L 
 Chloride   95 mEq/L 
 Hemoglobin   7.2 g/dL 
 Reticulocyte count  4.5% 
 Aspartate aminotransferase  20 U/L 
 Alanine aminotransferase  18 U/L 
 Bilirubin, Total  3.4 
 Bilirubin, Direct  0.3 
 Lactate dehydrogenase  368 U/L 
ECG shows the following:


Reproduced from: Wikimedia Commons    
Which of the following additional laboratory findings is most likely to be present in this patient’s condition?  

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