Systemic sclerosis (scleroderma) Quiz: Ace Your Exams

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A 54-year-old woman presents to the emergency department with sudden onset severe headache and blurry vision. The patient states that her symptoms started an hour ago and have progressively worsened. She was recently diagnosed with systemic sclerosis and is currently taking pantoprazole for gastroesophageal reflux and maintaining core and digital warmth to manage Raynaud phenomenon. Temperature is 37 ºC (98.6 °F), heart rate is 98/min, blood pressure is 215/120 mmHg, and respiratory rate is 18/min. Physical examination reveals visible skin tightening on the face, forearms, chest, and legs. Retinal hemorrhages are seen on eye exam, and there is no papilledema. Cardiopulmonary examination is unremarkable. Urinalysis shows a bland urine sediment. Results from laboratory studies are shown below. Which of the following is the best next step in management?  

 Laboratory test  Result  Reference range 
 Hemoglobin  9.2 g/dL 12-16 g/dL
 Leukocytes  6,200/µL 4,500-11,000/µL
 Platelets  61,000/µL 150,000-400,000/µL
 Lactate dehydrogenase  2,154 U/L 140-280 U/L
 Creatinine  2.91 mg/dL (patient’s baseline is 1.1 mg/dL) 0/6-1.2 mg/dL
 Peripheral blood smear  Schistocytes  Normocytic, normochromic RBCs 

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