Case Report

Macrophage Activation Syndrome, Glomerulonephritis, Pericarditis, and Retinal Vasculitis as Initial Presentation of Systemic Lupus Erythematosus

Table 1

Laboratory examination in the hospital and during follow-up visit.

AdmissionDischarge6 weeks after discharge12 weeks after discharge

Blood count
Leukocyte (K/μL)1.95.29.95.9
Hemoglobin (g/dL)6.588.310.9
Hematocrit19.223.726.332.5
Platelets (K/μL)1438130236

Chemistry
Sodium (mmol/L)127135135141
Potassium (mmol/L)4.65.24.14.2
Chloride (mEq/L)104109106106
Bicarbonate (mmol/L)212222
Blood urea nitrogen (mg/mL)23432916
Creatinine (mg/mL)1.421.111.031.05
Glomerular filtration rate56758179
Calcium (mg/mL)5.877.68.4
Glucose (mg/mL)1008813076
Aspartate aminotransferase (U/L)191718
Alanine aminotransferase (U/L)332110
Alkaline phosphatase (U/L)475344
Total bilirubin (mg/dL)0.20.20.2
Total protein (g/dL)4.44.84.34.6
Albumin (g/dL)1.41.52.32.4
Ferritin (ng/mL)65421027527330
Lactate dehydrogenase (U/L)336252275187
Haptoglobin (mg/dL)<820<852
Thyroid-stimulating hormone (uIU/mL)7.5
Creatine kinase (U/L)105
C-reactive protein (mg/L)0.67
Vitamin B12 (pg/mL)414
Triglycerides327

Coagulation
Activated partial thromboplastin time (seconds)31.5
Prothrombin time (seconds)14.2
International normalized ratio1.1
Dilute Russell’s viper venom time (seconds)40.5

Others
Erythrocyte sedimentation rate (mm/hr)137
Complement 3 (mg/dL)14
Complement 4 (mg/dL)3
Direct antiglobulin test, broad-spectrum Coomb’s serumPositive
Direct antiglobulin test, anti-IgG Coomb’s serumPositive
Direct antiglobulin test, anti-C3 Coomb’s serumNegative
Antibody identificationCold autoantibody

Urine study
Protein3+3+1+1+
Protein/creatinine ratio7.04
Blood3+3+2+2+
Red blood cell (/HPF)6011–2511–25
White blood cell (/HPF)70–40–4

Autoimmune serology
Antinuclear antibody1 : 640 (homogeneous pattern)
Anti-dsDNA antibody (IU/ml)195
Anti-Ro antibody (AU/mL)12
Anti-ribonucleoprotein antibody (AI)0.5
Anti-Smith antibody (AI)0.4
Anti-Scl 70 antibody (AI)0.2
Rheumatoid factor (IU/mL)<15
Anti-cyclic citrullinated peptide antibody (units)19
Anticardiolipin antibody, IgM (U/mL)22
Anticardiolipin antibody, IgG (U/mL)48
Anticardiolipin antibody, IgA (U/mL)<9
Beta-2 glycoprotein I antibody, IgM (GPI IgM units)<9
Beta-2 glycoprotein I antibody, IgG (GPI IgG units)55
Beta-2 glycoprotein I antibody, IgA (GPI IgA units)9