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 BOF 4

 

   

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BOF: 4

A 48-year female presents with a rash, joint pains and weakness of her right lower limb.

On examination she has palpable purpura, no definite arthritis but examination of the lower limb reveals common peroneal nerve palsy.

Investigations reveal:

Haematology normocytic normochromic anaemia

White cell count normal

ESR 120 mm in 1st hour

Rheumatoid factor strongly positive

ANA negative

ANCA negative

C3 90 mg /dL (65-190)

C 45 mg/dL (15-50)

Echocardiogram normal

In this patient the likely diagnosis is:

a)      Rheumatoid arthritis

b)      Systemic lupus erythematosus

c)      Churg-Strauss syndrome

d)      Subacute infective endocarditis

e)      Mixed cryoglobulinaemia

 

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