Maloney Keisha
University of the West Indies, Kingston, Jamaica.
BMJ Case Rep. 2013 Aug 13;2013:bcr2013010223. doi: 10.1136/bcr-2013-010223.
A 14-year-old girl with no known illness presented with a several week history of headaches and vomiting. The patient also reported having joint pain and swelling to the wrists and knees. She had no prior history of headaches, use of hormonal contraception or other medications, recent weight changes or family history of autoimmune disease. Blood pressure temperature, height and weight were normal. She was alert, there was alopecia, cervical lympadenopathy, symmetrical synovitis to the wrists, bilateral papilloedema and cranial nerve VI palsy. Laboratory investigations revealed a normochromic normocytic anaemia, leucopenia and lymphopenia. Serum chemistries were normal. CT of the brain was normal. Lumbar puncture revealed an opening pressure of greater than 300 mm H2O; cerebrospinal fluid (CSF) analysis was normal. HIV antibodies were non-reactive. Despite treatment with acetazolamide she developed somnolence. Hence MR venography was performed which showed no evidence of cerebral vein thrombosis. Further investigations revealed a positive direct coombs test, positive antinuclear antibodies (ANA) positive antidouble-stranded DNA (dsDNA) and false positive VDRL. Complement levels were reduced. Anti-Smith, anticardiolipin antibodies and lupus anticoagulant were negative.
一名14岁无已知疾病的女孩出现了数周的头痛和呕吐症状。患者还报告手腕和膝盖有关节疼痛和肿胀。她既往无头痛史、未使用过激素避孕药或其他药物、近期体重无变化，也无自身免疫性疾病家族史。血压、体温、身高和体重均正常。她神志清醒，有脱发、颈部淋巴结病、手腕对称性滑膜炎、双侧视乳头水肿和第六颅神经麻痹。实验室检查显示正细胞正色素性贫血、白细胞减少和淋巴细胞减少。血清化学指标正常。脑部CT正常。腰椎穿刺显示初压大于300 mm H2O；脑脊液（CSF）分析正常。HIV抗体呈阴性。尽管使用乙酰唑胺治疗，她仍出现嗜睡。因此进行了磁共振静脉造影，未显示脑静脉血栓形成的证据。进一步检查显示直接抗人球蛋白试验阳性、抗核抗体（ANA）阳性、抗双链DNA（dsDNA）阳性和VDRL假阳性。补体水平降低。抗史密斯抗体、抗心磷脂抗体和狼疮抗凝物均为阴性。
