Match each patient's clinical presentation with the most appropriate targeted laboratory test to confirm the underlying etiology or assess disease-specific risk.
- A 35-year-old woman with a history of recurrent late-term pregnancy losses presenting with a prolonged activated partial thromboplastin time that fails to correct with a normal plasma mixing study.Dilute Russell viper venom time (dRVVT)
- A 52-year-old man presenting with chronic, destructive sinusitis, cavitary pulmonary lesions on chest imaging, and acute kidney injury with red blood cell casts.Proteinase-3 antineutrophil cytoplasmic antibody (PR3-ANCA) assay
- A 45-year-old woman with rapidly progressive skin thickening over her trunk and proximal extremities presenting with acute oliguric renal failure and a blood pressure of 210/118 mmHg.Anti-RNA polymerase III antibody testing
- A 62-year-old woman evaluated for an acute onset of proximal muscle weakness and a violaceous periorbital rash, who was recently found to have a malignant ovarian mass.Anti-transcriptional intermediary factor 1-gamma (anti-TIF1-γ) antibody assay
Cevap
Match the prolonged uncorrectable aPTT with dRVVT; the destructive sinusitis and glomerulonephritis with PR3-ANCA; the scleroderma renal crisis with Anti-RNA polymerase III; and the paraneoplastic dermatomyositis with Anti-TIF1-γ.
Each clinical vignette represents a specific autoimmune or rheumatologic syndrome that requires a highly targeted laboratory test for definitive diagnosis or risk stratification. Dilute Russell viper venom time (dRVVT) confirms lupus anticoagulant in antiphospholipid syndrome. PR3-ANCA is highly sensitive and specific for granulomatosis with polyangiitis. Anti-RNA polymerase III is a major risk factor for scleroderma renal crisis in systemic sclerosis. Anti-TIF1-γ is a specific marker for paraneoplastic dermatomyositis.
Adım Adım Çözüm
Anahtar Kavram
Targeted autoantibody and specific laboratory test ordering for rheumatologic and systemic autoimmune diseases based on distinct clinical phenotypes.