J Clin Med Res

Journal of Clinical Medicine Research, ISSN 1918-3003 print, 1918-3011 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Clin Med Res and Elmer Press Inc

Journal website http://www.jocmr.org

Case Report

Volume 8, Number 11, November 2016, pages 819-823

Generalized Lymphadenopathy as Presenting Feature of Systemic Lupus Erythematosus: Case Report and Review of the Literature

Figures

Figure 1. (a) CT neck with IV contrast demonstrating multiple enlarged supraclavicular lymph nodes. (b) CT chest with IV contrast demonstrating enlarged axillary lymph nodes. (c) CT abdomen and pelvis with IV contrast demonstrating a hypodense lesion in the periphery of the spleen measuring 1.4 × 3.4 × 3.6 cm. (d) CT abdomen and pelvis with IV contrast demonstrating multiple enlarged external iliac lymph nodes.

Figure 2. (a) Right inguinal lymph node sample indicating numerous hyperplasic follicles (H&E, × 10 magnification). (b) Right inguinal lymph node sample indicating hyperplastic follicles with prominent germinal centers and reactive lymphocytosis (H&E, × 40 magnification).

Tables

**Table 1.** Initial Investigations
Complete blood count	Comprehensive metabolic panel	Inflammatory and coagulation profile	Endocrinology and nutrition	Urine analysis
*Abnormal values.
WBC: 3,700/µL*	Glucose: 81 mg/dL	CRP :0.50 < mg/dL	TSH: 4.67 µU/mL	Color: yellow
Neutrophils: 32.7%*	BUN: 11 mg/dL	ESR: 132 mm/h*	Free T₄: 2.23 ng/dL	Appearance: clear
Lymphocyte: 53.3%*	Creatinine: 1.0 mg/dL	D-dimer: 1,331 ng/mL*	T₃: 91.5 ng/dL	Specific gravity: 1.026
Monocytes: 11.7%	Sodium: 135 mEq/L	PT: 9.1 s	hCG: < 5.0 mIU/mL	pH: 6.0
Eosinophils: 0.0%*	Potassium: 3.8 mEq/L	aPTT: 30.4 s	Folate: 4.8 ng/mL	Protein: ≥ 500 mg/dL*
Basophils: 2.3%	Chloride: 110 mEq/L*	LDH: 964 U/L*	Vitamin B12: 886 pg/mL	Blood: negative
Hemoglobin: 8.7 mg/dL*	Bicarbonate: 25 mEq/L		Cholesterol: 364 mg/dL*	Urobilinogen: < 2.0 EU
Platelets: 96/µL*	Calcium: 7.0 mg/dL		Triglycerides: 580 mg/dL*	WBC: 3/HPF
	Albumin: 1.5 g/dL*		HDL: 44 mg/dL	RBC: 3/HPF
	Bilirubin: 0.3 mg/dL			Epithelial cells: 3/HPF
	AST: 33 U/L			Hyaline casts: 4/LPF
	ALT: 23 U/L			Mucous threads: rare
	ALP: 169 U/L*

**Table 2.** Connective Tissue Disease Panel
Test	ANA	ds-DNA antibody	SM antibody	RNP antibody	SS-A	SS-B	C3	C4	Rheumtoid factor	Anti-CCP
Results	1:1,280 homogenous	38 U/mL	> 8 AI	> 8 AI	< 1.0 AI	< 1.0 AI	< 40 mg/dL	9.6 mg/dL	Negative	Negative