Make the Dx: Solution to 'The great imitator'

By MDLinx staff
Published October 4, 2023
young woman at the doctor

Key Takeaways

Can you make the diagnosis? Click here to review the case and check your answer below.

This case could be mistaken for arthritis or fibromyalgia. But if the patient had presented with the characteristic malar (butterfly) rash, you would have likely guessed the diagnosis: systemic lupus erythematosus. 

Keep in mind, however, that only about 30% of patients present with malar rash, and it doesn’t always appear on the bridge of the nose and cheeks.

To make things even more complicated, there is no gold-standard diagnostic test for lupus. Instead, physicians consider it a diagnosis of exclusion and rely on medical history, family history, and physical exam for help. A biopsy of the kidney or skin are helpful in picking out autoimmune disease, but antinuclear antibodies picked up in blood and urine have low specificity.

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