Case 38-1988: A 58-Year-Old Woman with Fever, Sweats, Congestive Heart Failure, and Lymphadenopathy after Treatment for a Diagnosis of Systemic Lupus Erythematosus

Presentation of Case A 58-year-old woman was admitted to the hospital because of lethargy, weakness, and depression. She was well until 10 years earlier, when patchy hair loss appeared, followed by loss of fingernails; pain and swelling developed in the fingers, elbows, shoulders, knees, and toes. A diagnosis of rheumatoid arthritis was made, and a nonsteroidal antiinflammatory drug was prescribed, with resolution of the polyarthritis. Two years before entry low-back pain occurred, and anemia was found. A test for antinuclear antibodies was positive in a titer of 1:40. Microscopical examination of a needle-biopsy specimen of bone marrow was considered nondiagnostic.