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A 35 year old Afro-Caribbean man was referred by the dermatology department in March 2002. He had a 2 year history of a photosensitive rash, patchy alopecia, and a 1 year history of arthralgia affecting wrists, knees, and shoulders. He also described occasional night sweats. There was no history of thromboembolic events or migraine.
On examination he had two patches of alopecia and a small right knee effusion. His pulse was 64 beats per minute and regular, with a blood pressure of 120/70 and normal heart sounds. Otherwise his examination was unremarkable.
Investigations showed: positive antinuclear antibody (ANA; 1/160 homogeneous pattern); positive double stranded DNA on enzyme linked immunosorbent assay (ELISA) testing (169 IU/ml; negative <40); extractable nuclear antigen negative …
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