title: Is Identification of Lupus Erythematosus Cells Still Useful? A Case Report.
abstract: A 13-year-old girl presented with significant weight loss, depression, anemia, and neutropenia. The preliminary diagnosis was anorexia nervosa combined with depression. Due to peripheral cytopenia, a bone marrow biopsy was performed to rule out leukemia. Lupus erythematosus (LE) cells were found in the bone marrow aspirate, which prompted autoantibody testing, although clinically it was not suspected the patient had systemic lupus erythematosus (SLE). Further testing demonstrated very high levels of antinuclear antibodies (ANA) (>12 U) and anti-double strand DNA (dsNDA) (>1000 IU/mL), which confirmed the diagnosis of SLE. The patient was treated with steroids for SLE, and symptoms improved quickly. In conclusion, although the identification of LE cells as one of the diagnostic criteria for SLE has been obsolete, careful examination of bone marrow to identify LE cells is still very important in the diagnosis of unsuspected SLE.
authors.affiliation: 1 Department of Laboratories, Seattle Children's Hospital, Seattle, WA, USA.|2 Department of Laboratory Medicine, University of Washington, Seattle, WA, USA.
authors.forename: Min
authors.initials: M
authors.lastname: Xu
authors.affiliation: 3 Department of Family Medicine3 Providence Alaska Medical Center, Anchorage, AK, USA.
authors.forename: Lucinda A
authors.initials: LA
authors.lastname: MacNeal
authors.affiliation: 4 Pediatric Hematology and Oncology, Providence Alaska Medical Center, Anchorage, AK, USA.
authors.forename: Brenda J
authors.initials: BJ
authors.lastname: Wittman
authors.affiliation: 1 Department of Laboratories, Seattle Children's Hospital, Seattle, WA, USA.|2 Department of Laboratory Medicine, University of Washington, Seattle, WA, USA.
authors.forename: Joe C
authors.initials: JC
authors.lastname: Rutledge
mesh_terms: D000293:Adolescent; D000740:Anemia / Q000209:etiology; D001853:Bone Marrow / Q000473:pathology*; D003863:Depression / Q000209:etiology; D005260:Female; D006801:Humans; D008180:Lupus Erythematosus, Systemic / Q000150:complications / Q000175:diagnosis*; D009503:Neutropenia / Q000209:etiology; D015431:Weight Loss
keywords: LE cells; SLE; autoantibodies; bone marrow; depression; systemic lupus erythematosus