9. A Frayed Knot

  1. James C. Pile3,
  2. Thomas E. Baudendistel4 and
  3. Brian J. Harte5
  1. Thomas E. Baudendistel4,
  2. Irena L. Ilic1 and
  3. Harry Hollander2

Published Online: 21 MAR 2013

DOI: 10.1002/9781118483206.ch9

Clinical Care Conundrums: Challenging Diagnoses in Hospital Medicine

Clinical Care Conundrums: Challenging Diagnoses in Hospital Medicine

How to Cite

Baudendistel, T. E., Ilic, I. L. and Hollander, H. (2013) A Frayed Knot, in Clinical Care Conundrums: Challenging Diagnoses in Hospital Medicine (eds J. C. Pile, T. E. Baudendistel and B. J. Harte), John Wiley & Sons, Inc., Hoboken, NJ, USA. doi: 10.1002/9781118483206.ch9

Editor Information

  1. 3

    Departments of Hospital Medicine and Infectious Diseases, Cleveland Clinic, Cleveland, Ohio, USA

  2. 4

    Department of Medicine, Kaiser Permanente Medical Center, Oakland, California, USA

  3. 5

    South Pointe Hospital, Cleveland Clinic Health System, Warrensville Heights, Ohio, USA

Author Information

  1. 1

    Department of Medicine, Palo Alto Medical Foundation, Palo Alto, California, USA

  2. 2

    Department of Medicine, University of California, San Francisco, California, USA

  3. 4

    Department of Medicine, Kaiser Permanente Medical Center, Oakland, California, USA

Publication History

  1. Published Online: 21 MAR 2013
  2. Published Print: 15 MAR 2013

Book Series:

  1. Hospital Medicine: Current Concepts

Book Series Editors:

  1. Scott A. Flanders and
  2. Sanjay Saint

ISBN Information

Print ISBN: 9780470905654

Online ISBN: 9781118483206

SEARCH

Keywords:

  • acute multisystem disease;
  • infection;
  • rheumatic diseases;
  • systemic lupus erythematosus (SLE);
  • thrombosis

Summary

Using the American College of Rheumatology (ACR) definition, systemic lupus erythematosus (SLE) is diagnosed when at least four criteria are met with a sensitivity and specificity above 95%. These criteria were developed for study purposes to differentiate SLE from other rheumatic diseases. At disease onset, a patient may not meet the ACR threshold, but delaying treatment may be harmful. With SLE prominent in the differential diagnosis of a critically ill patient, physicians must consider the three most common causes of death in lupus patients: lupus crisis, severe infection, and thrombosis. In addition to lupus crisis and infection, the differential diagnosis of acute multisystem disease in a patient with SLE includes catastrophic antiphospholipid syndrome (APS) and thrombotic thrombocytopenic purpura, In critically ill lupus patients, initial treatment may need to be empirically directed at multiple causes until the diagnosis is clear.