PAINE #PANCE Pearl – Hematology

31-year-old female, with a history of controlled SLE, presents to your office with a 2 week history of headache, weakness, dizziness, and nausea.  She also reports a new rash on her legs that is non-pruritic.  She denies any recent illnesses, sick contacts, vomiting, abdominal pain, cough, or shortness of breath.  She has been taking hydroxychlorquine for her SLE and has had little complications from this disease.

Vital Signs


BP-131/72, HR-116, RR-15, O2-100%, T-101.2 F

Physical Exam


GeneralMild distress


Image result for ttp rash



NeckSupple, no LAD

PulmonaryCTA without adventitial breath sounds

CVTachycardic without M/G/R


PV2+ throughout

Neurologic5/5 strength throughout, 2+ reflexes throughout


Laboratory Screening



  1. What is the most likely diagnosis?

  2. What other laboratory tests can be helpful in making the diagnosis?

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