CASE I. AUTOIMMUNE HEMOLYTIC ANEMIA (AIHA)
A. TYPE II AUTOIMMUNE REACTION
A twenty eight year old woman with a four-year history of SLE presented for a scheduled follow-up in clinic. Because she avoids the sun and started taking hydroxychloroquine four years ago, her rash and arthritis had improved, but over the past six months, she had become progresivvely more fatigued and began to notice dark urine. Review of medications, alcohol intake, recreational drug use, and sick contacts was unrevealing. On physical exam, she was mildly tachicardic at 105, with a two out of six systolic ejection murmur at the left sternal border, dullness to percussion over Traubes’space (the normally resonant gastric bubble), and palpable spleen tip.