Difficulties in the diagnosis of systemic lupus erythematosus
Three clinical cases are presented: women with systemic lupus erythematosus (SLE), diagnosed after comprehensive examinations including histological studies of skin biopsy specimens and immunologic studies: blood testing for antinuclear factor on HEp-2 cells with evaluation of the nucleus fluorescence type, testing for plasma lupus anticoagulant, rheumatoid factor, antiphospholipid IgG and IgM, double-stranded DNA, and antinuclear auto-IgG to AMA-M2 (by the immunoblotting method). At first the disease clinically manifested only by skin involvement of the discoid lupus type on the face or head. SLE was diagnosed 1.5, 2, and 4 years after the skin involvement, in one case - disseminated lupus erythematosus in the presence of chronic nephritis, later classified as class IV lupus nephritis.