Journal of

Case Reports and Images in Medicine

 
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Case Report
 
Mixed connective tissue disease presenting as atrial fibrillation, fever, lymphadenopathy, and pericardial effusion
Jacob Mathew Jr.1, Tanner Kim2, Timilyn Nunu3, Jay Jahanmir4
1DO, Resident, Department of Medicine, Tripler Army Medical Center, Honolulu, HI, USA 96859.
2MS-III, Medical Student, John A. Burns, School of Medicine, Honolulu, HI, USA 96813.
3MD, MPH, Intern, Tripler Army Medical Center, Honolulu, HI, USA 96859.
4MD, PHD, Hospitalist, Tripler Army Medical Center, Honolulu, HI, USA 96859.

Article ID: 100014Z09JM2016
doi:10.5348/Z09-2016-14-CR-7

Address correspondence to:
Jacob Mathew Jr.
DO, Department of Med MCHK-DM
1 Jarrett White Rd
Tripler Army Med Ctr HI

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How to cite this article:
Mathew Jr., J, Kim T, Nunu T, Jahanmir J. Mixed connective tissue disease presenting as atrial fibrillation, fever, lymphadenopathy, and pericardial effusion. J Case Rep Images Med 2016;2:24–30.


Abstract
Introduction: Mixed connective tissue disease (MCTD) is a poorly understood rheumatologic condition that presents with clinical symptoms related to the underlying presence of distinct overlapping autoimmune conditions. Patients can be identified by the presence of a shared antibody to the U1 small nuclear ribonucleoprotein autoantigen. While the condition is considered incurable, prognosis is relatively good with most patients responding well to glucocorticoids. We report a case in which a patient presented with multiple nonspecific symptoms but was found to have multiple organ involvement that ultimately was tied to MCTD.
Case Report: We report a 48-year-old male admitted with multiple nonspecific symptoms who was found to have atrial fibrillation, pericardial effusion, pleural effusions, diffuse lymphadenopathy and among other lab abnormalities, pancytopenia and various positive rheumatologic seromarkers. Extensive diagnostic workup led to a diagnosis of mixed connective tissue disease. Treatment with weight-based steroids led to a significant improvement of his symptoms.
Conclusion: Mixed connective tissue disease (MCTD) is an autoimmune condition affecting almost every major organ of the body, defined by the presence of overlapping features from other connective tissue diseases. The use of available classification criteria and newly available biomarkers can assist in earlier diagnosis. While the condition is considered incurable, prognosis is good with use of glucocorticoid therapy. This case highlights the need to keep heightened suspicion for entities such as MCTD in patients who have various symptoms that may fit multiple distinct autoimmune conditions.

Keywords: Mixed connective tissue disease (MCTD), Rheumatology, Reactive lymphadenopathy


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Author Contributions
Jacob Mathew Jr. – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Tanner Kim – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Timilyn Nunu – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Jay Jahanmir – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Guarantor of submission
The corresponding author is the guarantor of submission.
Source of support
None
Conflict of interest
Authors declare no conflict of interest.
Copyright
© 2016 Jacob Mathew Jr. et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.



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