Pancytopenia as a manifestation of late-onset systemic lupus erythematosus in an older patient: a case report

had no relevant family history.Her vital signs were within normal limits.Physical examination revealed a thin body build, diffuse alopecia, and mild conjunctival pallor.The results of cardiovascular, respiratory, and neurological examinations were unremarkable.There were no oral ulcers, gum hypertrophy, petechiae, skin rashes, or abnormal joint manifestations (eg, pain, swelling, stiffness, or deformity).Moreover, there were no palpable lymph nodes, breast lumps, sternal tenderness, hepatomegaly, or splenomegaly.Initial laboratory results revealed pancytopenia with autoimmune haemolytic anaemia, indicated by a positive direct Coombs test, low haptoglobin level, and high lactate dehydrogenase level (tablE 1).Peripheral blood test results showed red cell anisocytosis, occasional reactive lymphocytes, and thrombocytopenia.Bone marrow examination showed no evidence of haematological malignancies.Additional tests revealed antinuclear antibody positivity and anti-extractable nuclear antigen positivity (ie, dsDNA, anti-Ro, anti-La, anti-Sm, anti-ribonucleoprotein, and anti-Scl-70)The erythrocyte sedimentation rate was high and the levels of both complements were low.Serum protein electrophoresis findings were unremarkable.The levels of tumour markers (alpha-fetoprotein, cancer antigen [CA] 125, CA 19-9, and CA 15-3) were not elevated.