25 year old female

presentation

• Chest pain• Pain on breathing in and out• Severe indigestion• Severe Reynaud's• Malar rash

labs

• ANA 1:2560• Anti DNA >300• C3=10• C4=30• CH50= less than 40• WBC =2000

Physical exam

• Tender abdomen• No rash• Discolored fingers• Pain in trigger areas• Cardiac: 2/6 murmur systolic at left sternal

border radiating to axilla• Cardiac rub

imaging

• Chest x-ray=slightly enlarged silhouette• ECHO 2D=mitral regurgitation and small

effusion around cardiac border