29-Year-Old Female with Cardiopulmonary Symptoms and Positive ANA

Case at a Glance

A 29-year-old female presented with acute onset shortness of breath, chest pain, and arthralgia involving fingers and wrists. Laboratory workup revealed mildly elevated absolute monocytes and a positive antinuclear antibody (ANA) test at 1:320 with nuclear dense fine speckled pattern.

Patient's Story

The patient sought emergency care for several days of progressive dyspnea and chest discomfort. She also reported concurrent joint pain affecting her fingers and wrists. One month prior, routine dermatology follow-up revealed a positive ANA test at 1:320 titer with nuclear dense fine speckled pattern, for which she was advised to follow up with her primary care physician. The patient expressed concern about potential malignancy after researching her symptoms online.

Initial Assessment

Physical examination and initial vital signs were stable. The patient appeared anxious but in no acute distress. Cardiopulmonary examination findings were not documented in detail. Joint examination revealed tenderness in fingers and wrists without obvious swelling or deformity.

The Diagnostic Journey

Complete blood count was obtained showing: WBC 9.23 × 10³/μL (normal 3.5-11.0), RBC 4.00 × 10⁶/μL (normal 4.0-5.2), Hemoglobin 13.7 g/dL (normal 12.0-16.0). Differential count showed neutrophils 54.9% (normal 51-75%), lymphocytes 32.0% (normal 24-44%), monocytes 10.1% (normal 1-9%). Absolute counts revealed neutrophils 5.07 × 10³/μL (normal 1.8-7.7), lymphocytes 2.95 × 10³/μL (normal 1.0-4.8), and monocytes 0.93 × 10³/μL (normal 0.0-0.8). The only abnormal finding was mildly elevated absolute monocyte count.

Final Diagnosis

Pending further evaluation. Differential diagnosis includes early connective tissue disorder given positive ANA, viral syndrome, or stress-related symptoms. The mildly elevated monocytes and positive ANA warrant follow-up but are not immediately concerning for malignancy.

Treatment Plan

Symptomatic management for current symptoms. Scheduled follow-up with primary care physician in 8 weeks for further evaluation of positive ANA and clinical correlation. Patient education provided regarding the non-urgent nature of current laboratory findings and reassurance that results do not suggest malignancy.

Outcome and Follow-up

Patient was reassured that laboratory values were essentially within normal limits with only minor elevation in monocytes. The attending physician confirmed that findings did not warrant emergency intervention and that the scheduled 2-month follow-up appointment was appropriate timing for further autoimmune workup and clinical assessment.