Correct!
3. The CT scan shows ground glass opacities
There is no evidence of pleuritis, diffuse interstitial pneumonitis, pulmonary hypertension or filling defects in the pulmonary artery. The finding of ground glass opacities is nonspecific and seen with many pulmonary diseases.
The patient felt much better with steroid treatment and made the decision to be followed. She was seen by a rheumatology consultant who questioned the diagnosis of SLE. Antinuclear antibodies were weakly positive 1.3 U, double-stranded DNA antibodies were <12.3 IU/ml, C3 and C4 were normal and anti-nuclear cytoplasmic antibody, rheumatoid factor (RF) and anti-cyclic citrullinated peptide antibody (CCP) were negative.
The prior lung biopsy was reviewed and interpreted as showing ““Focal pleuritis and underlying lung tissue with increase in pigmented macrophages in the airspaces with occasional focus of organization and focal mild fibrosis; multiple meningothelial-like nodules”.
Due to clinical question of whether this was SLE, bronchoscopy was performed which recovered bloody fluid which did clear with repeated lavage. Smears/cultures and cytology were all negative.
Additional laboratory testing revealed a negative lupus anticoagulant, but elevated antiphospholipid IgG antibodies at >100.0 GPL (normal< 10) and beta 2 glycoprotein IgA antibodies 67.4 APL (normal < 10) and IgG antibodies > 100 GPL (normal < 10).
Based on the clinical picture and the laboratory findings what is the most likely diagnosis?