Mixed connective tissue disease and tuberculosis coexistence as a diagnostic dilemma: A case report

Table 1 Complete blood count

Test	Reference value, %	Result, %
WBC	4-11 × 109/L	2.3 × 109/L
RBC	3.5-5.5 × 1012/L	2.31 × 1012/L
HGB	12-15 g/dL	5.1 g/dL
Hct	36-46	17.8
MCH	76-96 pg	22.3 pg
MCHC	31.5-34.5 g/L	29.9 g/L
Platelets	150-450 × 109/L	35 × 109/L
MPV	40-80	9.6
Neutrophils	20-40	42.7
Lymphocytes	2-8	18.7
Eosinophils	1-5	0.2
MCV	27-31 fL	77.4 fL
Reticulocyte count	12.2-16.1	1
ESR	0-20 mm/hours	79 mm/hours

MCH: Mean corpuscular haemoglobin; MCHC: Mean corpuscular haemoglobin concentration; MCV: Mean corpuscular volume; WBC: White blood cells; RBC: Red blood cells; ESR: Erythrocyte sedimentation rate.

Table 2 Liver function test liver function tests

Test	Reference	Result
AST	10-40 IU/L	131 IU/L
ALT	10-40 IU/L	51 IU/L
Alkaline phosphatase	44-147 IU/L	427 IU/L
Total bilirubin	0.1-1.20 mg/dL	0.36 mg/dL
Renal function panel RFTs
Serum urea	10-50 mg/dL	18 mg/dL
Serum creatinine	0.7-1.20 mg/dL	0.89 mg/dL
Electrolytes
Sodium	135-145 mEq/L	137 mEq/L
Potassium	3.5-5.2 mEq/L	3.6 mEq/L
Chloride	96-106 mEq/L	116 mEq/L
Albumin
Albumin	3.5-5.5 g/dL	2 g/dL

AST: Aspartate transaminase; ALT: Alanine transaminase; RFT: Renal Function Tests.

Table 3 Urine complete examination

Physical examination
Test	Reference	Result
Colour	Normal/pale yellow	Pale yellow
Turbidity	Clear	-
Chemical examination
pH		6.0
Specific gravity	1.003-1.030	1.010
Leukocytes esterase	-	+
Nitrite	Negative	-
Protein	Negative	-
Ketone	Negative	-
Bilirubin	Negative	-
Glucose	Nil	-
Blood	Nil	+++
Urobilinogen	Nil	-
Microscopic examination
Pus cell	Negative	6-8
Crystals	Negative	-
Casts	Negative	-
Epithelial cells	Negative	-
RBC	Nil	Many
Bacteria	Nil	-
Yeast	Nil	-

RBC: Red blood cells.

Table 4 Arterial blood gas analysis

Test	Result
pH	7.407
pO2	70
pCO2	23
K+	3.8
HCO3-	14.5
SpO2	94.4%

RESULT: Respiratory Alkalosis with metabolic compensation.

Table 5 Serum markers

RA factor	Negative	U/mL
ANA	Positive	1:5120	Speckled pattern
Anti-nucleosome	Positive	84	SLE
Anti-dsDNA	Positive	86
Anti-histones	Positive	21
Anti-Sm	Positive	90
Anti-Sm/RNP	Positive	93	MCTD
Anti-SSA/Ro 60kD	Positive	92	Sjogren syndrome

RA: Rheumatoid arthritis; ANA: Antinuclear antibody; SLE: Systemic lupus erythematosus; MCTD: Mixed connective tissue disease.