19th February 2024

A 42-year-old female presents with a six-month history of fatigue

A 42-year-old female presents with a six-month history of fatigue, weight loss and arthralgia of the hands and feet. She describes transient discolouration to the fingertips in the cold, which turns white, blue and red and is associated with discomfort. She had central chest pain associated with fever and exacerbated by lying supine.

Clinical examination reveals a macular rash across her cheeks and oral ulcers. There is tenderness to palpation of the metacarpal and metatarsal joints but no palpable swelling. Her cardiac and respiratory examination is normal. Investigations revealed thrombocytopenia, normal renal function, and complement levels are low. Her urine dip reveals proteinuria.

Which of the following is the most likely diagnosis?

Select the SINGLE most appropriate option from the list below. Select ONE option only.