A 23-Year-Old Man Comes to the Emergency Department Due to Sudden-Onset

question 587

Multiple Choice

A 23-year-old man comes to the emergency department due to sudden-onset fatigue and dark urine.  The patient was recently diagnosed with dermatitis herpetiformis.  He began treatment with dapsone and a gluten-free diet 3 days ago.  This morning, the patient felt weak and had difficulty getting out of bed.  His urine also appeared dark.  Temperature is 36.8 C (98.2 F) , blood pressure is 130/76 mm Hg, pulse is 88/min, and respirations are 14/min.  The patient appears tired.  Examination shows scleral icterus and pale lips.  There is a papular rash along the scalp, elbows, and knees with overlying excoriation.  Laboratory evaluation reveals the following: Which of the following is the most likely mechanism for this patient's urinary findings?

• A)Autoantibody production
• B)Complement activation
• C)Immune complex deposition
• D)Interstitial leukocyte infiltration
• E)Oxidative injury

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