Systemic sclerosis presenting as recurrent pericardial effusion despite repeatedly negative multiplex antinuclear antibody results.
A woman in her 70s presented multiple times with recurrent pericardial effusions, despite negative multiplex antinuclear antibody (ANA) results.
Clinical pearl
Clinicians should not rely solely on multiplex ANA screens; persistent clinical suspicion warrants further testing with HEp-2 indirect immunofluorescence and disease-specific antibodies.