The patient went on to have extensive diagnostic work-up. 

• Neuromyelitis Optica antibodies: POSITIVE
• Rheumatoid Antibodies
  • Rheumatoid Factor <20 IU/mL (normal range: <20)
• Antinuclear Antibodies
  • Antinuclear antibodies: POSITIVE
  • Speckled Titer: 40
  • Speck/Nuclr Titer: 640
• Extractable Nuclear Antigens
  • Ext. Nuclear Ags Positive
  • Anti - Sm: Negative
  • Anti - RNP: Negative
  • Anti - Ro: POSITIVE
  • Anti - La: POSITIVE
  • Anti - Topo1: Negative
  • Anti - Jo1: Negative
• Double Stranded DNA Antibodies
  • dsDNA 0.7  2.7 IU/mL (normal range: 0-4.0)