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She was noted to be hypotensive and bradycardic on presentation. Initial labs were remarkable for WBC of 12K, SCr of 1.6. C3 and C4 were noted to be low, 22 and 2 respectively. CRP and ESR were elevated. ANA was positive (1:320) and dsDNA was negative. Bedside ECHO revealed biventricular dilatation with severely depressed systolic function. ................
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