{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T13:12:01Z","timestamp":1788786721400,"version":"build-2803163510"},"reference-count":6,"publisher":"BMJ","issue":"9","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2026,8,25]]},"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:p>A woman in her 70s was admitted three times over 22 months with recurrent pericardial effusions. A multiplex antinuclear antibody (ANA) assay by chemiluminescent enzyme immunoassay, reported only as a combined index, was repeatedly negative. Reassessment with careful history revealed long-standing Raynaud\u2019s phenomenon and episodic abdominal bloating, prompting further evaluation for systemic sclerosis (SSc). Indirect immunofluorescence (IIF) on HEp-2 (human epithelial type 2) cells showed ANA positivity (fine speckled 1:640 and nucleolar 1:320) and ELISA detected anti-RNA polymerase III antibodies, confirming SSc. Because of pre-existing renal impairment and anti-RNA polymerase III positivity, glucocorticoids were avoided; colchicine 0.5 mg\/day was started to prevent recurrence. No further pericardial effusion occurred during follow-up. This case illustrates that relying solely on a combined-index multiplex ANA screen can delay diagnosis and that HEp-2 IIF and disease-specific antibody testing are essential when clinical suspicion persists.<\/jats:p>","DOI":"10.1136\/bcr-2026-272372","type":"journal-article","created":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T12:55:12Z","timestamp":1788785712000},"page":"e272372","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Systemic sclerosis presenting as recurrent pericardial effusion despite repeatedly negative multiplex antinuclear antibody results"],"prefix":"10.1136","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-9495-3256","authenticated-orcid":false,"given":"Tsubasa","family":"Omae","sequence":"first","affiliation":[{"name":"Neurosurgery, Kyoto University Hospital, Kyoto, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5043-8778","authenticated-orcid":false,"given":"Kazuya","family":"Nagao","sequence":"additional","affiliation":[{"name":"Cardiovascular Center, Osaka Red Cross Hospital, Fudegasaki, Tennouji-ku, Osaka, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-0982-806X","authenticated-orcid":false,"given":"Sohei","family":"Funakoshi","sequence":"additional","affiliation":[{"name":"Department of Rheumatology and Clinical Immunology, Kyoto University Hospital, Kyoto, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4163-980X","authenticated-orcid":false,"given":"Koh","family":"Ono","sequence":"additional","affiliation":[{"name":"Cardiovascular Medicine, Kyoto University Graduate School of Medicine Faculty of Medicine, Kyoto, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,9,7]]},"reference":[{"key":"2026090705550719000_19.9.e272372.1","doi-asserted-by":"publisher","DOI":"10.1002\/art.38098"},{"key":"2026090705550719000_19.9.e272372.2","doi-asserted-by":"publisher","DOI":"10.3899\/jrheum.091048"},{"key":"2026090705550719000_19.9.e272372.3","doi-asserted-by":"publisher","DOI":"10.1002\/1529-0131(199809)41:9<1613::AID-ART11>3.0.CO;2-O"},{"key":"2026090705550719000_19.9.e272372.4","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(13)62709-9"},{"key":"2026090705550719000_19.9.e272372.5","doi-asserted-by":"publisher","DOI":"10.1515\/cclm-2023-0209"},{"key":"2026090705550719000_19.9.e272372.6","doi-asserted-by":"crossref","first-page":"154","DOI":"10.1016\/j.cca.2017.11.014","article-title":"Analytical and clinical comparison of two fully automated immunoassay systems for the detection of autoantibodies to extractable nuclear antigens","volume":"476","author":"van der Pol","year":"2018","journal-title":"Clin Chim Acta"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2026-272372","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T12:55:12Z","timestamp":1788785712000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2026-272372"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9]]},"references-count":6,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2026,9,7]]},"published-print":{"date-parts":[[2026,9]]}},"alternative-id":["10.1136\/bcr-2026-272372"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2026-272372","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9]]}}}