Mohammadreza Sheikh Sajjadieh , Olena Sheikh Sajjadieh , Ghazale Aghababaei , Mohammad Farzi , Abdolsamad Ghorbani ,
Volume 20, Issue 2 (6-2026)
Background: Anti-centromere antibodies (ACA) are commonly detected by indirect immunofluorescence (IIF) on HEp-2 cells, typically producing the classic centromere pattern (AC-3). However, discrepancies between IIF and solid-phase immunoassays, such as ELISA, may complicate interpretation.
Case Presentation: We report the case of a 75-year-old woman who presented with progressive inflammatory polyarthritis, morning stiffness, dry mouth, photosensitivity, and mild exertional dyspnea. Antinuclear antibody (ANA) testing by IIF on HEp-2 cells demonstrated a multiple nuclear dots pattern (AC-6), with features resembling a CENP-F–like pattern (AC-14), rather than the typical centromere pattern. By contrast, solid-phase assays, including ELISA and immuno-dot blot, demonstrated anti-centromere antibody reactivity. Additional serologic findings included strong positivity for SSA/Ro60, Ro52/TRIM21, SSB/La, and DFS70 antibodies.
Conclusion: This case demonstrates that anti-centromere reactivity detected by solid-phase assays may occur despite the absence of a classic AC-3 pattern on IIF. The interpretation of discordant serologic findings requires careful integration of clinical features with complementary laboratory methods.
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