Reporting the CENP-F-like (AC-14) antinuclear antibody pattern in the internet age: a case report

Laboratory immunologists occasionally encounter rare immunofluorescence patterns, such as the centromere protein F (CENP-F)-like pattern, classified as AC-14 by the International Consensus on ANA Patterns (ICAP). The clinical and biological significance of anti-CENP-F antibodies remains unclear, but their presence appears to be related to events involving increased or abnormal cell proliferation, including malignancies.

This case report describes the diagnostic journey of a patient who presented with clinical manifestations of chronic spontaneous urticaria (CSU), the laboratory report for which indicated the presence of a CENP-F-like (AC-14) antinuclear antibody (ANA) pattern during routine testing for the cause of her symptoms. Concerned by the result, the patient independently searched for information online and discovered a potential association between anti-CENP-F autoantibodies and cancer. This search led to considerable anxiety and prompted her to pursue further medical evaluations to rule out malignancy. The resulting diagnostic pathway involved consultations across several medical disciplines.

This case highlights the complexity of interpreting uncommon ANA patterns and underscores the critical role of the laboratory in such contexts. In particular, it emphasizes that (1) ANA testing should be requested only in well-defined clinical contexts; (2) the CENP-F-like ANA pattern is not diagnostic of malignancy in low-risk patients.

Laboratories can play a crucial role in supporting clinicians, providing confirmation of laboratory results, even in the absence of commercial tests for determining the antigenic specificity. We believe that this case exemplifies the importance of correct and careful laboratory reporting, especially in an era where patients frequently engage in self-diagnosis. It also underlines the value of multidisciplinary collaboration in the management of unexpected laboratory results.