The patient was then referred to our rheumatology clinic for further evaluation to rule out an autoimmune etiology. Antinuclear antibody (ANA), anti-ds DNA, antineutrophil cytoplasmic antibodies (ANCA) screen with myeloperoxidase (MPO) and proteinase 3 (PR3), Coombs test, cytomegalovirus (CMV), hepatitis panel, and sexually transmitted infections (STI) testing-HIV, Chlamydia polymerase chain reaction (PCR), and rapid plasma reagin (RPR) were all negative, but HLA B51 resulted in a positive result. This evidence concerns the gene MPO and hepatitis A virus infection.