A new case study in which R.W. presents to her PCP with a cough, mild fever, joint stiffness and pain and a history of rashes, anemia and hair loss. Specialties Critical Case Study
Updated:
R.W. is a married, 34-year-old Hispanic female with two young children who presents to her primary care provider with a productive cough, stiffness and pain in her hands and feet that comes and goes. She states, "It moves around from joint to joint. I'm worried I've got RA like my sister.” Her PCR test for COVID-19 has come back negative.
Five years ago, R.W. went to her PCP after four months of rashes that appeared on her arms and legs whenever she went into the sun. She had lost several small patches of hair on her scalp and stated she thought it was related to stress. She also complained of fatigue that required her to take daily naps. She had mild arthritic pain in her fingers and elbows but thought it was related to aging. A tissue biopsy of one of the multiple rash-like lesions from her arm revealed vasculitis (white blood cells within the walls of blood vessels). Her CBC indicated mild anemia, but microscopic examination of a peripheral blood smear revealed that red blood cells were normal in shape size and color, ruling out iron, folate and vitamin B12 deficiencies. A two-month course of prednisone caused all signs and symptoms to resolve.
Unremarkable, current with all vaccinations including influenza.
She has two brothers and one sister. Her older sister has rheumatoid arthritis, and an aunt has pernicious anemia. Her mother has Graves' disease.
No smoking or drinking
Naproxen for joint pain, antacid for heartburn, no other over the counter drugs
NKA
What is causing the lung symptoms, jaundice, joint stiffness and pain?
What happened 5 years ago?
Imagine you only get 5 questions. What information should you ask for that will give you the most information for a diagnosis?
What labs do you want?
What other diagnostic tests should we run?
Ask me some questions!