Case Study: Joint Pain, Rash, Hair Loss - What's Going On?
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.
SpecialtiesCriticalCase Study
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.
History of Present Illness
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.
Past Medical History
Unremarkable, current with all vaccinations including influenza.
Family History
She has two brothers and one sister. Her older sister has rheumatoid arthritis, and an aunt has pernicious anemia. Her mother has Graves' disease.
Social History
No smoking or drinking
Medications
Naproxen for joint pain, antacid for heartburn, no other over the counter drugs
Allergies
NKA
Vital Signs
BP 141/90 sitting, RA
HR 105
RR 20
T 100o F
HT 5'6"
WT 105 lbs
Review of Systems (only abnormal values presented)
