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DWIGHT PARKER
10/22/18
16 yo female presenting with 10
days of diffuse joint pain, swelling of
her hands, feet, and face, other
“swollen joints” and intermittent
rash
HPI
Previously healthy
10 days of bilateral PIP joints, wrists, elbows, shoulders, feet, ankles,
knees, hips, neck and back pain and possible swelling. Has now
been to the ED 4 times and treated with steroids and
antihistamines
5 days ago began experiencing intermittent rash (started after
lying on some grass), large welts appearing first on her back and
side. Now affecting her palms, soles, scalp, and body. Has been
taking occasional doses of benadryl and loratadine with no
improvement. Very itchy. Some itchy eyes. No bleeding, bullae, or
ulcerations
3 days ago got severe lip swelling but no respiratory symptoms. Got
better.
Yesterday got shortness of breath, felt like her heart was beating
quickly, and felt burning in her chest
Has been seen in the ED 4 times in the past 5 days
Evaluated by rheumatology today who recommended she be
admitted for further workup
PMHx: “Healthy.” No PCP.
Hospitalized once at age 7 for an episode of swollen feet and
rash that resolved after 3 days, no diagnosis
PSHx: No prior surgeries
Meds: No regular prescribed medications. During the past
week has received:
Naproxen as needed, IV Benadryl, Famotidine,
Methylprednisone (125 mg x2), and Prednisone (40 mg x4 at
home)
Allergies: NKDA. No known food or environmental allergies
FHx: Parent with history of rheumatoid arthritis.
SHx: Recently spent 6 months living in central Mexico recieved
tattoos at the local parlor before she came back to the
states.
ROS: as above
Exam
General: Alert and oriented, well nourished, no acute distress;
quiet
GC/CT negative
HLA-B27 normal
RPR negative
HepBSAB, HepBcAB, HepBsAg, HepCAB all neg
aldolase, IgM, IgA, IgE, IgG, vWF, Cryoglobulin, EHEC
toxin, Stool culture, urine culture all negative/normal
Discuss!