Editor's Note:
The Case Challenge bid includes difficult-to-diagnose conditions, immoderate of which are not often encountered by astir clinicians but are nevertheless important to accurately recognize. Test your diagnostic and attraction skills utilizing the pursuing diligent script and corresponding questions. If you person a lawsuit that you would similar to suggest for a aboriginal Case Challenge, delight contact us.
Background
A 46-year-old pistillate (G1P1) with a past of congenital splenomegaly and thrombocytopenia, who follows up with the hematology service, presents to the infirmary arsenic a transportation for worsening lung infiltrates. The diligent besides has a past of asthma, bipolar disorder, migraines, and recurrent lower-extremity deep venous thrombosis (DVT), with 2 affirmative tests for lupus anticoagulant (12 weeks apart) portion taking apixaban.
She initially presented to different infirmary with respective days of worsening fatigue and fevers. At the different hospital, she underwent thorax imaging, which demonstrated right-sided multifocal patchy crushed solid opacities and a right-sided multiloculated effusion. Antibiotic therapy was started, and her symptoms improved; however, repeated CT showed caller near precocious lobe infiltrates with unchangeable close lung findings. The caller findings prompted her transportation for further workup and evaluation.
The diligent notes that she has experienced respective weeks of mediocre appetite and intermittent abdominal symptom associated with her fevers and fatigue. She has a 6-month past of oral ulcers and a 2-year past of bilateral hand, wrist, and elbow pain, with intermittent swelling, erythema, and stiffness that has progressed for the past 6 months. The remainder of her reappraisal of systems is notable for Raynaud phenomenon and a past of photosensitivity, which manifests arsenic profound fatigue aft prima exposure.
Before her hospitalization, the diligent had sought aesculapian attraction for her abdominal pain. At that visit, a CT scan showed caller hint perisplenic fluid and laboratory results demonstrated leukopenia with thrombocytopenia, for which she underwent a bony biopsy respective days earlier her existent presentation. The results of the biopsy are pending.
She has nary household past of rheumatologic oregon pulmonary disease. She works arsenic a teaching assistant, and her societal past is notable for uncommon intoxicant usage and a 30–pack-year smoking history.
English (US)