Mysterious Bruising, Weakness, Back Pain, and Gum Bleeds

Arun Gupta, MD, DNB

Disclosures

March 09, 2017

Editor's Note:
The Case Challenge series includes difficult-to-diagnose conditions, some of which are not frequently encountered by most clinicians but are nonetheless important to accurately recognize. Test your diagnostic and treatment skills using the following patient scenario and corresponding questions. If you have a case you would like to suggest for a future Case Challenge, please contact us.

Background

A 42-year-old woman presents to the emergency department with a 2-day history of bleeding from her gums. For the past month, the patient has also experienced progressive weakness and occasional bruising over the buttocks, thighs, and shoulders without significant trauma. For the past year the patient has been intermittently using oral analgesics for low back pain. She denies any history of hematemesis, melena, hemoptysis, epistaxis, fever, or rash. The patient does not smoke or use illicit drugs, but she does consume 1-2 cans of beer daily. She denies using any regular medications, including oral contraceptives. There is no history of any gastrointestinal or genitourinary illnesses. She is unmarried, lives alone, and works as a clerk in an office.

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