A 29-Year-Old Woman With Worsening Pain and Memory Issues

Caroline Tschibelu, MD


May 08, 2019

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 recognize accurately. Test your diagnostic and treatment skills using the following patient scenario and corresponding questions. If you have a case that you would like to suggest for a future Case Challenge, please contact us.


A 29-year-old woman is referred to a rheumatologist for multiple joint and muscle pain, back pain, and increasing fatigue. Her wrists are painful at the end of the day whenever she performs repetitive movements in her job as a research assistant. The patient states that her symptoms started over five years ago with the sudden onset of sharp, left shoulder pain, which she attributed to carrying her shoulder bag. She noted gradual radiation of the pain to both arms and worsening of symptoms with cold temperature. Her primary care provider (PCP) recommended over-the-counter analgesics as needed, to relieve the pain, and these resolved the symptoms at the time.

However, the shoulder pain has returned and is associated with diffuse muscle pain. The patient has also recently developed occasional bilateral hip pain and has noticed ascending numbness from her feet whenever she sits down for prolonged periods of time. The numbness usually resolves whenever she stands up. She has become increasingly fatigued and has trouble falling and staying asleep. The patient also reports difficulty with memory and concentration, as well as feelings of depression. She denies having burning or tingling sensations, or urinary or fecal incontinence.

The remainder of the review of system is unremarkable. Her medical history includes well-controlled asthma, eczema, seasonal allergies, and endometriosis. She had an appendectomy as a child. Her medications include albuterol as needed, as well as formoterol, fexofenadine, acetaminophen, and a cortisone cream.