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 that you would like to suggest for a future Case Challenge, please contact us.
In response to user comments, this case was updated with additional information to clarify the diagnostic approach.
A 35-year-old-woman presents with a 10-month history of fatigue that has progressively worsened to the point that it is limiting her ability to work as a waitress. It is accompanied by muscle stiffness, joint pain, recurrent headaches, and an inability to concentrate. Adequate rest and over-the-counter analgesics have failed to relieve her symptoms, and she feels tired all the time. She snores at night and has difficulty staying asleep.
She has no history of tick bite or skin rash, and the region has low incidence of tick-borne illnesses. She reports no history of alcohol or drug abuse but did have multiple unprotected sexual encounters in the past 5 years. She denies any suicidal or homicidal ideation. She has visited multiple physicians in the last few months with the same symptoms and is not satisfied with the work-up done so far. She is stressed by her symptoms and concerned that she might lose her job. Her medical history is significant for hyperlipidemia, and she has taken atorvastatin (40 mg daily) for the past year.
Medscape © 2015
Cite this: A 35-Year-Old Woman With Fatigue and Joint Pain - Medscape - Apr 14, 2015.