A 46-Year-Old Woman With Weakness and Leg Swelling

Unnikrishnan Pillai, MD; Jameel Muzaffar, MD; Santosh G. John, MD; Pascale Salem, MD; Philip B. Vaidyan, MD

Disclosures

June 26, 2017

Editor's Note:
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Background

A 46-year-old black woman is admitted to the intensive care unit with a diagnosis of congestive heart failure after presenting to the emergency department with a 4-day history of progressive generalized weakness, increasing shortness of breath, and leg swelling. She denies having any recent chest pain, cough, or fever.

The patient reports that approximately 7 months ago, she had been admitted to another hospital for chest pain and shortness of breath. She states that at that time, she had elevated cardiac enzyme levels, and a cardiologist performed angiography that revealed normal coronary arteries. Three months ago, she was admitted to a different hospital with shortness of breath and leg swelling and was diagnosed with congestive heart failure.

In addition to the leg swelling and trouble breathing that had prompted her to call 911 in this instance, she is also complaining of mild dysphagia, gastroesophageal reflux symptoms, and difficulty getting up from a sitting position (which has been getting progressively worse for about 4 weeks). She mentions that she has lately been using a cane to help her walk. In addition, for the past 4 months, she has noticed swelling of her tongue, with loss of taste sensation; hair loss; bruising of her eyes; and a nontender, nonpruritic, ecchymotic rash on her abdomen and chest.

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