A 67-Year-Old Woman With Orthostatic Hypotension and Edema

Catherine Anastasopoulou, MD, PhD; Kimberly Lessard, DO

Disclosures

March 08, 2018

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.

Background

A 67-year-old woman presents to the emergency department for evaluation of progressive bilateral lower extremity edema. The patient is a poor historian and appears confused. She has a medical history of osteoporosis, fibromyalgia, chronic cough, mild intermittent asthma, anemia, and glaucoma. She was also recently involved in a significant motor vehicle accident and sustained a pelvic fracture. The patient's recovery was complicated by the development of acute deep vein thrombosis and pulmonary embolism. She was also discovered to have heparin-induced thrombocytopenia and thrombosis. She has since remained on anticoagulation therapy with rivaroxaban.

Discussion with family members reveals that the patient has demonstrated a gradual decline in mental status following her car accident and has complained of frequent headaches, shortness of breath, and progressive leg swelling. She is also reported to have had several recent falls without associated loss of consciousness or significant trauma. She has been compliant with all of her home medications, including escitalopram, albuterol, cholecalciferol, and rivaroxaban as well as recently prescribed daily furosemide.

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