A 25-Year-Old Mother With Joint Pain Who Feels Faint

Rebecca V. Nadelman, MD; Meigra Myers Chin, MD

Disclosures

March 15, 2021

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 25-year-old woman presents to the emergency department (ED) with a 3-day history of lightheadedness and dyspnea. She reports that she has felt faint and short of breath, especially when she is walking and exerting herself. She also had vague joint aches and fatigue over the past few days. She has had no recent illnesses and specifically denies having any fever, headache, or cough. She has no pain or swelling in her legs.

The patient has no significant past medical history and reports no personal or family history of blood clots, heart disease, or syncope. She does not believe she is pregnant and states that her last menstrual period ended several days ago and was normal; she denies any history of menorrhagia or anemia. She takes no medications.

She is a nonsmoker and has no history of substance use. She lives at home with her husband and two children and has not recently traveled. She has no known exposure to coronavirus disease 2019 (COVID-19) or any other contagious illness. The patient had been enjoying the warm weather, sitting on a lawn chair in her backyard in New Jersey while her children played outside. Her husband noted a "bug bite" on her inner leg approximately 2 weeks earlier that caused an itchy rash, which improved with topical diphenhydramine.

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