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.
A 30-year-old woman presents with a 1-week history of severe right upper quadrant abdominal pain, bilateral shoulder and wrist pain, fever, and chills. She also has a rash, which developed 2 weeks ago and has nearly resolved. During the past year, she has had mild abdominal discomfort, which she attributes to menstrual cramps. She has not noticed any vaginal discharge and reports no gastrointestinal or urinary tract symptoms.
The patient is otherwise healthy, with no history of HIV infection, arthritis, or any other comorbidity. She has been sexually active with three partners during the past year and had a miscarriage 6 months ago. She reports that she has used condoms inconsistently during sexual intercourse and is currently taking an oral contraceptive. She has not seen her obstetrician/gynecologist since her miscarriage 6 months earlier.
She reports that she does not have history of substance abuse, including intravenous drug use, but does drink a few beers two or three times per week. She does not smoke, and her body mass index is within normal limits. She has no family history of a similar presentation.
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Cite this: Amber M. Bokhari. A Sexually Active 30-Year-Old Woman With Rash and Wrist Pain - Medscape - Jan 11, 2022.