Presenter: Tyler Reimschisel, MD Preceptor: Harvey Singer, MD


October 07, 2002

Past History

The patient was born at full term by a spontaneous vaginal delivery. Her mother experienced spotting in the first trimester. Evaluation of the placenta after delivery revealed that a twin product of conception had undergone fetal demise. The patient has had no developmental delays.

Medical History

Approximately 1 1/2 years ago, the patient began to experience episodes of swelling of her face and feet. These symptoms were initially thought to be due to chronic mononucleosis. When the symptoms persisted, she was placed on amoxicillin/clavulanate and loratadine, but the episodes continued. Approximately 1 year ago, during a particularly severe episode, her legs swelled from the knees down to her feet. She was unable to wear shoes for about 1 week. This resolved spontaneously, and she has experienced no further problems with swelling.

She also has a history of secondary amenorrhea for 4-5 months. A thorough endocrine evaluation was unremarkable. Her menses resumed spontaneously, and she has not noted any additional menstrual abnormalities.

Family History

The patient's maternal grandfather and maternal great-grandmother had Parkinson's disease. There is no family history of any other neurologic or psychiatric diseases.

Social History

The patient lives in New Jersey with her mother and 2 healthy siblings. Her parents have been divorced for several years. There have been no changes in her home setting. She denies substance abuse. She is not sexually active. She has not traveled out of the country recently.

Review of Systems

No additional problems are noted in an extensive review of systems.


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