Fever, Rash, and Swelling: Don't Miss This Diagnosis

Stephen Paget, MD

Disclosures

January 04, 2011

Presentation

A 24-year-old woman presented to her primary care physician reporting a 1-week history of fever (peaking at a body temperature of 102°F in the late afternoon), along with pain and swelling of her hands and feet. She also noted fatigue and a fleeting rash on her arms and legs.

In her physician's office, her temperature was 101°F and her vital signs were normal. No rash was seen, but she did have cervical, axillary, and inguinal adenopathy. The general examination was normal except for enlarged and swollen spleen and liver and tenderness of the wrists, metacarpophalangeal and proximal interphalangeal joints, ankles, and metatarsophalangeal joints.

Laboratory testing showed a white cell count of 22,000 cells/mm3, hemoglobin level of 11.8 mg/dL, platelet count of 500,000 cells/mm3, erythrocyte sedimentation rate (ESR) of 88 mm/h, C-reactive protein (CRP) level of 12 mg/L, aspartate aminotransferase level (AST) of 102 U/L, and alanine aminotransferase level (ALT) of 188 U/L.

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