CDC Case Challenge: A Woman With Fatigue, Palpitations, and Headache

Jennifer R. Chevinsky, MD, MPH; Sallyann M. Coleman King, MD, MSc; Robert A. Bonacci, MD, MPH; Brendan R. Jackson, MD, MPH; Alyson B. Goodman, MD, MPH; Jessica Rogers-Brown, PhD, MPH; Valentine Wanga, PhD, MS; Jennifer R. Cope, MD, MPH; Stacey Konkle, PhD, MPH; Miriam Nji, MD, MPH; Melissa Briggs-Hagen, MD, MPH; Elizabeth R. Unger, PhD, MD; Brook Belay, MD, MPH; Sharon Saydah, PhD


September 02, 2021

Editorial Collaboration

Medscape &

A previously healthy 34-year-old woman presents to her primary care provider for fatigue, palpitations, headache, dyspnea, and difficulty sleeping. She reports no chronic medical conditions or recent illnesses. She reports difficulty thinking through complex tasks at work, which seems to be worse after she tries to exercise, and notes that she is not able to lift as much weight or run as far as she normally could. She states that sometimes when she feels the palpitations, she also feels anxious and dizzy like she might faint, but she has not had any fainting episodes.

She mentions that her husband had a cold a couple of months ago and he lost his sense of taste and smell after returning from a business trip to New York, but she does not remember catching the cold or being ill. She explains that throughout the COVID-19 pandemic there have been stressors related to childcare, isolation from extended family members, and economic challenges, but that she was coping well with all of these factors up until this week when her new symptoms started.

She was planning to receive COVID-19 vaccination this week so she could feel comfortable visiting her elderly parents, but due to these new symptoms she has been experiencing, she was not sure whether she should get vaccinated.

On examination, the patient has a heart rate of 115 and tenderness at multiple large and small joints. All other findings are unremarkable.

Results of a complete blood count (CBC) and complete metabolic panel (CMP) are as follows:

  • Hemoglobin: 12.5 g/dL

  • Hematocrit: 40.0%

  • White blood cell count: 5.5 x 103/µL

  • Platelets: 300 x 103/µL

  • Sodium: 141 mmol/L

  • Potassium: 4.0 mmol/L

  • Chloride: 108 mmol/L

  • Glucose: 94 mg/dL

  • Creatinine: 0.88 mg/dL

  • CO2 : 28 mmol/L

  • BUN: 17 mg/dL