Case Published: September 2018

History of Present Illness (HPI)

A 40-year-old woman with a past medical history of seasonal allergies, migraine headaches, and a recent deep vein thrombosis (DVT) after a long plane ride presents with a 1 month history of muscle and joint pains (myalgias and arthralgias, respectively), a new rash, and 4 days of shortness of breath.

She says the rash began 3 weeks ago and does not itch (non-pruritic). It started on her hands, then progressed to her arms, lower extremities, and abdomen. She also now notes oral lesions that are painful. Over the past several days, she has developed progressively worsening shortness of breath. Yesterday, she noted her urine appeared dark.

The patient denies fever, chills, chest pain, nausea, vomiting, or abdominal pain. She has not had recent outdoor exposures like hiking or camping. She does have a history of intermittent epistaxis and underwent surgical correction of a deviated nasal septum several years ago.

She works as a pastor. She does not use tobacco, alcohol, or illicit drug use. Other than warfarin that she started taking for the DVT, she has not been taking any other medications or over the counter medications including non-steroidal anti-inflammatory drugs (NSAIDs).

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