Case 7 Introduction

History of Present Illness (HPI)

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A 32 year old woman with a past medical history of well-controlled asthma presents to the Emergency Department with 2 weeks of intermittent fevers, arthralgias (joint pains), and worsening fatigue.

She reports she was in good health until the onset of these symptoms, although she had noted a “bad sunburn” on her face about 1 month ago that has since resolved. She also reports mild ankle swelling that developed over the past 1 week. She denies any headaches, vision changes, chest pain, shortness of breath, cough, nausea, vomiting, or change in bowel habits. She works as a lawyer and has no recent travel or sick contacts. She saw her primary doctor for an annual physical 3 months ago, at which time she was told all her blood tests was normal.

Aside from an as-needed albuterol inhaler, which she has not required in over 1 year, she takes no medications and denies any known drug allergies. She does not drink alcohol, smoke, or use illicit drugs. Her mother has a history of rheumatoid arthritis, and her father has hypertension. There is no known history of kidney disease in her family.

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