Kaitlyn Case 01x - CASEBANK

heehawultraMechanics

Feb 22, 2014 (3 years and 5 months ago)

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Kaitlyn Brown

Training 2010


Genevieve is a twenty
-
three year old African American student
at University of Toronto.



She visits her family physician because she has been
experiencing the following symptoms for the past 3
-
4 days:


Chest pain


Headache


Mood swings


Polymyalgia and pain in joints (wrists and knees)


Extreme fatigue


General malaise








Genevieve has visited walk
-
in clinics a couple times in the
past year with complaints of headaches, myalgia, joint
pain, and fatigue.


No infections or signs of disease were found in routine physical


Doctors recommended maintaining a healthy lifestyle and taking
NSAIDs for pain.


Following advice of one physician, Genevieve began recording
information about symptom onset, duration, and nature to show
her family doctor.



She observed the following:


Photosensitivity resulting in frequent sunburns on face and
shoulders


Symptoms experienced every 1
-
2 months for about 1
-
2 weeks. In
between, she feels slightly tired and has some aches, but is
otherwise normal.


This is the first time she has experienced chest pain.







Otherwise, has no history of significant illness or injury and
has had no recent infections.



Maintains a healthy weight, follows guidelines for healthy
eating, and enjoys playing tennis in spare time.



Non
-
smoker and moderate drinker



Not taking any medications (with exception of occasional OTC
painkillers) or oral contraceptives



Completing her Masters degree in linguistics at University of
Toronto and is living with two friends in an apartment



She has been in a monogamous relationship for one year.



Has had significant sources of stress throughout university
years: abusive ex
-
boyfriend and death of close friend, in
addition to typical student anxieties



Grew up in suburbia and is the eldest of four healthy children



Family medical history is unremarkable


all parents and
grandparents are still living and in good health


Temperature: 100.1
°

F



Heart rate: 82 beats per minute



Blood Pressure: 112/70 mmHg



Rate of Respiration: 20 breaths/minute


Two painless oral ulcers found on wall of left
cheek



Chest pain became worse when breathing deeply
or lying down; improved when leaning forward



On auscultation of chest, physician heard a
friction rub.



Joint stiffness and slight swelling noted in wrists
and knees
-

range of motion is slightly decreased



Swollen ankles and feet







The physician decides to run a battery of
tests, with emphasis on diagnosing a cardiac
issue.


Electrocardiogram


Echocardiograph


Complete blood count


Autoantibody testing


Urine analysis


Chemistry profile


Thyroid panel


Erythrocyte sedimentation rate




Echocardiograph

Normal Electrocardiograph shown
above. Genevieve’s showed:


ST segment elevations (upwardly
concave)

Depression of PQ segment



Based on interpretation of electrocardiogram
and echocardiograph, the cardiologist
determines
pericarditis

in the patient. There
is some pericardial effusion, but it is minimal.



What should be done, now that the cardiac
problem is diagnosed?



Does
pericarditis

adequately explain all
symptoms?

Component

Genevieve’s
Results

Normal Values
for Female

Red Blood Cells

4.0 million/mm3

4.2


5.4
million/mm3

White

Blood Cells

3,950/mm3

5,000



10,000/mm3

Hemoglobin

11 g/dl

12
-
16 g/dl

Hematocrit

36%

37
-
47%

Platelet Count

148,700/mm3

150,000
-
400,000/mm3

Mean corpuscular
volume

86 um

80
-
95 um

Mean

corpuscular
hemoglobin

concentration

33 g/dl

32
-
36

g/dl

Neutrophils

62%

55
-
70%

Lymphocytes

28%

20
-
40%

Monocytes

7%

2
-
8%

Eosinophils

2%

1
-
4%

Basophils

1%

0.5
-
1%

Erythrocyte Sedimentation
Rate:


Normal = up to 20 mm/hr


Genevieve’s = 210 mm/hr


Results from chemistry profile, urinalysis, and thyroid panel
were all within normal range.





Autoantibody Test Results


Antibody

Normal Result

Genevieve’s
Result

Anti
-
nuclear

Positive or
Negative

Positive

Anti
-
Sm

Negative

Positive

Anti
-
double

stranded DNA

Negative

Positive

(high)

Anti
-
SSA

Negative

Negative

Anti
-
SSB

Negative

Negative


These results implicate that Genevieve’s
disease falls under a certain group of
disorders.



What group is this?



Based on her collective symptoms and test
results as well as epidemiological data, a
certain disease is highly suspect.


This rash is found
below Genevieve’s
neck.



A definitive
diagnosis can
be made.


Incurable auto
-
immune disease that primarily affects women. Non
-
Caucasian women are at significantly higher risk.



There are three types: Systemic Lupus
Erythematosus
, Discoid Lupus,
and Drug Induced Lupus.



Cause is unknown. Studies have loosely implicated genetics, hormones,
stress, and environment to disease development.



Can manifest with an extremely wide variety of symptoms in almost
every system of the body (kidneys, heart, lungs, skin, nervous system,
blood, joints, and muscles can all be affected).



Not everyone experiences all symptoms; every case is very different.



Michael Jackson reportedly had it!




NSAIDs and/or analgesics



Anti
-
malarials

(
Hydroxychloroquine
)



Immunosuppressives

(chemotherapy or anti
-
rejection
agents)



Glucocorticoids

(usually Prednisone)



Avoid direct sunlight



Eat a wholesome diet


preliminary studies have shown
that becoming vegetarian (with proper protein and nutrient
intake) can significantly help with symptoms






Systemic Lupus
Erythematosus

used to be
fatal within five years



Now, the treatment for it is very effective and
most people survive many years following
diagnosis



In later life, other diseases may be worsened
or develop in association to the lupus.