The Case Files: Polyarthralgias, Rash, Swelling of Joints

By Alice Chao, MD, and Ayesha Khan, MD, MPH   A 44-year-old previously healthy woman presented to the emergency department with chest pain and shortness of breath. The patient reported a two-month history of polyarthralgias and rash. She initially noted swelling and pain of her ankles that progressed to her knees, wrists, and shoulders.   The patient also reported a non-pruritic rash with erythematous borders on her extremities that would come and go (Figure 1), nodules in her skin, and intermittent fevers.   Figure 1.   She denied any insect bites or recent travel, and had no personal or family history of autoimmune disorders. She reported a sore throat two weeks prior to onset of symptoms that was not treated. The patient was found to be in sinus tachycardia (Figure 2), and she complained of chest pressure and difficulty breathing.   Figure 2.   She continued to have persistent tachycardia despite fluid hydration and pain control. A CT angiogram of the chest was negative for pulmonary embolism. The patient was admitted for persistent tachycardia and further workup of recent symptoms that were concerning for acute rheumatic fever. Laboratory tests revealed a high antistreptolysin O titer. Throat culture was positive for Streptococcus pyogenes.   She also had elevated ESR and CRP. An echocardiogram was done during the hospitalization, which revealed mild thickening of the mitral valve and aortic valve with mild mitral and aortic regurgitation. Echo also revealed mini...
Source: The Case Files - Category: Emergency Medicine Tags: Blog Posts Source Type: research