A 42-year-old woman was admitted to the hospital with 5 days of diffuse joint pain
and swelling associated with prolonged morning stiffness and intermittent fevers up
to 38.7°C. The review of systems was negative for rashes, mouth sores, pleuritic chest
pain, alopecia, dysuria, vaginal discharge, diarrhea or vomiting, cough or shortness
of breath, recent travel, sick contacts, or tick exposure. Her medical history was
significant for a 2-year history of an undifferentiated connective tissue disease,
which presented with inflammatory arthritis, palpable skin rashes (biopsy showed immunoglobulin
G and immunoglobulin M granular deposition along the basement membrane zone, suggestive
of a connective tissue disease), positive antinuclear antibodies, positive SS-A and
SS-B, low total complement, low C3 and C4, and positive rheumatoid factor with negative
anticyclic citrullinated peptide antibodies. She had been followed elsewhere for her
undifferentiated connective tissue disease, and the medications she had been on for
2 years prior to admission included hydroxychloroquine 400 mg/d and prednisone 15
mg/d. Her social history was significant for a new sexual partner, and her family
history was noncontributory.
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Article info
Publication history
Published online: April 01, 2021
Thomas J. Marrie, MD, Section EditorFootnotes
Funding: None.
Conflicts of Interest: None.
Authorship: All authors were involved in the preparation of the manuscript and have approved the manuscript and this submission.
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