Diagnostic Dilemma| Volume 134, ISSUE 9, P1107-1109, September 2021

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Troubling Tenosynovitis: When a Serious Sign Persists

      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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