A Woman with Pain in the Chest, Hands, and Feet

In this Morning Report from NEJM Evidence, a 40-year-old woman presented to the emergency department for evaluation of chest pain and pain in the joints of her hands and feet.

Case Presentation

Patient: 40-year-old woman
Chief complaint: Chest pain
History of present illness: Fever (101.4ºF) 9 days prior; symmetric pain and swelling in joints of hands and feet 4 days prior; pleuritic, positional left-sided chest pain 1 day prior
Social history: Lives with partner and children (1 attends day care), no recent travel
Physical exam: Normal vital signs; no rash or pericardial rub; metacarpophalangeal, proximal interphalangeal, and metatarsophalangeal joints swollen, tender, and with reduced range of motion
Key laboratory data: Leukopenia; normal troponin; positive anti-nuclear antibody (ANA) and anti-double stranded DNA (dsDNA) antibody; negative HIV and hepatitis B/C testing
Imaging: Normal ECG and chest x-ray; echocardiogr…

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Authors

Imran Naeem Aziz, MD

Kirtan Patolia, MD

Arfa Imran, MBBS

Seba Qaddorah, MD

Marlon Garcia, MD

A Woman with Pain in the Chest, Hands, and Feet

Topics

Case Presentation

Authors