Autoimmune or no? | Figure 1

Autoimmune or no?

36 year old female came into clinic with complaints of intermittent left ear pressure, occipital tension headaches, neck pain (muscular but only on left side), pain in right knee joint (bilateral knee crepitus, but no swelling), Lumbar spinal narrowing and pain, bilateral pressure under ribcage with strange muscle contractions in ribcage while twisting or bending forward, fatigue that causes her to sleep for 14 hours daily, and small petechiae around her left ribcage area. Patient also has developed what appears to be a red, itchy hive-like rash on her knees and elbows which lasted a few days. Labs are all within normal limits other than positive C1q antibodies, C1q binding complex, Antiphosphatidylserine Antibodies, and EBV nuclear antibodies which are elevated and low vitamin D. At this time Anticardiolipin antibodies, Anti-SSA and Anti-SSB antibodies are normal but pt has had elevations of Anticardiolipin Antibodies IgM and IgG as well as positive Anti-SSA Antibodies within low positive range. Lupus anticoagulant antibodies and cryoglobulin are normal as well. Pt vitals are all within normal limits with a lower blood pressure of 95/62 which she states is her baseline. Pt sent to rheumatologist. Would Lupus be out of the question here since her most recent labs came back negative for SSA antibodies and Lupus Coag? She was ANA positive but there was no pattern reported.

Similar Cases

Case 1

I had a 34 year old female come in today after complaining of constant fatigue and orthostatic hypotension. The patient reports lying down with her baby and feeling tired but nothing out of the ordinary. After about 2 hours of lying down, she got up and began to feel strange. Pt reports her heart pounding, feeling lightheaded, shaky, nauseous, weak and thought it was possibly caused by low blood sugar. She checked her blood pressure and it was 109/93 with a HR: 118. (Pt baseline blood pressure is 95/70). She reports eating some fruit snacks and a chicken nugget and drank some water, but still didn’t feel well. She then laid down again for about 25 minutes and while lying down took her blood pressure once more. This time it was 92/50 with HR: 90 (an hour after high bp was taken). At this point pt reports feeling tired but heart racing and lightheadedness subsided. She stood back up and after 3 minutes of standing, her blood pressure went to 111/78 with HR: 94. Her symptoms were gone and her energy was back to normal. Is this considered a typical POTS scenario? She did have blood work done about a month ago with the only off level being her see rate: 34 and negative ANA with elevated SSA and Anticardiolipin IgM. This is the second patient I’ve seen within the past 2 months with these symptoms and blood test results. Both females in their early 30’s with no significant past medical hx other than fatigue. Sending her to Rheumatologist next. Any idea what is causing it?

Case 2

Young woman in her thirties presents with a case of body aches (primarily in her legs, knees, and back), headache, cough, fatigue, and this rash which presented on bilateral knees, bilateral elbows, bilateral tops of feet and is itchy. She had a low grade temp of 99.9 but says she had the flu. She did vomit once earlier in the day but wasn’t sure if it was related to this or her vitamin that she takes. Vitals stable at office but she does appear to be fatigued and pale. Recommendations on any labs I should run? I was thinking maybe ANA due to the placement of the rash along with joint pain complaint. She has no medical hx and no hx of allergies or asthma.

Case 3

51 years old female patient complaining of severe chronic pain on left and right shoulders over the past 5 years. The pain is more pronounced on the left shoulder. There is no limitation of movement but crackling sensation is noted. All labs are within normal range except ESR which is markedly elevated. What is the possible diagnosis? and treatment plans.

Case 4

25-year-old female came to ED complaining of LLQ abdominal pain for six days exacerbated by physical activity and intercourse. All labs within normal limits. Ultrasound showed a 12cm cyst on left ovary. Surgery found a dermoid cyst and torsed ovary.

Case 5

A 52-year-old man presented with a 20-minute history of chest pain radiating to the left shoulder and neck, associated with dyspnea and diaphoresis. He had a history of hypertension, long-term smoking, and a sedentary lifestyle. On physical examination, bibasilar crackles were noted on lung auscultation. An electrocardiogram (ECG) was performed in the primary care setting, and the patient was promptly referred to the emergency department.

Case 6

A 28-year-old woman presented with a 3-day history of intense pruritus over the lower back. She reported no recent travel or exposure to new environments. She cares for a small kennel with approximately eight dogs rescued from the streets. Physical examination revealed multiple small vesicles, some clustered and others scattered, predominantly involving the lumbar region and the left gluteal area.

Case 7

A 4-month-old male infant presented with skin lesions localized to the chin for the past 3 days. Physical examination revealed multiple small pustules with surrounding inflammatory signs on the chin, along with a few scattered papules on the chest.

Case 8

Patient in late teens presenting after a collapse, no chest pain, no previous cardiac history, no history of sudden death in family, are there any features in this EKG that would warrant further work-up or is this just a pediatric EKG?