Troubling Tenosynovitis: When a Serious Sign Persists

A 42-year-old woman was admitted to hospital with five 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 is significant for a two-year history of an undifferenti ated connective tissue disease (UCTD) 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.
Source: The American Journal of Medicine - Category: General Medicine Authors: Tags: Diagnostic Dilemma Source Type: research