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CHICAGO—In the Thieves Market session at the 2018 ACR/ARHP Annual Meeting, rheumatologists from around the country presented a slate of challenging cases that emphasized the importance of clinical persistence and attention to detail, and the need to consider diagnoses that might not be common or obvious. Three of them are summarized below. (Look for more information on these interesting cases in coming issues.)
Case 1
Sonam Kiwalkar, MD, a fellow at Oregon Health & Science University, Portland, presented the case of a 30-year-old woman who arrived at University Hospital with headaches, a worsening skin rash, low-grade fevers and arthralgias that had persisted over the past three months or so. A few months before, she had fatigue and a rash, and was seen in an emergency department. She was referred to a dermatologist for a biopsy, but she did not follow up. About two weeks later, she was admitted to an outside hospital for fevers, headaches and confusion, and treated empirically for bacterial meningitis.
Four years previously, the woman was diagnosed with lepromatous leprosy, but was non-compliant with her medications. She had no history of rheumatic diseases. She had emigrated from Micronesia in 2004.