CC: Bilateral leg pain.
HPI: Patient is a 33 y.o. white female who is 13 weeks pregnant, G2P1001, who complains of progressively worsening muscle pains in both legs beginning 6 weeks ago. She also developed an increasingly painful, nonpruritic rash on both legs and now on her left arm during the previous 4 weeks. Her prenatal vitamins were changed 6 weeks ago because of complaints of palpitations which have continued. The patient has never had any similar symptoms in the past.
ROS: No fever, headache, chest pain, dyspnea, cough, sore throat, nausea, vomiting, diarrhea, abdominal pain, dysuria, vaginal bleeding or discharge, lightheadedness, or weakness. LMP was normal.
Denies any pets, recent travel, unusual exposures or ingestions. No new soaps or detergents.
Meds: None.
Allergies: None known.
Past Medical History: No known cardiac, pulmonary, renal, thyroid disease. No diabetes. Never hospitalized except for her previous normal vaginal delivery 4 yrs earlier.
Past Surgical History: None.
Social: Denies smoking, alcohol, drugs.
Family History: Mother with diabetes, hypertension. Has 6 siblings who are all healthy.
Physical Exam:
Vital signs: T=99.1, P=80, R=14, BP=140/90
General: Alert, oriented, pleasant, in no acute distress. Well developed.
Skin: Raised, indurated, patchy erythematous rash on both lower extremities, less on the arms and slightly involving the abdomen.
HEENT: Normocephalic, atraumatic. PERRLA, EOMI, throat clear, conjunctiva pink, mucous membranes moist.
Neck: Supple, without adenopathy. No masses or thyromegally.
Lungs: Clear.
Heart: Regular rhythm. No murmurs, rubs or gallops. Occassional extra beat.
Abdomen: Normal bowel sounds. Soft, flat, nontender. No guarding or rebound. No masses, hernias or CVA tenderness.
Extremities: +1 pitting edema bilateral calves, tender. No joint effusions. Full range of motion in all joints. Pulses are all normal. No cords or erythema other than the mentioned rash. No other skin lesions or breaks in the skin.
Neuro: Fully intact in all cranial nerves, motor and sensory. Normal cerebellar and mental status exams.
Pelvic: Unremarkable. Uterus 12-13 week size. Nontender.
ECG: NSR with frequent multifocal PVC's. No acute changes. Normal intervals.
Labs:
Urinalysis: within normal limits. No protein. No myoglobin.
CBC: wbc 9.0, Hgb 12.5, plts 220.
Na 137, K 3.7, Cl 107, CO2 24, BUN 8, Creat 0.6, Mg 1.9, SGOT 98, SGPT 50, Alk Phos 58, CK 1014, CK MB 15 (1.5%), Sed Rate 46.
Chest X ray: No active disease.
Pelvic Ultrasound: Normal intrauterine pregnancy.
Venous dopplers of both lower extremities: No deep venous thrombosis.
The patient was admitted for further work-up.
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