No Respecter of Age

旬な感染症の話。「診断のゲシュタルトとデギュスタシオン 」にも取り上げられています。

A CLINICAL PROBLEM-SOLVING article by Don Martin from Johns Hopkins University School of Medicine, Baltimore, Maryland.
A previously healthy 65-year-old woman went to her primary care physician in late August, seeking evaluation of a “spot” that had appeared on her right leg 3 weeks earlier. Her physical examination was notable only for a low-grade temperature elevation and a 7-to-8-mm erythematous macule on her right leg.
One week later, the skin lesion had resolved, but the patient returned, reporting malaise and diffuse arthralgias that had progressively worsened, with intense, disabling pain and stiffness in her neck, shoulders, wrists, hands, knees, and ankles. In addition, she noted pain in the left anterior part of her chest that had awakened her from sleep, was exacerbated by respiration, and was partially relieved by sitting up.
She reported no recent contact with anyone who was sick and had last seen her grandchildren 6 weeks earlier.
The patient's constitutional symptoms and polyarticular involvement suggest the development of a systemic inflammatory arthritis. Although the initial skin lesion may have been unrelated to her subsequent symptoms, this history points to a possible infectious cause.
Bacterial, atypical, and viral infections can cause inflammatory arthritis, and arthritis can also follow infection with a variety of organisms.
As this case illustrates, the absence of known contact with someone who is sick does not rule out infection.