Myalgias and myositis: Pathology review
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Pathology
Musculoskeletal system
AssessmentsMyalgias and myositis: Pathology review
Questions
USMLE® Step 1 style questions USMLE
USMLE® Step 2 style questions USMLE
A 41-year-old woman is evaluated by the outpatient physician for 5-months of generalized fatigue and diffuse soft-tissue pain. The pain is present in the upper extremities, lower extremities, and back. She feels tired every morning despite getting adequate sleep in the evening. Past medical history is notable for hypertension that is currently managed with propranolol. Temperature is 37.2°C (98.9°F), blood pressure is 136/88 mmHg, pulse is 61/min, and respiratory rate is 15/min. Physical examination reveals 5/5 strength and full range-of-motion in the upper and lower extremities. Soft-tissue tenderness is elicited at multiple locations across the patient’s body. Laboratory results are as follows:
Laboratory value | Result |
Hemoglobin | 14.8 g/dL |
Leukocyte | 7,800/mm3 |
Erythrocyte sedimentation rate (ESR) | 7 mm/h |
Serum creatinine kinase | 27 U/L |
Antinuclear antibodies | Negative |
Which of the following additional findings would most likely be found in this patient?
Content Reviewers:
Yifan Xiao, MDContributors:
Ursula Florjanczyk, MScBMC, Victoria Cumberbatch, Sam Gillespie, BSc, Daniel Afloarei, MDOn your rounds, you see two individuals. First is Yu Yan, a 58-year-old female who presents with a 2-week history of fatigue, weight loss, fevers, and bilateral pain with stiffness in the shoulder and hip girdles. These symptoms are worse at night and last for more than an hour. She also mentions that she finds it hard to get out of bed in the morning due to stiffness. On examination, her wrists and finger joints are painful and swollen, but there’s no muscle weakness. Then you see Elizabeth, a 38-year-old female who has a 4-year history of body pain. The pain was initially limited to her neck, but it has gradually spread and she now complains of constant pain all over. She does not sleep well and is chronically fatigued. Examination revealed many tender points throughout her body but no sign of joint swelling or muscle weakness. Blood tests were performed in both. In Yu Yan’s case, there was an increase in inflammatory markers, but creatine kinase levels were normal. In Elizabeth’s, blood tests were completely