[40F] With severe hip pain and multiple systemic symptoms
Patient Description
A 40-year-old female presents with severe hip pain radiating from the lower back to both sides, ongoing for a year and worsening in the last month. The pain is described as dull, sharp, and aching, with a severity of 8.5-9 out of 10, exacerbated by lifting heavy objects. Additional symptoms include a red, pustule-like rash on the chest and face, burning eyes with redness and discharge, palpitations, sudden fainting episodes associated with tachycardia, fatigue, insomnia, and joint stiffness in the wrists, thumbs, and knees with some swelling in the knees. The patient has a history of celiac disease, hypothyroidism diagnosed at age 20, isoimmunization in pregnancy at 23, and a recent celiac diagnosis at 39. There is a family history of autoimmune diseases, including an identical twin sister with lupus. Allergies include penicillin, Bactrim, and sulfa medications. Current medications are 100mcg of levothyroxine daily for hypothyroidism, 100mg of trazodone nightly for insomnia, and ibuprofen (50-75mg) for pain relief.
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Arora's Assessment
What might be happening
Your symptoms suggest a complex situation that may involve multiple issues:
-
Hip and Back Pain:
- This could be related to musculoskeletal issues such as arthritis or a herniated disc, especially given the sharp and aching nature of the pain.
- Inflammatory conditions, possibly linked to your family history of autoimmune diseases, could also be a factor.
-
Fainting and Palpitations:
- These symptoms might be related to cardiac issues, possibly arrhythmias, as indicated by your Holter monitor results.
- It's important to monitor these symptoms closely, as they can be serious.
-
Rash and Eye Symptoms:
- The rash and eye burning could be related to an autoimmune condition, given your family history and other symptoms.
- Allergic reactions or skin conditions like dermatitis could also be possibilities.
-
Fatigue and Insomnia:
- These could be related to your hypothyroidism, especially if your thyroid levels are not well-controlled.
- Stress, pain, and other underlying conditions might also contribute.
What you can do
Hip and Back Pain:
- Consider consulting a healthcare provider for imaging tests like an MRI to assess any structural issues.
- Continue gentle stretching and avoid heavy lifting. Over-the-counter pain relief like ibuprofen can help, but ensure you’re not exceeding recommended doses.
Fainting and Palpitations:
- Follow up with a cardiologist to evaluate your heart rhythm and discuss potential treatments.
- Keep track of episodes using a journal, like MDandMe, to identify any patterns or triggers.
Rash and Eye Symptoms:
- See a dermatologist or allergist for an evaluation of your skin and eye symptoms.
- Use gentle, hypoallergenic skincare products and consider over-the-counter antihistamines for relief.
Fatigue and Insomnia:
- Ensure your thyroid levels are regularly monitored and adjusted as needed.
- Practice good sleep hygiene, such as maintaining a regular sleep schedule and creating a restful environment.
What you should look out for
- Seek immediate medical attention if you experience severe chest pain, difficulty breathing, or prolonged fainting episodes.
- Monitor for any new or worsening symptoms, such as increased joint swelling or severe fatigue.
- Keep an eye on any changes in your rash or eye symptoms, especially if they become more severe or widespread.
Remember, it's important to consult with healthcare professionals for a formal diagnosis and treatment plan.
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3 mo ago
