[43F] With unexplained bruising, joint pain, and fatigue

Patient Description

A 43-year-old female presents with extreme fatigue, unusual bruising, and joint pain. The bruising appears on bilateral legs, bilateral arms, and abdomen without any known injuries and takes weeks to resolve. The joint pain, described as sharp, heavy, and aching, affects the knees, wrists, ankles, and hips, and has been present for over a year, rated at an intensity of 7 out of 10. The patient also reports frequent infections, night sweats, and occasional swollen lymph nodes in the armpits. There is a family history of Ehlers-Danlos syndrome, breast cancer, and skin cancer. The patient does not use alcohol, tobacco, or recreational drugs and maintains a diet with sufficient vitamins and nutrients. No recent changes in medications or supplements have been made. The patient has no known pre-existing conditions or chronic illnesses not already mentioned.

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Arora's Assessment

What might be happening

Based on the symptoms you've described, there are a few potential diagnoses to consider:

  1. Hematologic Disorders:

    • Blood Disorders: Conditions like leukemia or other blood cancers can cause unexplained bruising, extreme fatigue, and frequent infections. These disorders affect the blood's ability to clot and the immune system's function.
    • Platelet Disorders: Low platelet counts (thrombocytopenia) can lead to easy bruising and prolonged bleeding. This can be due to various causes, including bone marrow issues or autoimmune conditions.
  2. Autoimmune Diseases:

    • Systemic Lupus Erythematosus (SLE): This autoimmune disease can cause joint pain, fatigue, night sweats, and unexplained bruising. It often affects multiple organ systems and can present with a wide range of symptoms.
    • Ehlers-Danlos Syndrome (EDS): Given your family history, EDS could be a contributing factor. This connective tissue disorder can cause joint pain, easy bruising, and other symptoms related to tissue fragility.
  3. Nutritional Deficiencies:

    • Vitamin Deficiencies: Deficiencies in vitamins such as Vitamin C (scurvy) or Vitamin K can lead to easy bruising and prolonged healing times. However, you mentioned that your diet is adequate, so this might be less likely.
  4. Infections and Inflammatory Conditions:

    • Chronic Infections: Persistent infections can lead to systemic symptoms like fatigue, night sweats, and frequent infections. These could be due to underlying immune system issues.

What you can do

Unexplained Bruising and Frequent Infections:

  • See a Doctor: It's crucial to consult a healthcare provider as soon as possible. They may perform blood tests, including a complete blood count (CBC), to check for blood disorders or platelet issues.
  • Document Symptoms: Keep a detailed record of your symptoms, including the location and size of bruises, frequency of infections, and any other relevant details. This can help your doctor make a more accurate diagnosis.

Joint Pain:

  • Consult a Rheumatologist: A specialist can evaluate you for autoimmune diseases like lupus or Ehlers-Danlos Syndrome.
  • Pain Management: Continue using ice and heat therapy. Over-the-counter pain relievers like ibuprofen can also help, but consult your doctor before starting any new medication.
  • Physical Therapy: Gentle exercises and physical therapy can help manage joint pain and improve mobility.

Night Sweats:

  • Monitor and Record: Keep track of when the night sweats occur and any potential triggers. This information can be valuable for your healthcare provider.
  • Stay Cool: Use lightweight bedding and keep your bedroom cool to help manage night sweats.

What you should look out for

Given the severity and duration of your symptoms, it's important to seek medical care promptly. Reasons to seek care even more urgently include:

  • New or Worsening Symptoms: If you notice new symptoms like shortness of breath, chest pain, or severe headaches, seek immediate medical attention.
  • Severe Bruising or Bleeding: If you experience significant bruising, bleeding that doesn't stop, or blood in your urine or stool, go to the emergency room.
  • Fever or Signs of Infection: If you develop a fever, chills, or other signs of infection, contact your healthcare provider.

Remember, while I can provide information and suggestions, it's essential to consult with a healthcare professional for a formal diagnosis and appropriate treatment. You can use MDandMe to journal your symptoms, track progress, get insights, and share longitudinal medical notes with your provider.

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6 mo ago

People Also Ask


What could cause unexplained bruising and fatigue?

Unexplained bruising and fatigue can be caused by blood disorders such as leukemia, platelet disorders like thrombocytopenia, or autoimmune diseases such as lupus. These conditions can affect blood clotting and the immune system, leading to these symptoms.


How are autoimmune diseases like lupus diagnosed?

Autoimmune diseases like lupus are diagnosed through a combination of clinical evaluation, blood tests (such as ANA test), and assessment of symptoms. A rheumatologist often conducts these evaluations to confirm the diagnosis.


What role does family history play in conditions like Ehlers-Danlos Syndrome?

Family history can be significant in conditions like Ehlers-Danlos Syndrome (EDS) because it is a genetic disorder. If there is a family history of EDS, it increases the likelihood of having the condition, and genetic testing may be recommended.


What are the potential causes of frequent infections and night sweats?

Frequent infections and night sweats can be caused by chronic infections, immune system disorders, or hematologic conditions like blood cancers. These symptoms suggest an underlying issue with the immune system or a chronic inflammatory condition.


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