Vine Clinic Case Summary

This week I have seen a very interesting case at the Vine Clinic. A 17-year-old female who came in with her mother had a chief complain of joint pain and a severe headache uncontrolled by Ibuprofen. She has recently seen in the ER for joint pain. I observed my preceptor conducted a thorough history and physical exam. She started joint pain on the right side of her knee and then the pain migrated to the left side of her body and affecting all the major joints. Her other symptom is vomiting and the mother also stated that her daughter’s body felt warm to touch. From her past medical history, we learned that this patient has had generalized hives 4-5 times per year, and the etiology has not been identified. She also had a bundle branch block 10 years ago. Her ER report

Her age and duration of arthritis do not fit under the criteria, however, it is still a possibility since the forms of JIA can be so different. For Lyme disease, the patient has to be exposed to the source. The patient denies any traveling to high-risk area or recall ever been bitten by a tick. However, bundle branch block is associated with Lyme disease, she could have had a tick-borne disease 10 years ago and was in the latent phase until now. For SLE, the classic presentation of a triad includes fever, joint pain, and rash in a woman of childbearing age. Based on her health history, this patient should also be evaluated for SLE. From this experience I learn the importance of having a comprehensive history. If I was the one who conducted history, I might not have found out about the bundle branch block and related it to Lyme disease. I could completely overlook this possible diagnosis. An accurate and thorough health history aids primary care provider to explore possible differentials. Furthermore, it also helps to pin point down an accurate diagnosis, which results in prompt appropriate