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Case 3 

Case 3
Chapter:
Case 3
Author(s):

Joel David

, Anne Miller

, Anushka Soni

, and Lyn Williamson

DOI:
10.1093/med/9780199587506.003.0003
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date: 23 October 2019

A 19-year-old Brazilian woman, who was previously well, presented with a 10-day history of sudden-onset polyarthritis and a diffuse necrotizing rash. Since moving to England 4 years previously, she had noticed nasal congestion and clear discharge during the winter months. Examination revealed fever (37.9°C), tachycardia (110 beats/min), tender axillary and inguinal lymphadenopathy, and a symmetrical synovitis of elbows, wrists, ankles, and MCP joints. She had widespread tender erythematous nodules over her face, arms, and legs with truncal sparing (Fig. 3.1).

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