Welcome to Dungeons and Dragons: Healthcare edition. Dr Schmidt will be your dungeon master for this adventure. Listen to his scenario description and choose your action from the list below: A. Consult Infectious Disease B. Consult Rheumatology C. Order vanc and zosyn D. Ask Doc Schmidt's mom what the patient has E. Wake up in a cold sweat and remember all at once that you abandoned pre-med for a comfortable career in IT.
Makes me think dermatomyositis with a muscle biopsy from the affected areas. Not sure about EBV, but I know autoimmune diseases can sometimes be triggered after viral infections. (great video idea btw)
I imagine the EBV flare is a mix of increase stress from the condition and an increase in B cell proliferation (the disease is CD8 mediated largely but some B cell involvement is possible). That's my two cents
I’m guessing dermatomyositis with an underlying carcinoma . since she had high EBV and sore throat => that makes me think nasopharyngeal/oropharyneal carcinoma ( more so naso) . If there was LN involvement, biopsy can make the diagnose Edit: Ok maybe I overthought this lol 😂
This makes me so excited to see/hear people talk about dermatomyositis. I have the condition, but not much is ever really presented on it and it is never really talked about.
Definitely do more of these!! Dx: Dermatomyositis flare diagnosed from a proximal muscle bx. or MRI, Electromyography, Violet rash= Gottron’s Papules on knuckles. Heliotrope rash on eyelids. Could have Raynauds syndrome-symptoms usually not as bad in summer. +ANA, Elevated CK. Flare brought on by Mono (+EBV/HORRIBLE sore throat)
This happened to me!!! I had mono and dermatomyositis. What worse is that since then I then got Lyme, Meningitis and still have ongoing autoimmune issues 16 years later, chronic fatigue, horrible psoriasis and pain. 😖
Reddz SK. Yes because Lupus uses the body via lymph nodes to cause the body to attack itself through an inflammatory response. Although there isn't anything for the body to react to this response, the disease actually attacks the body itself as if it's a foreign body thus creating the inflammation, high WBC, which eventually leads to fatigue because the inflammation isn't controlled. This also leads to muscle weakness, swelling in the joints, and inability to perform even the simplest of tasks because of the joint inflammation. The. Joints will become swollen and painful too and until the inflammation is under control, the pain is constant and the body can't repair itself and remains weakened
by the way, really glad so many other commenters are thinking myositis . As a rare disease it usually takes years to get diagnosis and some specialties admit to never having heard of it "so it probably has no bearing" per pulm.
Diagnosis: Dermatomyositis evidenced by proximal muscle weakness, Gottron papules, and elevated ANA. Biopsy: Muscle Secondary to: Query nasopharyngeal carcinoma due to the association with DM/PM and elevated EBV, but EBV can cause a lot of things and I need more information at this time. Perhaps GI was involved because they found a mass in the nasopharyngeal space on imaging and asked for a biopsy.
Away from the obvs dermatomyositis, I'm going to be contrary and say it's psoriatic arthritis with either a reoccurance of glandular fever, or a contact allergy or long covid
Dermatomyositis. Diagnosis can be confirmed by muscle Bx but if the patient has typical symptoms like the one mentioned, one can make a diagnosis without a biopsy. But since dermatomyositis is often accompanied by cancer, cancer screening needs to be done too.
I am NOT a dr… but this sounds like how my mother described her rheumatic fever as a child, from a severe case of strep throat. Again I am not a medical provider, I just like to watch Doc Schmidt on RUclips 😊
The ebv could have triggered a nasopharyngeal carcinoma presenting as sore throat. The rash (sounds like gortton papules) and the proximal muscle weakness is suggestive of dermatomyositis which might be paraneoplastic syndrome of the cancer.
I have an autoimmune disorder. If you google the MOST obvious symptom, you'll get it right away, but the LESS obvious symptoms are beau lines and deep ridges on my fingernails and toenails. I'm pretty sure it's also related to how I've got scar-like lines running up and down my fingers now which make machines unable to capture a fingerprint but unfortunately for my attempts to research on the topic, there are paywalls.
Dermatomyositis with proximal muscle weakness and Gottron's papules/sign. High EBV levels could indicate nasopharyngeal cancer, with maybe symptom of sore throat. Or the pt could have sore throat from oropharyngeal muscle involvement from dermato, though usually more dysphagia/dysphonia. Or dermato sometimes has underlying malignancy leading to autoimmunity, could have EBV-associated lymphoma. Skin biopsy can show vacuolar interface dermatitis with mucin, though can be nonspecific and needs to be differentiated from lupus. Muscle biopsy can be done, but it'd be more of a blind biopsy into proximal weak muscles vs skin biopsy would be done on area of rash which usually has high yield.
Dx: Dermatomyositis as an autoimmune response to a stage I or II Nasopharyngeal carcinoma, which in turn may have been caused by her Epstein-Barr virus infection (especially if the nasopharyngeal carcinoma is type 2 or 3) EBV itself covers the fatigue and myopathy, fever, and elevated WBC. Elevated ANA is because this is autoimmune Biopsy was most likely of the carcinoma and was taken during a nasopharyngeal endoscopy (which is why Ben was involved and we're hearing about this case). Otherwise, the biopsy may have been of a lymph node
Ddx includes Oropharyngeal cancer (explains the sore throat better, but isn't known to be correlated with EBV, biopsy would still be of the carcinoma during endoscopy), a lymphoma of some kind, a super weird presentation of erythema multiforme, and being Dr. Greg House's Pt
Dermatomyositis. Biopsy will show perimysial inflammation and she should have an elevated creatinine kinase. Or I just think its this because I just learned about it and think everything is it because im a dumb med student...
I agree with dermatomyositis being the most probable diagnosis, but maybe crest syndrom/systemic sclerosis could be a DD? Don't think you necessarily need a biopsy for that though. Very cool video idea, keep 'em coming!
*Disclaimer - I'm not a doctor but imma give it my best shot based off of random bs I picked up from watching House. Elevated white count seems like an infection, but there's no fever so I'm guessing its some kind of autoimmune disorder that affects the skin? The biopsy could've been a lymph node biopsy? (I'm honestly not sure what lymph nodes even are still tbh) My other guess was cancer.
Love the channel, first time commenter, Your my GI inspiration, but if I’ve learned anything in medicine it’s common things are common and when uncommon things present keep your options open, so although dermatomyositis is high probability, one thing I’d outrule on presentation is Kawasaki Disease - High fever - extremely sore throat - rash on hands - She doesn’t fit the age profile or ethnicity, however Covid infection has been linked to new onset Vasculitis (Chronic fatigue she been experiencing). - it’s unlikely this is the diagnosis but involvement of the coronary arteries could be deadly so outruling while awaiting muscle biopsy would be beneficial.
The skin manifestations i,e the grottens papules,proximal nature of the muscle weakness,a preceding viral infection as a possible trigger inculding the tonsillopharyngitis may go for dermatomyositis.another ddx is infectious mononucleosis,severe throat pain caused by tonsillopharyngitis,can also cause rash usually not in this distribution,can also cause myositis ,high titer of ebv, and positive ANA may all go for that.
I think dermatomyositis and Proximal muscle weakness sounds like Gordon's Popsicles with a touch of butter and salt and peppa, with a beautiful balsamic vinegar reduction. Enjoy.
Mono? I had all of that when I had Mono and took my PCP 4 months to finally test me. Hadn't had it before so when I finally got it as an adult, it hit me pretty different. My EBV was over 1000 and can never be tested again, apparently. Rheumatoid arthritis based on the way you held your hands, the fatigue? But this being a GI doc seeing it? Makes me think more lymph?
EBV does cause mono but mono doesn’t explain everything in the presentation. Also, to be fair, my involvement as a GI doc was peripheral at best so don’t let that throw you off!
@@geriroush8004 I honestly got to the point I couldn't speak or eat most of the time. And when I plopped myself in front of my PCP she was so cavalier about it like it was normal. In hindsight, the fact it took me 4 months to get her attention by forcing myself on her at the clinic, she probably wasn't the best doctor. I was glad when the rashes on my hands went away--I do a lot of typing for a living and shaking hands when I'm not so it was both painful and disgusting. I'd choose between showering and doing tasks for almost 6 months because there were times I'd fold like an accordion from the weakness. I thought for a minute I had shingles. There was a genuine moment for a few days I thought I was never going to get out of bed again. Whatever "strain' of mono was going around in 2018 was gross 🤢 IDK how teenagers do this except we expect them to. I caught nothing but crap from colleagues for being in my 30s and just finally getting mono (which I think I got from seeing a client in a hospital since I don't think my indoor meownagers or the puppalegal gave it to me haha).
An autoimmune disease, known as polymyalgia rheumatica. It causes the pain in the proximal muscles and would make her fatigued. I am guessing it was either a skin or muscle biopsy. Her ANA was elevated meaning autoimmune, and usually one leads to another. So the rash on her hand could have been rheumatoid arthritis. Now if we consider the EBV (Epsein Barr Virus) the sore throat and elevated white blood count, as well as fatigue, could have been mono. So she probably had multiple illnesses.
A muscle biopsy?! Another something I didn't know was done and never want done so added "profound muscle weakness with a knuckle rash" to my list of things not to mention to my doctor as long as the Advil still works.
I think it is dermatomyositis, a muscle biopsy was done and revealed perivascular inflammation with predominance of B cell arround a blood vessel. The gottron papules is pathognomonic for DM that could be seen at the back of the fingers, elbows and knees.
Since you're a GI Fellow, I would have guessed an intestinal biopsy showed leaky gut that led to autoimmune disorder causing symptoms. Looking at the very specific comments, I've learned about a new disease. At least it's a zebra!
Here’s my extremely unqualified guess: mononucleosis. Biopsy from lymph nodes to exclude (/confirm?) lymphoma etc… Admittedly not that interesting to an M.D tho- so I’m probably wrong... Had fun playing in any case!
Was gonna say Polymyalgia Rheumatica but forgot about the rash, fever, and myalgia. It sounds like an rheumatologic disease that flared up due to an acute EBV infection. I
Развлечения
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Welcome to Dungeons and Dragons: Healthcare edition. Dr Schmidt will be your dungeon master for this adventure. Listen to his scenario description and choose your action from the list below:
A. Consult Infectious Disease
B. Consult Rheumatology
C. Order vanc and zosyn
D. Ask Doc Schmidt's mom what the patient has
E. Wake up in a cold sweat and remember all at once that you abandoned pre-med for a comfortable career in IT.
Love it! So funny!
D. Ask Doc Schmidt’s Mom!
D!
#PRICELESS!
🤣🤣🤣
Why is E so relatable 😭
"It's never lupus." - a handsome, tall and smart guy.
that's what I said too lmao
Omg 🤣🤣
God I could barely hear you over the rattling every time you move- what are you doing? Carrying skittles around to throw at passing orphans?
Nice
OMG . U gave me chills. YOU GAVE ME CHILLS
I’m not sure but thank you for the interesting consult.
😄🤣
👌
Lmao
Epstein Barr ?
Same 💀
Dx: Dermatomyositosis
The biopsy was a muscle biopsy.
The rashes on the knuckles were Gottron's papules
Will she get better?
Damn it..
She prob needs a thorough cancer screening and GI was consulted for a colonoscopy as to why he’s talking about this case
@@xino_z she is doing good now. I saw the next Video.
😁from Austria 🇦🇹
@@therealdachshunddjangosmom thanks Astrid!
I have no clue what dermatomyositis or Gottron's papules are, but I'll say that while nodding sagely because everyone else is.
my reply 😭😭😭
Sames, good job doc 👍
I concur 😌
You remind me of Joey in Friends.He dud the same.
Makes me think dermatomyositis with a muscle biopsy from the affected areas. Not sure about EBV, but I know autoimmune diseases can sometimes be triggered after viral infections. (great video idea btw)
I imagine the EBV flare is a mix of increase stress from the condition and an increase in B cell proliferation (the disease is CD8 mediated largely but some B cell involvement is possible). That's my two cents
Yea but so specific that only the front was affected?
That was my thoughts atleast from the info given
Definitely was thinking of the myositis family myself. Always interesting to me how EBV and + mono spots come alongside a lot of rheumatic Dx’s.
I’m guessing dermatomyositis with an underlying carcinoma . since she had high EBV and sore throat => that makes me think nasopharyngeal/oropharyneal carcinoma ( more so naso) . If there was LN involvement, biopsy can make the diagnose
Edit:
Ok maybe I overthought this lol 😂
Its an autoimmune disease for sure but what exactly not sure
Not sure on the dx but I know one thing for certain: Jones is going to get it too 🤣
🤣
😂😂😂😂
I hope not.
Truly funny.
😄
😂
This makes me so excited to see/hear people talk about dermatomyositis. I have the condition, but not much is ever really presented on it and it is never really talked about.
More of these please! This was awesome!
Definitely do more of these!!
Dx: Dermatomyositis flare diagnosed from a proximal muscle bx. or MRI, Electromyography, Violet rash= Gottron’s Papules on knuckles. Heliotrope rash on eyelids. Could have Raynauds syndrome-symptoms usually not as bad in summer. +ANA, Elevated CK.
Flare brought on by Mono (+EBV/HORRIBLE sore throat)
I'm a leaf!
Proximal muscle weakness made me think of Polymyalgia Rheumatica
I’m intrigued you said that. Have you seen it?
@@OneKindWord I had a great clinical medicine instructor in PA school. The way she described the patient presentation for PMR was pretty memorable.
Whatever it was, I suspect it was brought on by a failure to observe International Talk Like A Pirate Day.
Aarrgghh!
This happened to me!!! I had mono and dermatomyositis. What worse is that since then I then got Lyme, Meningitis and still have ongoing autoimmune issues 16 years later, chronic fatigue, horrible psoriasis and pain. 😖
As a non practicing non medical professional, I'm going to say Covid.
Beat me to it 😂
I know nothing about medicine, so I'm gonna say Lupus
I'm gonna say Covid
I think it was a dermal biopsy and possible diagnosis of psoriatic arthritis. It could also be possible to be Lupus
This is exactly what I was going to guess.
Thought the same thing
How can u explain proximal muscle weakness by psoriasis tho? Is that possible?
Reddz SK. Yes because Lupus uses the body via lymph nodes to cause the body to attack itself through an inflammatory response. Although there isn't anything for the body to react to this response, the disease actually attacks the body itself as if it's a foreign body thus creating the inflammation, high WBC, which eventually leads to fatigue because the inflammation isn't controlled. This also leads to muscle weakness, swelling in the joints, and inability to perform even the simplest of tasks because of the joint inflammation. The. Joints will become swollen and painful too and until the inflammation is under control, the pain is constant and the body can't repair itself and remains weakened
@@jimbelter2 well I do agree with that on Lupus , but he was talking about psoriasis too. So I don't know if psoriasis could do that
I was sure it was hepatitis. Turns out I didn’t know what hepatitis is. I’m guessing she went outside with her hair wet.
🤣🤣🤣
Dermatomyositis triggered by infectious mononucleosis
Idk but I had similar when my liver was mad at me for all the heroin. I’m clean now and no more rash or muscle fatigue
Whoa these medical mysteries are really interesting! Idk i was going to guess maybe lupus
It's never lupus
Thanks for the laugh 🤣❤️
@@chartinguncharted8400 may i ask why? serious question
@@aamirrazak3467 it's a reference to the show house
@@sklitterbeer106 thanks
Dermatomyositis
Muscle biopsy
I second this
Dx: Dermatomyositis
Biopsy: muscle biopsy
Rash on knuckles sounds like Gottron's papules.
As a clueless normal student I was about to say "Allergy" until all the comments said "Dermatomyositis".. I have no idea what that is.
Biopsy: skin biopsy to confirm histopathologic changes consistent with Dermatomyositis.
Dx: Dermatomyositis-with muscle weakness
by the way, really glad so many other commenters are thinking myositis . As a rare disease it usually takes years to get diagnosis and some specialties admit to never having heard of it "so it probably has no bearing" per pulm.
Could be mono, that’s pretty much all my symptoms.
Maybe a dermatomyositis , if so the labs would be muscle biopsy.
On a second thought, that can't explain the sore throats tho.
It was colonel Mustard in the library with the candlestick. 📖🕯🧐 😎
Diagnosis: Dermatomyositis evidenced by proximal muscle weakness, Gottron papules, and elevated ANA.
Biopsy: Muscle
Secondary to: Query nasopharyngeal carcinoma due to the association with DM/PM and elevated EBV, but EBV can cause a lot of things and I need more information at this time.
Perhaps GI was involved because they found a mass in the nasopharyngeal space on imaging and asked for a biopsy.
Away from the obvs dermatomyositis, I'm going to be contrary and say it's psoriatic arthritis with either a reoccurance of glandular fever, or a contact allergy or long covid
Please do more of these types of videos!
I think this case needs to be seen by Dr.House. Refer to princeton plainsboro teaching hospital , department of diagnostic medicine.
Dermatomyositis. Diagnosis can be confirmed by muscle Bx but if the patient has typical symptoms like the one mentioned, one can make a diagnosis without a biopsy. But since dermatomyositis is often accompanied by cancer, cancer screening needs to be done too.
I am NOT a dr… but this sounds like how my mother described her rheumatic fever as a child, from a severe case of strep throat. Again I am not a medical provider, I just like to watch Doc Schmidt on RUclips 😊
All are welcome to guess 😁
My first instinct was Lupus (Love House LOL) but I'm gonna go with infectious mononucleosis or dermatomyositis.
Wait, high EBV and weird s### sounds like secondary lupus without even going further. Lupus, the great imitator. But this would make Dr. House wrong 😳
It’s gut yeast. She needs crystals to bring her chakras into harmony.
😂👌
Excuse me? We all know crystals are dumb. #EssentialOilsGang rise up!
@@OGimouse1 only cause you don’t charge them under the moonlight properly. Essential oils are just good for smelling good
😂😂😂
This comment section is .....interesting
According to House, it’s Lupus, since it’s always Lupus
Dermatomyositis? Muscle biopsy.
You are amazing!
It’s gotta be Lupus, Dr. House.
Me, with no medical background, checking the comments to see if I agree.
I don't even know the other words he said... I'm just here because it makes me curious and learn something new 🤣
The ebv could have triggered a nasopharyngeal carcinoma presenting as sore throat. The rash (sounds like gortton papules) and the proximal muscle weakness is suggestive of dermatomyositis which might be paraneoplastic syndrome of the cancer.
me having absolutely no clue but still wanting to try: *uh...the flu?*
Dermatomyositis maybe-those knuckles papules +elevated ANA
I have an autoimmune disorder. If you google the MOST obvious symptom, you'll get it right away, but the LESS obvious symptoms are beau lines and deep ridges on my fingernails and toenails. I'm pretty sure it's also related to how I've got scar-like lines running up and down my fingers now which make machines unable to capture a fingerprint but unfortunately for my attempts to research on the topic, there are paywalls.
Oh and it's not lupus or contagious.
Dermatomyositis. She should also be screened for malignancies. My first patient with this had ovarian cancer on CT. Never forgot it.
I think ebv is Eppstein barr virus, so mono? That would explain the fatigue and sore throat at least. No idea on the biopsy.
Dermatomyositis Dg. muscle biopsy, EMG
Dermatomyositis with proximal muscle weakness and Gottron's papules/sign. High EBV levels could indicate nasopharyngeal cancer, with maybe symptom of sore throat. Or the pt could have sore throat from oropharyngeal muscle involvement from dermato, though usually more dysphagia/dysphonia. Or dermato sometimes has underlying malignancy leading to autoimmunity, could have EBV-associated lymphoma. Skin biopsy can show vacuolar interface dermatitis with mucin, though can be nonspecific and needs to be differentiated from lupus. Muscle biopsy can be done, but it'd be more of a blind biopsy into proximal weak muscles vs skin biopsy would be done on area of rash which usually has high yield.
These seem like all of the symptoms I had, and I was diagnosed with dermatomyositis last April so that's my guess
I dont have a medical background but I'm guessing lupus.
Er, I dunno. I was just looking for cat videos and I seem to have strayed into medical school, somehow .....
Dx: Dermatomyositis as an autoimmune response to a stage I or II Nasopharyngeal carcinoma, which in turn may have been caused by her Epstein-Barr virus infection (especially if the nasopharyngeal carcinoma is type 2 or 3)
EBV itself covers the fatigue and myopathy, fever, and elevated WBC. Elevated ANA is because this is autoimmune
Biopsy was most likely of the carcinoma and was taken during a nasopharyngeal endoscopy (which is why Ben was involved and we're hearing about this case). Otherwise, the biopsy may have been of a lymph node
Ddx includes Oropharyngeal cancer (explains the sore throat better, but isn't known to be correlated with EBV, biopsy would still be of the carcinoma during endoscopy), a lymphoma of some kind, a super weird presentation of erythema multiforme, and being Dr. Greg House's Pt
Dermatomyositis. Biopsy will show perimysial inflammation and she should have an elevated creatinine kinase. Or I just think its this because I just learned about it and think everything is it because im a dumb med student...
I would guess most likely is dermatomyositis with a muscle biopsy. There may be some overlap syndrome.
Dermatomiositis. I'm an allergist resident and had to read about this disease this week and it matches almost all the data.
I agree with dermatomyositis being the most probable diagnosis, but maybe crest syndrom/systemic sclerosis could be a DD? Don't think you necessarily need a biopsy for that though. Very cool video idea, keep 'em coming!
Doctors don't get enough credit they are literally life savers they definitely need to be on the front of magazines!
I think they'd hate that though.
*Disclaimer - I'm not a doctor but imma give it my best shot based off of random bs I picked up from watching House.
Elevated white count seems like an infection, but there's no fever so I'm guessing its some kind of autoimmune disorder that affects the skin? The biopsy could've been a lymph node biopsy? (I'm honestly not sure what lymph nodes even are still tbh) My other guess was cancer.
Love this!
Love the channel, first time commenter, Your my GI inspiration, but if I’ve learned anything in medicine it’s common things are common and when uncommon things present keep your options open, so although dermatomyositis is high probability, one thing I’d outrule on presentation is Kawasaki Disease
- High fever
- extremely sore throat
- rash on hands
- She doesn’t fit the age profile or ethnicity, however Covid infection has been linked to new onset Vasculitis (Chronic fatigue she been experiencing).
- it’s unlikely this is the diagnosis but involvement of the coronary arteries could be deadly so outruling while awaiting muscle biopsy would be beneficial.
Thanks for the support! The answer video goes live it 3 hours! 😁
I'm not a doctor but I believe this is a classic case of diarrhea with a side of narcissism and a sprinkle of thyme
The skin manifestations i,e the grottens papules,proximal nature of the muscle weakness,a preceding viral infection as a possible trigger inculding the tonsillopharyngitis may go for dermatomyositis.another ddx is infectious mononucleosis,severe throat pain caused by tonsillopharyngitis,can also cause rash usually not in this distribution,can also cause myositis ,high titer of ebv, and positive ANA may all go for that.
Holy Crap. I am going through this, now. Starting Methotrexate this week.
Mono
You just spat out all my symptoms when I had it.
I think dermatomyositis and Proximal muscle weakness sounds like Gordon's Popsicles with a touch of butter and salt and peppa, with a beautiful balsamic vinegar reduction.
Enjoy.
When my husband was in Medical School we would do this with the MMWR cases. Good fun!
When will jones get this? And sharon, make sure you ask her to write thank you for the consult
I’m thinking mononucleosis. I’m not sure which biopsy is necessary for that
Doctor: *starts saying big words*
Me: *s t o p t a l k i n g*
I was literally taking a break in the middle of musculoskeletal system review to watch this video 😂 seems like there's no running away from step 1
Mono? I had all of that when I had Mono and took my PCP 4 months to finally test me. Hadn't had it before so when I finally got it as an adult, it hit me pretty different. My EBV was over 1000 and can never be tested again, apparently.
Rheumatoid arthritis based on the way you held your hands, the fatigue?
But this being a GI doc seeing it? Makes me think more lymph?
EBV does cause mono but mono doesn’t explain everything in the presentation. Also, to be fair, my involvement as a GI doc was peripheral at best so don’t let that throw you off!
my first thought was mono, too. My daughter had it with a sore throat so bad they gave her vicodin.
@@Doc_Schmidt give the answer while you're at it😁
@@geriroush8004 I honestly got to the point I couldn't speak or eat most of the time. And when I plopped myself in front of my PCP she was so cavalier about it like it was normal. In hindsight, the fact it took me 4 months to get her attention by forcing myself on her at the clinic, she probably wasn't the best doctor. I was glad when the rashes on my hands went away--I do a lot of typing for a living and shaking hands when I'm not so it was both painful and disgusting. I'd choose between showering and doing tasks for almost 6 months because there were times I'd fold like an accordion from the weakness. I thought for a minute I had shingles. There was a genuine moment for a few days I thought I was never going to get out of bed again. Whatever "strain' of mono was going around in 2018 was gross 🤢 IDK how teenagers do this except we expect them to. I caught nothing but crap from colleagues for being in my 30s and just finally getting mono (which I think I got from seeing a client in a hospital since I don't think my indoor meownagers or the puppalegal gave it to me haha).
I guessed mono. But seems that’s incorrect
An autoimmune disease, known as polymyalgia rheumatica. It causes the pain in the proximal muscles and would make her fatigued. I am guessing it was either a skin or muscle biopsy. Her ANA was elevated meaning autoimmune, and usually one leads to another. So the rash on her hand could have been rheumatoid arthritis. Now if we consider the EBV (Epsein Barr Virus) the sore throat and elevated white blood count, as well as fatigue, could have been mono. So she probably had multiple illnesses.
sounds like Mono. elevated EBV, fever, fatigue, sore throat. rash,
Dermatomyositis
And i guess our clinical clues in her case would be sufficient for a dx but muscle or punch bx of skin can be helpful
Me who doesn't know what half these words even meant: "Uh yeah! That sounds like a severe case of (insert word that seems somewhat medical here)
Dermatomyositis, mononucleosis. And I don't think there is a malignancy. Oropharyngeal cancer doesn't present like that from what I've seen.
A muscle biopsy?! Another something I didn't know was done and never want done so added "profound muscle weakness with a knuckle rash" to my list of things not to mention to my doctor as long as the Advil still works.
"I like your funny words, magic man."
I think it is dermatomyositis, a muscle biopsy was done and revealed perivascular inflammation with predominance of B cell arround a blood vessel. The gottron papules is pathognomonic for DM that could be seen at the back of the fingers, elbows and knees.
What about chrohns or Scarlett fever?
Since you're a GI Fellow, I would have guessed an intestinal biopsy showed leaky gut that led to autoimmune disorder causing symptoms.
Looking at the very specific comments, I've learned about a new disease. At least it's a zebra!
These videos are cool. Very educational!
Oh a mystery... fun! 🥰
Wow so many Doctor here. Nice i just want to say thank you all of you.you help us during this hard time.
Watching too much House M.D. makes me want to say Lupus. Perhaps SLE. I dunno.
Awww, thank you so much for the heart Doc!
I have no medical knowledge...so...no idea. 🤣
Like my pediatrician always used to say.... "it's just a cold"
Flash foward to me with multiple chronic illnesses in my 20s 👍
Her presentation and positive ANA make me want to investigate her for Dermatomyositis
Anything I can't explain is meningitis.
Omg I love these.
Mixed connective tissue disease. She had a skin Biopsy to look at her collagen, which was negative
Here’s my extremely unqualified guess: mononucleosis. Biopsy from lymph nodes to exclude (/confirm?) lymphoma etc… Admittedly not that interesting to an M.D tho- so I’m probably wrong... Had fun playing in any case!
Oh shit- did not take your specialty into account! New guess: biopsy from the stomach! Diagnosis: Epstein-Barr virus-associated gastric carcinoma?
Sounded initially like PMR but with the rash sounds like dermatomyositis
My guess is the biopsy was taken from the throat during endoscopy and diagnosis was h.pylori infection
Was gonna say Polymyalgia Rheumatica but forgot about the rash, fever, and myalgia. It sounds like an rheumatologic disease that flared up due to an acute EBV infection. I