by Christine Bishundat
Med Ed Committee
On Tuesday July 23, 2013 Dr. Elizabeth Housman delivered an illuminating
didactic presentation on fatigue. This is a seemingly simple symptom,
but what makes it tricky is that there are a number of diagnoses to
consider on a differential, ranging from depression/anxiety,
diabetes/hypothyroid, renal failure, TB/mono/HIV, to a rheumatology
problem to sleep apnea, or perhaps the patient is simply on beta
blockers or another medication that is known to cause fatigue.
Here we have an 85 year old woman with body aches, 10 pounds of
weight loss, mild noromocytic anemia, renal failure, high ESR/CRP, and 3
weeks of fatigue. The best thing to do is to take a biopsy to diagnose Giant Cell Arthritis, the histology of which will show vasculitis of
medium and large vessels, and distortion of the elastic lamina. We can
then give her steroids to suppress the immune system if we're concerned
with these rheumatology complications. An ophtho exam shows bilateral
uveitis: redness, blurry vision, and eye pain.
Uveitis is actually a rare presentation of GCA. Vision loss in GCA
is due to ischemia of optic nerve or retina or ischemia of posterior
ciliary arteries. A lot of people with GCA have high platlet count as
the thrombocytosis leads to increased risk of vision loss. But then why
did she have renal failure? She wasn't eating or drinking much and still
taking her Lisinopril medication.
Key Points:
- Older folks are more prone to giant cell arthritis
- Dehydration with Lisinopril medication is something to look out for!
No comments:
Post a Comment