DrVirgo
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A 25-year-old woman comes to the clinic complaining
of pain and swelling in the right elbow. She noticed the
swelling 2 days before presentation. She reports that she
has been feeling somewhat feverish for the last several
days and also reports nonspecific symptoms such as
arthritis and myalgia. She denies any other medical history.
She is not taking any medications. She denies any
drug use. Her temperature is 38.3 C (101.0 F), blood
pressure is 120/80 mm Hg, and pulse is 100/min. She
has a vesiculopustular skin lesion on her abdomen and
a mildly tender and swollen right elbow. Which of the
following is appropriate pharmacotherapy?
(A) Acyclovir
(B) Azithromycin
(C) Ceftriaxone
(D) Ciprofloxacin
(E) Vancomycin
Diagnosis? answer?
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| robin082006
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C
Septic arthritis
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| Aashi
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Shingles?--->A
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| webjeee
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vesiculopustular skin lesion is good point
but, is it common that HZV causes arthritis?
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| paviraj
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Can"t it b GONORRHEA? Ceftriaxone.
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| NeimanPicksMOM
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The description sounds like every other Shingles scenario except for added distractors to throw you off. My guess is A.
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| mjl1717
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I go with answer A-Acyclovir
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| Dr.Luck
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Why can't it be lyme disease?...as the SX include..1-2 weeks of arthralgia, myalgia & malaise followed by rash(vesiculopustular) on the abdomen & arthritis as the Q clearly says mildly swollen & tender joints.So the RX should be Azithromycin/Erythromycin /doxycyclin.....I know there ain't typical presentation of lyme's dz + there isnt any geographical Hx or anything like that given but then there r alot of things missing in the q so we gotta make Dx from Sx only.
For septic arthritis,joint is very swollen & tender with decreased range of movements & pt is more sick looking.
For gonorrhea there gotta be vaginal discharge.
For shingles she gotta be over 65 or immuno compromised.
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| robin082006
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This question tries to distract you by myalgia and rash.
But in young person with fever,, swollen joint, we should think Gonoccocal arthritis first.
UW has a similar question, I used to pick an incorrect answer in UW and took note for the question.
C is the best choice here.
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| young_doc
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How do we explain the vesicopustular lesions on the abdomen with a septic arthritis?
I don't know if we can say that it's just a distractor! Vesicopustular lesion are a pretty significant physical finding..
Dr. Luck, Gonorroheal septic arthritis doesn't necessarily have to present with vaginal discharge. Also if they wanted to hint Lyme disease...one would expect to see the characteristic target lesions...(as opposed to a vesicopustular lesion)
In either case, Septic arthritis is still more likely than Shingles in this case...
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| DrVirgo
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C.
This patient has an infectious
arthritis. One of the most common causes of infectious
monoarticular arthritis in young patients is gonorrhea.
Symptoms include migratory arthritis, tenosynovitis,
and vesiculopustular skin lesions. Diagnosis can be
made through cultures grown on Thayer-Martin medium.
Treatment for disseminated gonorrhea infection
includes ceftriaxone.
Acyclovir (choice A) is used in the treatment of herpetic
lesions.
Azithromycin (choice B) is used in the treatment of
infection with chlamydia, which should be considered
in addition to gonorrhea because chlamydia is a common
coinfection with gonorrhea.
Although ceftriaxone is the preferred agent,
ciprofloxacin (choice D) is an alternative regimen that
may be used in the treatment of gonorrhea if ceftriaxone
cannot be used.
A gram-negative agent, Neisseria gonorrhea does not
respond well to vancomycin (choice E).
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| docsport
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good question. and one 'educational objective' among many is to expect a vesiculopustular rash in a case of gonorrheal arthritis.
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