A middle-aged woman presented to the emergency department with severe ankle pain, generalized body aches, malaise, and petechial rash over her extremities. The symptoms had been present for about a year, but on the night of presentation her husband, concerned over the worsening rash and crippling ankle pain, carried her to the emergency department. Her medical records revealed prior outpatient evaluation with laboratory tests, whole-body computed tomography with intravenous contrast, and whole-body scintigraphy. All test results were normal. She had been prescribed pain medications to treat her body aches and antidepressants for malaise.
Abou Ziki MD, Podell DN, Schiliro DM. The Value of the History and Physical Examination—Sailing Through Medicine With Modern ToolsA Teachable Moment. JAMA Intern Med. 2015;175(12):1901-1902. doi:10.1001/jamainternmed.2015.5768