A 22-year-old woman presented to the emergency department with severe and generalized muscle ache for the past week mainly involving the shoulder and thigh muscles. The aching was so severe that it incapacitated her from her daily activities 2 days before the current presentation. There was no history of fever, chills, chest pain, palpitations, dyspnea, skin rashes, or joint pains. Her past medical history was not significant and no trauma, recent illness, physical exertion, heat exposure, or medication use were reported.
She complained of a weight gain since the past 2 months but denied any cold intolerance, menstrual abnormalities, or peripheral edema. She had developed a 2-3 cm nodule in the anterior neck which spontaneously resolved within a few days. Physical examination: Temperature: 36.8°C Pulse: 90 bpm RR: 16/min B.P.: 116/66 mmHg BMI: 23.03 kg/m2 Head and neck examination did…
