Case A 22-year-old woman was presented to the ED because of progressively severe unilateral wrist pain in a 24 hours duration. No physical injury or physical activity was noted. X-ray images did not reveal any anomaly She was prescribed ibuprofen at 600mg and was discharged with a wrist pain diagnosis. Over next 12-18 hours, her condition worsened. Her sleep was interrupted due to wrist pain.
She developed a fever during the night and presented to the ED again. She was febrile with temperature 101F but hemodynamically stable. There followed progressive malaise and diminished appetite Physical Examination Articular examination noted swelling and warmth at the left wrist. The wrist joint was tender to palpation and examination Dorsal hand surface was swollen except fingers Skin examination indicated presence of several tender palmar pustular eruptions Pelvic examination revealed a…
