A 20-year-old girl was presented to the hospital because of progressively severe unilateral wrist pain of 24 hours duration. History No preceding injury or unusual physical activity was identified. Plain radiographs of the wrist were unremarkable. Ibuprofen was prescribed at 600 mg and she was discharged with a diagnosis of a wrist sprain. Over the next 12-18 hours, her condition worsened. Her sleep was frequently interrupted by wrist pain. Moreover, she developed a fever during the night.
There followed progressive malaise and diminished appetite. Painful palms ensued. Further inquiry revealed the absence of nausea, vomiting, diarrhoea, bloody stool, swollen glands, photophobia or ocular irritation. Her past medical and family histories were noncontributory. Physical examination The patient was a well-developed, well-nourished 20-year-old girl. She was febrile, temperature 101oF,…
