Age: 27.0
Sex: F
Vaccine: COVID19, COVID19
Symptoms: Blood albumin decreased, Blood alkaline phosphatase increased, Blood calcium increased, Blood chloride decreased, Blood creatine phosphokinase decreased
Clinical narrative: Mid April 2022 ? present : swelling of bilateral hands wrists, knees, and ankles. Muscle stiffness and weakness. Decreased range of motion in all joints. Can?t close fist and hurts to straighten fingers. Can?t extend or flex wrist past 45 degrees in either direction. Pain with supination of wrist. Unable to kneel down. Unable to curl toes. Lower back pain and strain while bending at waist. Muscle cramps after using muscle for a while. Fatigue. Malaise. Decreased appetite. Last week of April 2022 : severe leg cramps randomly. Mostly nocturnal cramps. One night it was so bad that the cramp was isolated in my left calf, but felt muscle twitching all the way up to the glute. This specific cramp lasted for approximately 5 minutes. Did not relieve with flexing muscle. This was very painful. Hands and fingers lock in place after using for approximately 1-2 minutes. 27 Apr 22 ? Saw ER. Gave Prednisone 20 mg for 1 weeks? Arthritis trial. 09 May 22 ? ER follow up. Referral for CXR and echocardiogram. BNP elevated. May 11-13, 2022 : episodes of feeling: lightheaded, very weak, slight shortness of breath, tachycardia (130 BPM), obtained EKG, felt heart beating in head, headaches 24 May 22 ? Echocardiogram completed. 60-65% Ejection fraction, no PAH Slight Mitral Insufficiency Started last week of May 2022 ? present : pain in feet when walking and strain on ankles. Intermittent pain in hips, shoulders, and elbows. 31 May 22 ? Saw clinic for worsening Edema. Referral placed for Rheumatology. Started Last week of June 2022 ? Swelling has decreased, but still have muscle and skin stiffness, weakness and decreased ROM 30 Jun 2022 ? Noticed small light-colored bumps on back of bilateral hands. No pain to touch. Approximately 0.5 cm in size.     07 Jul 22 ? Saw Rheumatology. Labs ordered. 09 Jul 2022 ? Fell while getting out of my truck. Knees gave out. Hit the back of my head. My husband helped me get up. No injuries 18 Jul-2022 ? Discoloration of tendon in bilateral forearms 20 Jul 22 ? Rheumatology follow up. Diagnosed with Diffuse Scleroderma. 22 Jul 2022 ? Started taking Methotrexate 15 mg once a week and Folic Acid 24 Jul 2022 ? Discoloration in between ribs on left side. Discoloration and stiffening of breasts - circumferential 27 July 22 - Noticed ?groove signs? or ?lumpy muscles? on thighs. Thought they were possibly cellulite? 02 Aug 22 ? Saw Pulmonology. Scheduled PFT 05 Aug 22 ? New Rheumatologist. More labs ordered 06 Aug 2022 ? D/C Methotrexate and Started Cellcept 1500mg po bid 10 Aug 2022 ? Discoloration of tendons behind bil knees 13-16 Aug 2022 ? Couldn?t straighten legs and had to walk on forefeet. Tendon pain behind bil knees 18 Aug 2022 ? Started using Flexeril for muscle cramps. 02-13 Aug 22 - Elevated BP 140s/90s   -Only happened for approximately 2 weeks 23 Aug 22 ? Present - Elevated HR noticed 23 Aug 22. 120-130 resting HR. Gets up to 170 while walking around Started first week of Sep - Constipation Early Sept annotation - The distance I am able to walk or amount of time able to stand is getting shorter and shorter. My calves will start cramping and knees feel like they are going to give out. 09 Sep 22 ? PFT Completed. FVC 73%, FEV1 78%, FEV1/FVC 92, DLCO 93% 19 Sep 22 ? Started seeing clinic for depression about diagnosis. 20 Sep 22 ? Started seeing Nutritional Medicine 23 Sep 22 ? Started Physical Therapy 10 Oct 22 ? Noticed feet getting blue without having cold feet. Feet turn blue at sitting position only. 12 Oct 22 ? Husband wants a divorce 17 Oct 22 ? Started Dronabinol 5 mg for appetite stimulant 19 Oct 22 ? Started taking Zoloft 25 mg 30 Oct - 12 Nov 22 ? Stay for workup Early Nov 22 ? Grooves started to appear on upper arms. Skin at worst condition. Dry cracked skin despite applying Petrolatum Jelly once a day in the morning after showering. I would describe the skin being Crocodile-like. Started noticing Cellcept was helping with knees ROM. Less cramps per day. 04 Nov 22 ? Muscle biopsy on posterior left thigh. Sedated with Fentanyl 25 mcg prn. Given a block on left leg. 7 sutures placed and left in place for 3 weeks to allow healing. Caused possible nerve damage. Toes are numb and area proximal to surgical site is numb constantly. Tingling in toes sometimes. 09 Nov 22 ? Confirmed Eosinophilic Fasciitis J Started Prednisone, Bactrim, Pantoprazole, Caltrate 13 Nov 22 ? Cramps almost everywhere. Extremely painful leg cramps. Cramps brought me to tears. Sometimes have to pull over to the side of the road due to extreme pain. Eating Muscle cramps dissolvable tablets like candy. Applying topical magnesium. Eating spoonful?s of mustard. Stretching.   19 Nov 22 ? D/C Cellcept and Bactrim, Started Methotrexate and Atovaquone. 03 Dec 22 ? BP 182/111. HR got to 188 BPM - ROID RAGE. Extreme anger and depression due to seeing husband moving out and pretending like he cared about my health. 05 Dec 22 ? Almost died due to choking on food. Food dislodged when falling to the ground trying to alert neighbor. 06 Dec 22 ? D/C Zoloft and Flexeril, Start Remeron and Robaxin 07 Dec 22 ? Started Metoprolol for Inappropriate Tachycardia. 12 Dec 22 ? PFT Completed. FVC 73%, FEV1 81%, FEV1/FVC 96, DLCO 93% 13 Dec 22 ? Fell in snow. Was unable to get up for ~20-30 mins due to weak legs, decreased ROM and getting short of breath while attempting to get up. Was finally able to dig my foot in the snow to help with getting u. 16-Dec 22 ? D/C Robaxin. Started Baclofen 25 mg TID. 27 Mar 2023 ? Seen at hospital to determine if I have Scleroderma along with Eosinophilic Fasciitis, since it has affected the internal organs 06 Apr 2023 ? EGD completed, found H. Pylori, started antibiotics. 26 Apr 2023 ? Started 10%nIVIG 40 gm daily x3 days every 30 days 24 May 2023 ? Mediport placement 25 Jun-27 Jun 23 ? Stay in ICU for Encephalitis, Encephalopathy, overuse of Baclofen