Article

Obese Woman With Fibromyalgia and Increasing Back Pain

An obese woman in her 30s with a fibromyalgia, depression, polycystic ovarian syndrome, and diabetes has gradually worsening midline back pain. Would you be able to make this "great save"?

An obese woman in her thirties with a history of fibromyalgia syndrome (FMS), depression, polycystic ovarian syndrome, and diabetes mellitus presents to her local emergency department with one week of gradually worsening midline back pain. At first she thought the pain was a result of her FMS, but because it did not improve after a few days like it usually does, she saw a chiropractor, which also did not help. She finally went to her regular doctor, who prescribed hydrocodone/acetaminophen and cyclobenzaprine; neither has helped her.

Over the past 24 hours, the patient has been constipated and has had difficulty with urinating. Both legs have started to feel “wobbly” and numb. The pain extends from below her neck down to her waist in the midline; it seems to move around some but usually is worst “just above her bra strap.”

The patient has no additional complaints and states that this episode definitely is not like her typical FMS attack.

A radiologist orders a CT scan, deferring an MRI until morning "if needed." 

 Click here to see the diagnosis and discussion.

Related Videos
John Tesser, MD, Adjunct Assistant Professor of Medicine, Midwestern University, and Arizona College of Osteopathic Medicine, and Lecturer, University of Arizona Health Sciences Center, and Arizona Arthritis & Rheumatology Associates
Gaith Noaiseh, MD: Nipocalimab Improves Disease Measures, Reduces Autoantibodies in Sjogren’s
Laure Gossec, MD, PhD: Informing Physician Treatment Choices for Psoriatic Arthritis
Søren Andreas Just, MD, PhD: Developing AI to Mitigate Rheumatologist Shortages for Disease Assessment
Shreena K. Gandhi, MBBS: Recognizing Fibromyalgia as a Continuous Variable, Trait Diagnosis
Reducing Treatment Burden of Pegloticase for Uncontrolled Gout, with Orrin Troum, MD
Exploring CAR T-cell Therapy for Rheumatic/Autoimmune Diseases With Georg Schett, MD
John Stone, MD, MPH: Inebilizumab Efficacious for IgG4-Related Disease in MITIGATE Study
Uncovering the Role of COVID-19 in Rheumatic Disease, with Leonard Calabrese, DO
© 2024 MJH Life Sciences

All rights reserved.