Pregnant Woman With Aching Pain, Muscle Fatigue, and Rash

A 39-year-old woman, in her eighth week of pregnancy, experienced aching pain that worsened with activity. Weakness and fatigue set in three days later in her  thigh and proximal arm muscle. Then a mildly pruritic rash developed across the forehead, nose, and forearms.

Her symptoms progressed rapidly, and within days she required assistance from two persons to rise from a chair. She also had difficulty walking, brushing her teeth, bringing objects to her mouth, and washing her hair. She felt feverish.

One year earlier, a few weeks into a pregnancy, the patient had experienced similar proximal myalgia and very mild weakness, without rash. The symptoms had resolved in two weeks without medical attention. This pregnancy ended in miscarriage at 10 weeks.

What do you think might be the diagnosis?

What tests would you order?

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