15yo female, presented in May 2020 during the COVID-19 pandemic.
The patient was referred via ambulance by her primary care doctor. She’s been having a high fever (> 40° C) for 3 days. During the visit in the primary care office she had a syncopal episode.
The last 2 days she also has experienced mild headaches, as well as chest tightness and shortness of breath. In addition she was complaining about a slight cough that has been getting worse over the last few days.
Furthermore she reported worsening pain in her toes as well as her 4th finger of her right hand. And she spontaneously told us that she experienced loss of her sense of taste.
No vomiting, no nausea. Only one episode of diarrhea 3 days ago before the fever started.
Prior to arrival she had received 500ml Ringer’s lactate in the primary care office and 600mg Ibuprofen at home.
ASD closure with Amplatzer Device 4 years ago
On estrogen containing birth control pill
General appearance slightly unwell looking.
Vital signs: Heart Rate 142/min, Blood pressure 106/55 (mean 70) mmHg, Resp. Rate 32/min, SpO2 99%, Temp. 40.2 C.
A/B: Tachypneic, not talking in full sentences, but otherwise no additional signs of dyspnea, normal auscultation with no crackles.
C: tachycardic, normal heart sounds, no murmur, cap refill < 2 secs.
D: awake, alert, GCS 15, not meningitic.
E: Abdominal exam normal with no hepatosplenomegaly. Normal exam of ears and throat.
Skin: no rash. Redness of skin and pain on palpation on fingertip of 4th finger of the right hand, as well as on tip of toes I and II of the right foot. All joints with normal range of motion and no pain, swelling or redness.