Case 1: Introduction

Case Published: May 2021

History of Present Illness (HPI)


Mr. S is a 63-year-old electrician with past medical history of essential hypertension who presents to the emergency department with severe constant pain in multiple joints for 3 days. When asked which joints bother him the most, he points to right elbow, right wrist, both knees, and both ankles. These joints feel swollen and hot to touch. He has been very limited in movement due to pain and swelling, having to miss work for the past 2 days. Since his pain began, he has experienced nausea, fatigue, and poor appetite. He is unsure if he has had any fevers. He has tried smoking THC to relieve the pain without any success, but attempted no other interventions. He has never had symptoms like these before. No rashes or myalgias. He has not had any prodromal URI symptoms, abdominal pain, vomiting, diarrhea, dysuria or penile discharge. Sexually active with one partner for many years, no history of STDs. Admits to intravenous drug use in his teenage years, but none recently. He has not traveled out of the state of North Carolina in many years.

Social history: works as an electrician, lives alone, quit smoking cigarettes 5 years ago, quit drinking a year ago, occasional marijuana use

Past medical history: essential hypertension diagnosed many years ago, not treated due to lack of insurance

Family history: hypertension in mother

Medications: none  

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