Rower With Atraumatic Bilateral Hands Edema And Pain

Hx: 20yo F rower p/w a 2 month hx of BL hand pain and swelling. She admitted to some BL feet pain and swelling that has resolved. Symptoms occurred first in the L UE then spread bilaterally and started while on a training trip however she denies any trauma or injury. No inciting event. She notes some slight weakness in her hands. Denies numbness, tingling, redness, or warmth. Denies sick symptoms such as illness, fevers, or weight loss. No supplements or lifestyle changes. No PMH or FHx of rheumatologic disorders. PHYSICAL EXAM VSS & afebrile. No rashes/lesions. CV RRR with no murmurs, Pulm CTA, abdomen NT/ND and no hepatosplenomegaly. Hand/wrist exam diffuse nonspecific tenderness of MCPs, PIPs, DIPs, and phalanges, no effusion nor temp changes. Full ROM and strength with BL wrist flexion, extension, ulnar/radial deviation. 4/5 strength with BL grip & finger abduction. Neg ligament exam. Bilateral elbows normal. Bilateral ankles/feet exam unremarkable with normal gait. Neurovascularly intact. DIFFERENTIAL DIAGNOSIS includes rheumatologic autoimmune processes such as SLE, Psoriatic arthritis or RA and infectious etiology such as HFMD. Tx X rays of BL hands/feet were unremarkable. MRI showed diffuse tenosynovitis with no erosions. Labs showed an elevated WBC at 11.8 otherwise normal CBC. Ferritin elevated at 200. CMP AST 146 and ALT 329. Transaminitis prompted liver studies which showed neg hepatitis A/B/C serology with normal alk phos and Billi. Hepatology obtained a Liver US and obtained a liver biopsy which showed nonspecific results. Rheum was consulted and obtained labs, which were all Neg including RF, ANA, CRP and ESR. Due to an elevated WBC ID was consulted and ordered labs, which showed Neg EBV, STI, Strep, Lyme, and HFM PCR. However, showed positive Parvovirus B19 quant PCR and ab IgG & IgM. Echo unremarkable Diagnosis is Parvovirus induced arthralgia/edema with subacute hepatitis Rheum initiated prednisone taper which improved her symptoms. Patient was also started on 7.5 mg meloxicam, Humira and hydroxychloroquine. ID started Bactrim for PJP ppx for 2 weeks and repeated PCR. Hepatology trended liver enzymes which normalized. Patient’s polyarthralgia stabilized. She is to follow up with specialists every 3 months for labs and symptom management. Can consider RTP when symptoms resolve, and labs are unremarkable