It Really is a Disease!

A volunteer who just returned from a mission to West Africa comes to your clinic. Two days upon returning, he develops abrupt high fever and malaise. His oral temperatures have been up to 40 degrees Celsius. The fever lasts about four days, and at that time, he starts developing arthralgias of the hands, wrists, and ankles. These joint pains are symmetric and seem to affect distal rather than proximal areas. There is some axial skeletal involvement. These arthralgias are intense and disabling.

The rash shown above started developing about three or four days into the illness. Other symptoms include headache, myalgias, and nausea. Physical exam demonstrates periarticular edema and cervical lymphadenopathy. Laboratory tests show lymphopenia and thrombocytopenia.

You aren't sure what this is so you advise symptomatic treatment and schedule follow-up in 2 weeks.

On his next visit, the patient complains of ongoing arthralgias, edematous polyarthritis of the fingers and toes, morning pain and stiffness, and tenosynovitis of the wrists, hand, and ankles. His exam is positive for carpal tunnel syndrome. He has joint and bony pain at sites of prior trauma.

Challenge: This case could also be called "that which bends up" or "stooped walk." What's the diagnosis?

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