Rachael Bell Case Studies

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Thank you fore referring Rachael Bell, a 47-year-old lady who has previously worked for a family cabinet making business. She is non-smoker and keeps no pets. As you are aware, Rachael has a complex medical history including rheumatoid arthritis that was diagnosed 11 years ago. She reports poly-articular involvement including the hands, feet, elbows and knees. She is now under the care of rheumatogist Russell Buchanan and for the last three years has been treated with Humira with good response. Prior to that, she had tried various treatments including methotrexate, Imuran, Plaquenil and prednisolone. Rachael also has a longstanding history of myopathy with intermittent episodes of rhabdomyolysis. On reflection, she believes she has had symptoms since she was a child, but they…show more content…
Three months ago she developed another episode including cough, core throat, coryza and fevers. She also become dysphonic and it took a number of weeks for this to settle. There is a cough at time productive of some clear/yellow phlegm. There has also been mild dyspnoea and some wheeze. There have been some fleeting, atypical chest pains. Rachael also reports some post-nasal drip with nasal stuffiness. She does describe an ongoing feverish feeling, but has not checked her temperature to validate this. She reports night sweats once to twice a week. Recent chest x-rays and pathology including FBE, U&Es, LFTs, CK?, TFTs and common pertussis serology are unremarkable. Treatment wise, Rachael has been treated with amoxicillin, roxithromycin an Augmentin, the most recent course of antibiotics was completed a month ago. She also had a five-day course of prednisolone around two months ago. On review today, oxygen saturation was 97% and oropharyngeal inspection was unremarkable. Chest auscultation was surprisingly clear.

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