Jane is a 23 year old female who presents with acute headache, neck stiffness aches and pains very diffuse. She was very healthy up until 3 weeks ago. No fever, sweats, exanthem. She is extremely fatigued. She is not pregnant. Takes no meds. Non-smoker, no drugs, or drug seeking behavior. No history of insect bites or animal contact. No ill relatives.
No recent travel, she has no appetite. No relevant PFSH.
Exam is totally unremarkable except for demeanor and a sullen facial appearance. No meningeal signs. Mild chronic lumbar root signs.
A few chiropractic treatments provide Jane only temporary relief.
A complete battery of labs is next ordered.
ALSO: Her History also includes long standing myofascial neck and shoulder pain and a lumbar disc. She is hypothyroid.
QUESTIONS: Which lab tests besides CBC, ESR, CRP, RA might you order?
HINT: She lives exclusively in the Mass Coastal area.
ANSWERS: Doctor, Post on our Blog for discussion and final DX.
The first doctor with the correct lab tests wins a signed copy of “Getting to YES!”.

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