Published: 8 July 2017
Author(s): Tetsuji Sawada, Haeru Hayashi
Issue: July 2017
Section: Internal Medicine Flashcard

A 27-year-old Japanese woman presented with a three-week history of swelling of her hands and lower extremities. She had no history of allergic diseases and had taken no medication prior to the development of her symptoms. There were no remarkable physical findings except for edema of her left hand and bilateral lower extremities (Fig. 1A, B). A white blood cell count was elevated (12,600/mm3) with eosinophilia (absolute eosinophil count, 8800). Liver and renal function tests and creatine phosphokinase (CK) level were normal, except for a slightly increased level of lactate dehydrogenase (287U/ml; normal value, 106–211).


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