CASE 15
A 23-year-old woman, LL, is seen in your office complaining of flu-like symptoms that had persisted for several weeks. A physician at a local walk-in clinic gave her an antibiotic 2 weeks ago. She does not remember the name of it, but she finished the course of medications 3 days before coming to your office. She has noticed progressive pain in her hands and feet, and this morning on arising she noticed tender small bluish red spots on her fingertips. Your routine physical examination reveals nothing else of note. She is not a smoker, and she is currently afebrile. You order routine blood work and are called by the laboratory director when he noted the results indicated that she was profoundly anemic (see Appendix for reference values). At this stage you need to consider possible explanations for these findings; how might you investigate further?
