A 32-year-old, white woman presented for psychiatric follow up with complaints of spontaneous bruising to the left upper and lower abdomen that had been present for the past 5 days in addition to routine psychiatric care for medication management of schizoaffective disorder, depressed type. She had reported previous episodes of bruising only to her primary care provider. She had been experiencing an increase in stress recently due to having to travel 26-hours round trip on multiple occasions because of divorce proceedings, and a custody dispute, which were taking place out of state. She was also completing her last semester in a bachelor’s degree program and was finding it difficult to balance everything.
The unexplained lesions were painful, but she denied any history of trauma. She reported multiple similar episodes in the past, all of which, on review, occurred during times of increased stress. She described the typical course of these lesions as experiencing pain for the first few days, which would resolve with the appearance of bruising that would last for 2 to 3 weeks. Previous workup by her primary care provider included complete blood count (CBC), complete metabolic panel (CMP), and imaging of affected sites, all of which were unremarkable.
Her medical history was significant for irritable bowel syndrome (IBS), polycystic kidney disease (PKD), and schizoaffective disorder. She had no new exposures or medications. Review of systems was negative for fever, headache, dizziness, epistaxis, nausea, vomiting, diarrhea, hematuria, arthralgia. Her family history was negative for bleeding or coagulation disorders. Surgical history was negative. Allergies to drugs included doxycycline, varenicline, promethazine, metoclopramide. Her medications included aripiprazole, lamotrigine, and prazosin for management of psychiatric symptoms and bentyl for management of irritable bowel syndrome (IBS).
Ms. Sierra is a Physician Assistant and Assistant Professor, Idaho State University, Department of Physician Assistant Studies, Caldwell, ID; Ms. Brown is a Physician Assistant, Community Partnership of Idaho and Lifeways Behavioral Health of Oregon Affiliate Faculty, Idaho State University, Department of Physician Assistant Studies.
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