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To Whom It May Concern,
I am a 24 yo female, otherwise healthy, healthy lifestyle, active, except for the following: I have been having joint pain since 05-09, starting in my R hand and L elbow. This occured through the summer and then subsided in the fall. Then in 01-10 it spread to nearly all of my joints, namely both elbows, hands, knees etc. This pain was mild to severe, depending on the day, and worsened after heavy use (ie shoveling snow) but also popped up unpredictably. Accompanying the pain, I have had some petechiae on and around my affected joints that have not faded since 02-10 (*I do not take aspirin). I had 2 rashes--what appeared to be a folliculitis on my face and chest in 02-10 and 03-10. Finally, bouts of extreme fatigue and malaise, on and off, since 06-09, very prominent in the fall and then returning and leaving again in 03-10.
I saw my pcp who sent me to a PM&R guy and a rheumatologist. The physiologist ruled out carpal tunnel syndrome but I am holding off on PT because I don't want to potentially damage my joints until I have a clear dx. Then I saw a rheumatologist and had a (nearly) full autoimmune work-up which was strikingly negative for any autoimmune process. Thyroid normal, CBC w/ diff, normal, no vasculitis, no RF, no ANA, sed rates normal etc. My second appointment with the rheumatologist was after a "breakout" of new petechiae on my arms and hands. He suggested 2 things--that I see a hematologist for the petechiae and stop my birth control which he thought could be the root of the joint pain. He was not interested in following me as a patient until my bloodwork was positive for an autoimmune process.
I saw the hematologist and had a coagulation study (this less than a week after stopping the birth control) and it was normal. I suggested to her Behcet's as a possible dx to explore because I have also dealt with recurring mouth ulcers, but she thought I was nuts and had never seen a case during her practice. I also requested a CBC to be hand-counted and a Von-Willebrand's profile, but she refused both. She also would like me to have a bleeding time done, but my understanding is that the test is outdated, difficult to reproduce and not a clear indication of platelet function for situations like post-surgery (where it would be important). As well, she recommended a full-body CT scan, which I think is totally unnecessary for the time being. I will not be seeing her again.
By this time, end of 3-10, I have been having diffuse muscle pain in addition to the joint pain, especially in my upper arms and thighs. Generally speaking, however, after stopping the birth control, I have had less pain, though the frequency of discomfort is the same/more chronic. Last night I gave myself the Hess test, out of desperation/curiosity (I own a BP cuff and steth) for 5 minutes instead of 10. Petechiae notably congreated only on my upper arm and on my elbow joint. The whole evening following that, and today, my arm and elbow are quite sore.
The only other long term health issues that I have dealt with were migraines as a teenager, heavy menstrual bleeding and clotting (but not into my 20's) and chronic bruising for the past ~3 years with no recollection of trauma. The bruising was not important enough to follow up in the absence of other symptoms. I feel that it may be important now because after having blood taken on my finger (CBC) and arm, I bruised in both places. Some bruises last for weeks, some last only for a few days. Many of them are quite palpable.
I currently take 300mg Wellbutrin daily for depression/anxiety primarily related to school, as I am in a stressful part-time graduate program and I work full time in a lab. (I mentioned joint pain as a result of the Wellbutrin to the rheumatologist, but he doubted it even though it's listed as a side effect.) I am married, have a dog and like my life.
My plans now are to see another rheumatologist who is a former colleague of my husband and continue taking notes on the nature and frequency of the joint pain/petechiae. I will request another coagulation study as well as a Von-Willebrand's profile in a month with the birth control is out of my system. I wonder about (in no order) Behcet's, RA, Type 2-3 Von Willebrand's, hemophilia and very slightly, leukemia.
Does anyone enjoy a mystery diagnosis and have some ideas for me--which way to go with my search for a diagnosis and treatement? Many thanks.

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Have you been tested for Epstein Barr Virus?  I have chronic Epstein Barr Virus. I have all of the same symptoms. I have read that with EBV it can cause inflammation of your veins and arteries leading to petichae. I have also been told that with Lupus you don't always test positive right away. My pcp regularly checks me for it because she swears that I have it.
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Get platelet count done, you might have itp , ideopathic thrombocytopenia , hope u feel better
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I have the sam problem,joint and body aches and petichie.My doctor does not know why.

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Mine started out with joint pain in both knees, my left elbow, then the petechia on my lower extremities from my feet to the knees, then on my hands. My symptoms subsided after a round of prednisone, but after a few days of finishing the medication, my joint pain and petechia have returned. My WBC, sed rate, were slightly elevated. I have chronic fatigue. Just recently my lymph node on my neck was swollen and painful lasted 4 days. I see a hematologist next week. They are still trying to get me in to a rheumatologist. My PCP is unsure of what I have. Any thoughts?
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