Differential diagnosis of microangiopathic hemolytic anemia and thrombocytopenia
Feature HUS TTP Scleroderma Renal Crisis (SRC) HELLP Malignant HTN Typical setting Child after diarrheal illness (EHEC) Adults; autoimmune or idiopathic Systemic sclerosis (esp diffuse, early disease) Pregnancy (3rd trimester/postpartum) Long-standing uncontrolled HTN Key trigger Shiga toxin ↓ ADAMTS13 RAAS activation from endothelial injury Placental endothelial dysfunction Severe BP elevation Platelets ↓ ↓↓↓ ↓ ↓ […]
Immune system and rheumatology resources
Systemic sclerosis and Raynaud’s phenomenon
Case study 1: Hae Tap the arrow to view the case.Hae, a 40-year-old woman, is evaluated for a 9-month history of Raynaud phenomenon. She reports no difficulty swallowing, dyspnea on exertion, or hand stiffness. She has recently developed gastroesophageal reflux disease.On physical examination, vital signs are normal. The skin between the distal and proximal interphalangeal […]
Inflammatory myopathies​
Case study 1: Anna MarÃa Tap the arrow to view the case.Anna MarÃa, a 49-year-old woman, presents to her primary care clinic with 5 months of progressive difficulty climbing stairs and lifting objects overhead. She reports needing frequent breaks when folding laundry and brushing her hair.She denies diplopia, ptosis, numbness, tingling, dysphagia, dyspnea, joint swelling, […]
Sjogren’s disease and mixed connective tissue disease​
Case study 1: Suzanne Tap the arrow to view the case.Suzanne, a 44-year-old woman with Sjögren’s disease, presents for routine follow-up. She takes ibuprofen for joint pain and omeprazole for heartburn. She reports no new symptoms.Vital signs are normal. Physical examination reveals tenderness at the proximal interphalangeal and metacarpophalangeal joints bilaterally and bilateral parotid enlargement. The […]
Systemic lupus erythematosus
Case study 1: Blair Tap the arrow to view the case.Blair, a 17-year-old female, presents to the emergency department with progressive shortness of breath for 3 weeks and intermittent hemoptysis for 1 day. She reports painful oral and nasal ulcers, diffuse swelling of her hands and feet, morning stiffness lasting 2 hours, and a 10-pound unintentional […]
Miscellaneous rheumatology
Case study 1: Maribell Tap the arrow to view the case.Maribell, a 72-year-old woman, is evaluated for a 3-month history of abdominal and back pain and 4-month history of an increasingly rounded face. On physical examination, vital signs are normal. BMI is 29. Bilateral lacrimal and parotid glands are enlarged. Laboratory evaluation shows a hemoglobin A1c  value […]
Small vessel vasculitis
Optional resources American College of Rheumatology (ACR) Rheum2Learn 2.0: Small Vessel Vasculitis Estimated time: 10–15 min. (Cases 2 and 3 only) Rheum2Learn 2.0 is a free, case-based online program from the ACR that uses interactive patient cases to build core skills in recognizing and managing rheumatic diseases. Flexible and self-paced, it’s designed for students, residents, […]
Crystalopathies and mimickers
Case study 1: Maksym Tap the arrow to view the case.Maksym, a 12-year-old boy with newly diagnosed high-grade B-cell lymphoma, is evaluated for severe nausea, colicky abdominal pain, and tea-colored urine that began overnight. He started combination chemotherapy 48 hours ago.Physical examination shows mild flank tenderness bilaterally. Laboratory studies reveal elevated creatinine and hyperuricemia. Urinalysis […]
Peripheral spondyloarthritis
Optional resources The Intern at Work, #205: Beware of PEAR—An Approach to Seronegative Spondyloarthritides Estimated time: 14 min. In this podcast, the pathophysiology, clinical presentation, associated diseases, investigations and treatment for the seronegative spondyloarthritides are reviewed. These include psoriatic arthritis, enteropathic or IBD-associated arthritis, ankylosing spondylitis and reactive arthritis—or PEAR ! American College of Rheumatology (ACR) […]