The Clinical Problem Solvers Episode 442: WDx #40: Clinical Unknown with Kassidy and Dr. Ann Marie Kumfer
Feb 4, 2026
Kassidy Lovins, a third‑year med student who presented the case, and Dr. Ann Marie Kumfer, a cardiologist and clinical educator, walk through a 35‑year‑old with fevers, diffuse myalgias, and profound weakness. They explore infection versus inflammatory causes, evolving cardiac findings with pericardial effusion and purulent pericarditis, and the diagnostic clues that reveal an underlying immunodeficiency.
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Episode notes
Differentiate Myalgias From True Weakness
- A previously healthy young adult with fever, diffuse myalgias, and weakness after GI illness can represent a broad differential from infection to post-infectious inflammatory syndromes.
- Early distinction between myalgias versus true weakness guides workup (CK, neuro exam, fluids) and prevents premature closure.
Stabilize Then Reassess The Neuro Exam
- Get CK and basic labs early when exam is limited by pain to evaluate for rhabdomyolysis and inflammatory myositis.
- Give intravenous fluids and analgesia first, then re-examine to clarify neurologic deficits and guide further testing.
Interpret Thrombocytopenia In Context
- A pattern of thrombocytopenia with AKI and hematuria-like UA raises concern for microangiopathic processes like HUS/TTP but requires hemolysis labs and peripheral smear to differentiate.
- Normal haptoglobin, absent schistocytes, and modest LDH argue against MAHA in this case.
