I picked up that next chart and saw the chief complaint was rash after taking prednisone. Sounded straight forward. The patient was a 16 year old female who looked like she was feeling fine and with no visible rash when I walked in the room. Her mother told me that after taking the prednisone she broke out in hives and so they gave her Benadryl, and now the rash was gone. Great, I thought, I love it when patients treat themselves appropriately. Nothing left for me to do but give her my blessing to go home. She looked fine and had a negative physical exam while laying on the gurney. On my way out the door I asked the patient’s mother the reason she was taking Prednisone, was it because she has been have some type of recurrent rash? “No”, she answered, “It is because she can’t move.” That stopped me in my tracks. Can’t move? What does that mean? This question lead me down the rabbit hole. It turns out that the patient started having symptoms 2 weeks ago with extremity tingling and neck pain. She was seen in the ER and had neck x-rays which were negative and then followed up with her doctor and had an out patient MRI of her neck that was negative. She had her symptoms progress to weakness and cramping pain in her extremities. It did not seem to her that her symptoms were ascending but seemed to involve the proximal muscles of her hips and shoulders more then the distal muscles. The mother also told me that sometimes she would get facial symptoms with drooping eye lids or

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