01941nam a2200313   4500001000800000005001700008007000300025008004100028040000800069041000800077100003400085245007100119300002500190520093800215650001801153650003301171650001701204650003401221650003301255650002401288650003101312700003101343700003001374700003001404700003501434773011001469942003101579999001701610ESSALUD20260902162130.0ta      t        pe ||||| |||| 00| 0 spa d  aBMG  aeng  aZiperstein, Joshua C. 954484  aCase 14-2026: A 50-year-old woman with vaginal bleeding and anemia  apáginas: 1940-1951  aA 50-year-old woman was admitted to this hospital because of vaginal bleeding and anemia. The patient had been in her usual state of health, with leg edema that was attributed to chronic venous insufficiency, until 6 months before the current presentation, when increased swelling and new weakness developed in the legs. Before the onset of these symptoms, she had been physically active. She first noted that her legs felt more tired and sore than usual after normal physical activity, and the symptoms were accompanied by increased swelling and a feeling of heaviness in the legs. Over the course of the next 2 months, the leg weakness progressed to the point that she was unable to rise from a seated position or climb stairs. The patient also noted that her arms felt heavy, and she had difficulty reaching and holding them above her head. During this time, she had intermittent fever that resolved with the use of acetaminophen.  aALERGIA97055  aINMUNOLOGÍA GENERAL953664  aANEMIA97417  aREUMATOLOGÍA GENERAL954450  aENFERMEDAD GLOMERULAR954474  aHEMATOLOGÍA97422  aONCOLOGÍA GENERAL954224  aBarnawi, Rashid A. 954485  aAl-Samkari, Hanny 954486  aBolster, Marcy B. 954487  aHeusinkveld, Lauren E. 9544880 022717922669dMassachusetts NEJM GroupoNEJM014tThe New England Journal of Medicine wESSALUDx0028-4793  cARTICULOSe2026-08-31zsqb  c22906d22906