Professional Assessment: The presentation suggests post-viral reactive arthritis (PVRA) as a primary differential diagnosis, with other considerations including seronegative spondyloarthropathy, early rheumatoid arthritis, or viral-induced vasculitis, particularly given the patient's young age and female gender which increases risk for autoimmune conditions. The pathophysiological mechanism likely involves immune complex deposition and inflammatory cytokine cascade triggered by the viral infection, leading to synovitis and periarticular inflammation, particularly affecting the ankles. Given the patient's age and presentation, additional testing should include inflammatory markers (ESR, CRP), complete blood count, comprehensive metabolic panel, rheumatoid factor, anti-CCP antibodies, and potentially imaging studies (X-ray/MRI) of the affected joints to rule out other inflammatory arthropathies and guide treatment decisions.
Urgency Level Assessment: This case presents as MODERATE urgency given the post-viral inflammatory symptoms, significant mobility impairment, and recurrence of symptoms in a young adult. While post-viral arthritis/inflammation is common in this age group and often self-limiting, the inability to walk and persistent symptoms after initial treatment warrant medical evaluation within 24-48 hours to rule out more serious conditions like reactive arthritis or deep vein thrombosis. Red flags include severe mobility limitation and recurring symptoms despite initial treatment, though the presence of a prior viral infection provides context for the likely diagnosis. The patient should see their primary care physician or an urgent care center within 2 days, but immediate emergency care is not required unless symptoms significantly worsen, new neurological symptoms develop, or severe joint swelling/redness occurs.
Based on the post-viral inflammatory symptoms, I recommend taking an NSAID like Ibuprofen (400-600mg every 6-8 hours) to reduce inflammation and pain, combined with regular ice pack application (15-20 minutes, 3-4 times daily) on the affected ankle area. Additionally, implement the RICE protocol (Rest, Ice, Compression with an elastic bandage, and Elevation of the legs above heart level) for 2-3 days to reduce swelling and support recovery. Continue taking the prescribed Vitamin D supplements as they support immune function and may help with inflammation reduction. For additional treatment recommendations, ask in the chat.
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