A previously healthy 18-year-old woman presented to a primary care provider with a 2-month history of headaches and midscapular pain. The midscapular pain was worse at night and lessened with exercise.
Funding and Disclosures
Disclosure forms provided by the authors are available with the full text of this article at NEJM.org.
Drs. Mayfield and Hidano contributed equally to this article.
We thank Kelly D. Smith, M.D., Ph.D., from the Department of Laboratory Medicine and Pathology at the University of Washington for providing histologic photomicrographs and valuable interpretation and Ruchi Kapoor, M.D., Ph.D., from the Division of Cardiology at the University of Washington for her critical review of an earlier version of the manuscript.
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