6th February 2024

A 72-year-old female presents to the emergency department with weakness.

A 72-year-old female presents to the emergency department with weakness. She has had increased myalgia and tiredness. Examination shows generalised weakness with power 4/5 with intact sensation. She had a swollen knee joint, with blood-stained joint fluid aspirated. She was found to have perifollicular haemorrhages and ecchymosis. Bleeding gums were accompanied by poor dentition. Multiple poor-healing wounds were noted.

Basic observations showed a blood pressure of 80/50mmHg and a heart rate of 60. Blood tests showed mild normocytic anaemia of 100g/L with hypoalbuminemia. Normal platelet levels, coagulation screen and ADAMTS13 activity were noted. Bone marrow biopsy was unremarkable. 

Which of the following is the unifying diagnosis?