The Case Challenge series includes difficult-to-diagnose conditions, some of which are not frequently encountered by most clinicians but are nonetheless important to recognize accurately. Test your diagnostic and treatment skills using the following patient scenario and corresponding questions. If you have a case that you would like to suggest for a future Case Challenge, please contact us.
A 43-year-old Hispanic man with no significant medical history is referred from his primary care provider to the emergency department for evaluation of severe intermittent headaches, subjective fever, chills, weakness, abdominal pain, reduced appetite, early satiety, and a 30-lb weight loss over the last few months. He was in normal health until approximately 8 months ago, when he developed nonspecific abdominal pain with partial response to over-the-counter calcium carbonate and ranitidine.
He had been living in the United States for several years but returned to his home country in Central America 2 months ago, after which the abdominal pain intensified and localized to the right upper quadrant of his abdomen. The patient decided to return to the United States for a complete medical evaluation.
His medical history is significant for migraine headaches, which are well controlled with ibuprofen. He does not take any prescription medications. His current over-the-counter medications include ibuprofen, calcium carbonate, and ranitidine. He has no significant surgical history. He denies smoking, drinking alcohol, and illegal drug use.
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Cite this: An 8-Month History of Vague Systemic Symptoms - Medscape - Apr 28, 2011.