Fatigue, Weight Loss, and Abdominal Cramping in a 70-Year-Old Man

Tomislav Dragovich, MD, PhD; Shailja B. Amin, PA-C


December 19, 2014

Editor's Note: The Case Challenge series includes difficult-to-diagnose conditions, some of which are not frequently encountered by most clinicians but are nonetheless important to accurately recognize. Test your diagnostic and treatment skills using the following patient scenario and corresponding questions.


A 70-year-old man presents to a clinic with unintentional weight loss, worsening fatigue, and abdominal cramping. He has a history of breast cancer (estrogen and progesterone receptor-positive and HER2-negative) for which he underwent a right mastectomy 9 years ago. This was followed by adjuvant chemotherapy and a 5-year course of tamoxifen. He also has a distant history of superficial melanoma, which was treated with wide excision 15 years ago. In addition, his medical history is relevant for superficial bladder cancer and irritable bowel syndrome.

The patient's family history is notable for lung cancer in his mother in her mid-70s. His current medications include aspirin, omeprazole, and fenofibrate. He has a 20–pack-year history of smoking but quit at age 51 years.


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