A 32-Year-Old Man Vomiting Blood

Suzan Sanavi, MD; Reza Afshar, MD

Disclosures

March 12, 2019

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. If you have a case that you would like to suggest for a future Case Challenge, please contact us.

Background

A 32-year-old man presents to the emergency department with sudden onset of hematemesis. He reports having vomited bright-red blood three times during the past 4 hours; the last incident occurred about 1 hour ago. He estimates that he has vomited about a half-cup (approximately 118 mL) of blood each time. He has been nauseous for several days.

He denies having any abdominal pain or any previous episodes of hematemesis; however, he states that he has had black, tarry stools and decreasing urine output for the past several days. He last urinated about 14 hours ago and he currently has no urge to urinate.

He denies any significant past medical history. He denies smoking, drinking alcohol, or using illicit drugs. He does not take any medications, including over-the-counter nonsteroidal anti-inflammatory drugs, and is not taking herbal supplements. He denies any prior surgeries. During the past 2 weeks, the patient noticed some swelling in the glands along his neck, but he has no other complaints.

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