A 28-Year-Old Soccer Player With Odd Abdominal Pain, Fatigue

Thomas D. Pinkney, MB ChB; Simon F. Hobbs, MB ChB; Timothy D. Stone, MB ChB; Tim C.F. Sykes, MD, BSc, MB BCh, FRCS


August 09, 2021

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.


A 28-year-old man with a medical history significant for asthma presents to the emergency department with a 2-week history of intermittent lower abdominal pain, loose stools, myalgia, and low-grade fever. His symptoms began after an episode of diarrhea and vomiting, which had also affected his wife and children at the same time. Although his family's symptoms resolved shortly after their onset, his symptoms have progressed. He has been generally active, playing soccer at least twice per week, but he has recently felt too ill to participate in any physical activity.

The patient's only medication is a salbutamol inhaler, which he uses intermittently for asthma exacerbation. He is employed as a groundskeeper, which involves the occasional handling of raw animal manure. Because of his occupation and manure exposure, his family healthcare provider had considered leptospirosis as a potential diagnosis accounting for his symptoms; however, laboratory examination of the patient's blood and urine for leptospirosis is negative.


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.