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 you would like to suggest for a future Case Challenge, please contact us.
Background
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.
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Any views expressed above are the author's own and do not necessarily reflect the views of WebMD or Medscape.
Cite this: Thomas D. Pinkney, Simon F. Hobbs, Timothy D. Stone, et. al. An Unusual Cause of Lower Abdominal Pain in a 28-Year-Old Man - Medscape - Jun 24, 2015.
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