An Adopted 43-Year-Old With Bad Breath, Dyspnea, Dysphagia

Alexander B. Norinsky, DO; Andrew Caravello, DO; James Espinosa, MD


July 14, 2022

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 43-year-old man who is nontoxic but somewhat uncomfortable presents to the emergency department (ED) with dyspnea secondary to swelling in his left neck region. He also has progressive difficulty tolerating his secretions and swallowing. He initially noted the swelling earlier that night while trying to eat dinner when he was unable to swallow. He also describes his voice becoming progressively muffled over the past few days and foul-smelling breath.

He does not have fever, chills, sore throat, congestion, rhinorrhea, pain elsewhere, or any other symptoms. He has no recent history of tooth extractions or dental procedures. He has never experienced anything similar and, prior to this event, reports being in his normal state of health, without any illnesses or known sick contacts or exposures.

He has no significant medical history; however, he has not seen a primary care physician in more than 10 years. The patient has had no surgeries. His family history is unavailable because he was adopted and is unaware of the health status of his biological parents. Social history is significant for smoking one pack of cigarettes daily for about 15 years, without any illicit drug or alcohol abuse. He has no known drug allergies and does not routinely take any medications.


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.