A 35-Year-Old Man With Palpitations and Dizziness

Christopher Redmond, MD, MSc; Kristine M. Lohr, MD, MS

Disclosures

August 31, 2016

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 healthy 35-year-old man presents to the emergency department with dizziness and palpitations. He has been experiencing sudden episodes of dizziness intermittently over the past 2 days without provocation. His dizziness is not positional. He denies difficulty hearing, feeling of fullness in his ears, and vertigo.

He reports mild, intermittent knee swelling of each knee over the past several months. The effusion lasts for approximately 1 week and spontaneously resolves. He does not recall any recent rash or bug bites. He denies any chest, abdominal, or back pain, and any sensory or focal motor deficits. He has no history of cardiovascular or neurodegenerative disease or of an immunocompromised state. He lives in Western Massachusetts and is an avid mountain biker but has been unable to participate in any outdoor activities for a few weeks because of knee swelling and dizziness.

He is single and has had three female sexual partners in the past 6 months. He uses barrier contraception intermittently, but denies dysuria, genital lesions, and penile discharge. He drinks two alcoholic beverages a night and has never used tobacco or any illicit drugs. His father has hypertension. His mother and sister both have systemic lupus erythematosus.

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