Gastro Case Challenge: An Incarcerated 24-Year-Old With Dyspnea, Fatigue, and Chronic Nausea

Nicola E. Burch, MBChB, MRCP; Victoria M. Gordon, MBBS, MRCP


March 18, 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 24-year-old Caribbean man who is currently incarcerated presents with symptomatic anemia. He is primarily complaining of exertional dyspnea, generalized fatigue, and some mild chronic nausea. He has no known history of hematemesis, melena, rectal bleeding, or hemoptysis.

His family history is significant for sickle cell anemia in both his grandmother and sister. His medical history is limited to asthma that is controlled with salbutamol and beclomethasone inhalers and to previous admissions for symptomatic idiopathic anemia, for which he has been maintained on iron supplementation.

The patient is a nonsmoker and does not drink alcohol. He has no history of nonsteroidal anti-inflammatory drug or aspirin use. His diet is varied and nonvegetarian.


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