A 78-Year-Old Man With Delirium

John L. Brusch, MD


July 10, 2017

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 78-year-old man with overall good health, except for symptoms of moderate benign prostatic hypertrophy, presents to the emergency department after becoming unable to pass urine. While watching a football game during a cold autumn afternoon, the man took several drinks of alcohol from a flask to "keep himself warm." After that point, he found himself unable to urinate and was taken to the emergency department. After a traumatic Foley catheter placement, he developed shaking chills and fever. Eventually, he developed septic shock. The patient survived this episode.

After a few days, the patient's Foley catheter was removed. During his hospitalization, an underlying vascular dementia became more prominent. He was then transferred to a short-term rehabilitation facility but never regained the ability to return home. He experienced fluctuating levels of delirium, and his confusion worsened.


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