A 23-Year-Old Woman With Emesis and Generalized Weakness

Greg P. Hansen, DO; Christo T. Philip, MD; Larissa I. Velez, MD

Disclosures

September 14, 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.

Background

A 23-year-old woman presents to the emergency department with a 3-day history of progressively worsening generalized muscle weakness and nonbilious emesis. She has been vomiting once or twice daily, mostly upon awakening. The emesis does not seem to be associated with oral intake. She is also experiencing intermittent hematuria, without any flank pain or dysuria. She denies having fever, diarrhea, chills, headache, abdominal pain, visual disturbances, or paresthesias.

Before the onset of symptoms, the patient was in good health, with a medical history significant only for renal colic 8 months before presentation. She had cosmetic rhinoplasty 2 years ago but otherwise has not had any prior major surgery. She has no known allergies and is not taking any medications. Her last menstrual period was 1 month ago. She recently moved to the United States from Mexico, works as a waitress, and denies tobacco or illicit drug use.

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