A 22-Year-Old Man in Pain After Collapsing

Faizah Siddique, MD; Herbert S. Diamond, MD


March 18, 2019

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 22-year-old man presents to the emergency department after collapsing on a college football field about 45 minutes earlier, after doing several 50-yard sprints. He describes aching pain in his muscles and feeling weak and lightheaded. He is not sure whether he lost consciousness. He felt dizzy and was confused after the event. No seizure activity was observed.

The patient says that he felt well that afternoon, when he began the first August training session for his football team. The temperature on the football field was 90°F, with 85% humidity. He was sweating profusely.

The patient has not had recurrent syncope. He maintains an active lifestyle and is on his college football team; however, he admits to having been out of shape and having gained weight over the summer.

The patient's past medical history is notable for a left ankle sprain. He denies smoking or any illicit drug use. He drinks alcohol socially, typically limiting his intake to four beers on the weekend, but he has not had a drink in over 2 weeks. He has no allergies, and his family history is notable for diabetes and hypertension. He is not on any prescription medication or over-the-counter supplements. The patient denies recent travel, illness, or sick contacts.


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