A 30-Year-Old Man With Hallucinations After a House Party

Warren C. Harvey, MD

Disclosures

November 17, 2020

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 30-year-old man who was previously healthy is brought by his friend to the emergency department owing to visual hallucinations, vomiting, and paranoia. The patient had arrived in town earlier that day and reports mild diffuse abdominal pain and lightheadedness when he stands up. He denies any vertiginous symptoms. His friend reports that he has had these symptoms for the past 2 hours. The patient complains of seeing "people moving in the room" but denies any auditory hallucinations.

The patient denies chest pain, shortness of breath, diarrhea, blood in the stool or vomit, and recent fever. In recounting the events leading up to the start of the patient's symptoms, his friend describes they had been to a house party, as well as several bars and breweries throughout the afternoon.

The patient has no other medical problems and is not currently under the care of a physician. No medication use is reported by the patient, his family, or his friends. Upon questioning, the patient admits that he smokes tobacco "occasionally," has tried cannabis "a few times," and drinks four or five alcoholic beverages per week.

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