A 57-Year-Old Man With a Fever Who Can't Stop Bleeding

Hanan Alharthy, MD; Rima Koka, MD, PhD; Hira Latif, MD


May 10, 2021

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 57-year-old man is referred to the emergency department for excessive bleeding after a dental cleaning procedure. He has no prior history of uncontrolled bleeding or easy bruising. He had a fever 4-5 days earlier, with no weight loss or night sweats. His appetite is normal, and he denies any history of shortness of breath, chest pain, palpitations, dizziness, vomiting, abdominal pain, hematuria, constipation, melena, hematochezia, or hemoptysis. He has no oral ulcers, joint pain or stiffness, rashes, alopecia, or dryness of the eyes or mouth.

The patient has no chronic illnesses that require long-term medications. He does not take any over-the-counter medications. His surgical history is remarkable only for a hernia repair 6 years earlier. He denies any tobacco smoking, illicit drug use, or alcohol intake. His family history is unremarkable.


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