A 53-Year-Old Social Media Worker With Dysphonia and Paresis

Paul P. Rega, MD


July 20, 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 53-year-old woman comes to the emergency department (ED) in the middle of the night with a 1-day history of diffuse, constant, and worsening abdominal pain. The pain is not associated with fever, nausea, vomiting, constipation, diarrhea, or urinary symptoms. Her review of symptoms is positive only for visual blurriness and xerostomia.

The patient takes atorvastatin and atenolol/chlorthalidone. She has no recent history of trauma or hospitalizations. Past surgeries include an appendectomy at 10 years of age and a hysterectomy at 42 years of age.

She lives with her husband and adult son, and they all work from home on their social media business. Her husband and son are not ill, although they have generally shared the same environment and foods. They have been living in isolation as much as possible for fear of contracting SARS-CoV-2. The COVID-19 pandemic has significantly affected their private lives; however, new projects such as painting lessons, canning workshops, and jewelry-making have enhanced their physical and mental health. None of the family has been tested for the virus, and they have not yet been vaccinated.


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