After Travel, a 50-Year-Old Grandfather Has Dyspnea, Fever

Dushyant Singh Dahiya, MD; Farah Wani, MD; Tin Wong; Asim Kichloo, MD

Disclosures

August 16, 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.

Background

A 50-year-old man with hypertension and type 2 diabetes mellitus presents to the emergency department (ED) with a 4-day history of epigastric pain. About 1 year earlier, he received a diagnosis of end-stage renal disease (ESRD) secondary to diabetic nephropathy and started hemodialysis. Approximately 8 months later, he transitioned to continuous ambulatory peritoneal dialysis (PD) to accommodate his travel plans.

The patient flew to Michigan about 2 weeks ago to visit his grandchildren, who had "the flu," for a week. He was highly compliant with PD throughout the trip and did not have any complaints.

About 4 days ago, he noted the onset of mild epigastric pain, which he initially attributed to overeating throughout the trip and which he tried to manage with over-the-counter calcium carbonate. However, during the next few days, the pain worsened, and he started to develop shortness of breath, prompting him to present to the ED.

He describes the pain as sharp, nonradiating, and diffuse but most prominent in the epigastric region. He rates the intensity of the pain at 7/10. Movement, deep breathing, and coughing exacerbate the pain. He reports no specific relieving factors or positional variations of the pain. He also feels nauseated and warm but did not check his temperature at home.

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