A Veteran With Lesions, Alcohol Use, and Opioid Dependence

R. Hal Scofield, MD

Disclosures

October 27, 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 57-year-old man is brought to the emergency department because of falling and bruising. The patient and his wife report that 3 years ago he started taking oxycodone for back pain, which he obtained from prescriptions as well as by purchase through illegal means, and rapidly increased his dosage to about 50 pills day.

About 1 year ago, he completely stopped taking oxycodone but began drinking about one fifth (750 mL) of vodka each day. About 3 months before presentation, his diet deteriorated such that he was eating very little and was drinking only vodka. Over the past 2 weeks, his wife noted that he had difficulty in walking and was falling up to five times a day within their home. During several of the falls, he struck his head but had no loss of consciousness.

He reports no nausea, vomiting, diarrhea, fever, or chills. He has not had any confusion or double vision. The review of systems is positive for nocturia one or two times a night as well as difficulty in starting urination.

The patient lives with his wife. For most of his life he was a welder, but he has not worked in several years. Up until a few weeks ago, he was taking care of himself, performing tasks around the house, and doing yardwork. He smoked while in the US Army but stopped more than 30 years ago. His family history is positive for hypertension and lung cancer in his father.

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