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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 53-year-old man with obesity has had substernal chest pain for 1 hour is brought to the emergency department (ED) by emergency medical services (EMS) providers. The patient describes the pain as sharp, constant, nonradiating, and 7 out of 10 in intensity. The pain started 10 minutes after he had finished eating lunch, while he was watching television. He reports no specific aggravating or relieving factors. The EMS providers gave him nitroglycerin, which provided mild symptomatic relief.
The patient works from home and sits on a chair for 8-12 hours per day. He has also had a nagging, dry cough for many years. He also reports frequent fevers and night sweats for the past few months. He attributes his symptoms to "the flu," which he suspects he may have contracted from his children. He tested positive for COVID-19 about 6 months ago but had no symptoms and has since been vaccinated.
He has smoked one pack of cigarettes per day for the past 20 years and has been using medical marijuana edibles for the past 6 months to help increase his low appetite. He does not use any illicit substances.
He denies nausea, vomiting, hematemesis, hemoptysis, diarrhea, redness or swelling of the legs, bowel or bladder disturbances, dizziness, and weakness. He had some weight loss and difficulty swallowing 6 months ago, which resolved when he switched to healthier, softer foods, such as smoothies and milkshakes, and started eating small meals throughout the day instead of three large meals.
The patient has a past medical history of coronary artery disease, hypertension, type 2 diabetes, and gastroesophageal reflux disease (GERD). He reports that he is highly compliant with his medications. His blood pressure has been well controlled with amlodipine and lisinopril. He uses sliding-scale insulin at home, and his most recent A1c level was 8% about 1 year ago. He takes antacids as needed for symptomatic relief of his GERD. He has not been able to follow up with his primary care provider for the past year owing to a busy schedule.
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Any views expressed above are the author's own and do not necessarily reflect the views of WebMD or Medscape.
Cite this: Dushyant Singh Dahiya, Farah Wani, Asim Kichloo. Edible Marijuana Use, Chest Pain, and Cough in a 53-Year-Old - Medscape - Dec 07, 2021.
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