Gastro Case Challenge: A Coffee Drinker With Chronic Diarrhea, Epigastric Pain, and Fever

Sarah El-Nakeep, MD


November 09, 2022

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 60-year-old man presents with severe abdominal pain, mainly in the epigastrium and right hypochondrium, which is associated with fever of 1 week's duration. He also reports that fatigue and headache accompany the fever.

For the past year, the patient has had chronic diarrhea and abdominal pain. The diarrhea is mildly loose, with two to three nonbloody bowel movements per day. The diarrhea increases when he consumes a high-fat diet and improves when he lowers his fat intake. He reports no vomiting, weight loss, or cachexia.

The patient does not drink alcohol or smoke; however, he consumes three to four cups of coffee per day. He suggests that his diarrhea may be caffeine-related, although he has not noticed changes when he varies his coffee intake.

Colonic diverticulosis was detected incidentally 5 years ago through routine colonoscopy, when he was age 55 years (Figure 1, Figure 2, and Figure 3). Because the diverticulosis was asymptomatic, no treatment was recommended.

Figure 1.

Figure 2.

Figure 3.


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