Emergency Medicine Case Challenge: A Trucker Who Drinks Six Beers Daily Has Fever and Odynophagia

Parker Maddox, MS; Scott Goldstein, DO, EMT-PHP


March 28, 2023

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 45-year-old man presents to the emergency department (ED) with a fever and a sore throat. His symptoms began 2 days ago when he woke up and had general fatigue, malaise, and mild shortness of breath. His temperature was 102.2 °F (39.0 °C). He also reported a sensation of burning in his throat while eating breakfast. He took acetaminophen and ibuprofen with minimal change in his symptoms. Over the next 2 days, the symptoms did not improve, and the patient developed odynophagia that has continued to worsen.

Today, he is unable to tolerate any oral intake (food or water), which prompted him to seek medical attention. He also has marked pain when he talks, and he responds to most questions by nodding or shaking his head. His history was obtained with the help of his wife, who accompanied him to the ED. He has not experienced any recent nausea, vomiting, or diarrhea. He has no history of trauma or recent travel.

The patient's medical history includes hypertension and type 2 diabetes. He is intermittently compliant with his medications (amlodipine [5 mg] and metformin [850 mg]). He is up to date on all vaccinations, including influenza and COVID-19 vaccines, and he has not had any sick contacts.

His deceased mother had type 2 diabetes, and his deceased father had chronic hypertension. He has a 30-year-old brother and a 36-year-old sister, both of whom have type 2 diabetes.

The patient has been a truck driver for the past 25 years and is married with a 3-year-old son. He typically drinks at least a six-pack of beers daily when he gets off work and on the weekend. He denies any tobacco or illicit drug use.


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