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 24-year-old man presents to the emergency department with a 1-week history of progressive weakness in both lower extremities. He reports that he has difficulty walking and rising from a seated position, as well as numbness and tingling in both lower extremities. Since yesterday, he has also had difficulty controlling his bowel and bladder functions, which has led to incontinence. His symptoms have worsened over the past week, and he has not had similar episodes in the past. He says he does not have any pain or tingling in his hands, headaches, fevers, chills, or vision abnormalities. The patient has no history of recent trauma or illness, cancer, or intravenous drug use.
His past medical history is unremarkable. His family history is notable for hypertension and diabetes. He is not currently taking any medications and has no known allergies.
The patient reports consuming 8-12 alcoholic drinks over the weekend, which is usual for him. He reports no syncope or "blacking out." He is an avid hiker, and on a recent trip he inhaled nitrous oxide with his friends, as he usually does. He says he does not use other illicit substances or tobacco products. He is sexually active with multiple partners and uses condoms consistently.
Medscape © 2023 WebMD, LLC
Any views expressed above are the author's own and do not necessarily reflect the views of WebMD or Medscape.
Cite this: Weakness and Incontinence in a 24-Year-Old Hiker With Multiple Sex Partners Who Uses Whippets - Medscape - May 18, 2023.