Clinicopathological Conference: A Case of a 26‐year‐old Male with Diarrhea, Weakness, and Dizziness

Abstract

A 26-year-old Chinese male presented to the emergency department (ED) at an urban, academic medical center at 11 AM on a Monday morning with a chief complaint of ''weakness and dizziness.'' He describes having had several episodes of watery, nonbloody diarrhea, mixed with yellow ⁄ brown stool, throughout the day and evening 1 day prior, often feeling the urge to defecate without actually having passed a bowel movement. Since the evening prior to his arrival, he describes feeling acutely weak with an inability to ambulate. He reports having been bed-bound since the onset of diarrhea. On review of systems, he denies having had fevers, chills, vomiting, or abdominal pain during this time. However, he does report being increasingly fatigued with his usual work duties over the past 3-4 weeks. He has been working for a family-owned furniture company and his job requires heavy lifting and transferring of furniture. The remaining review of systems is negative. He has not traveled outside of the state or country within the past 6 months. He emigrated from China at the age of 7 years. He denies having any medical problems and reports having seen his primary physician 4 months ago for a routine check-up, which to the best of his knowledge was ''normal.''The patient was tachycardic, pale, and listless on presentation. Vital signs were as follows: temperature 97.4°F, blood pressure 150 ⁄ 97 mm Hg, pulse rate 130 beats ⁄ min, respiratory rate 30 breaths ⁄ min, and oxygen saturation 98% on room air. On physical examination, he was noted to be of medium build, slumped over on his gurney. He was somnolent with eyes closed but easily arousable and was slow to respond to questions and to follow commands. His head was atraumatic, with pale conjunctiva. His pupils were 4 mm bilaterally and equally reactive to light, with no obvious nystagmus. His mucous membranes were dry, and no meningeal signs were elicited. His respirations were tachypneic and shallow, but lungs were clear to auscultation. His abdominal examination was significant for a moderately tender right upper quadrant with hepatomegaly extending 4 cm below the costal margin, otherwise nondistended, lacking significant ascites, and with normal active bowel sounds. Rectal examination showed brown, heme-negative stool. Musculoskeletal and neurologic examinations were unremarkable. Skin turgor was normal but diffuse pallor was noted.A complete blood count revealed a leukocytosis of 20,500 cells ⁄ lL ⁄ mm 3 , hemoglobin 6.5 g ⁄ dL, hematocrit 21.5%, platelets 852,000 cells ⁄ lL ⁄ mm 3 , with a differential of 88% neutrophils and 5% bands. The mean corpuscular volume was 65 lm 3 . Chemistry profile revealed sodium of 137 mEq ⁄ L, potassium 4.7 mEq ⁄ L, chloride 107 mEq ⁄ L, bicarbonate 10 mEq ⁄ L, blood urea nitrogen 26 mg ⁄ dL, creatinine 2.0 mg ⁄ dL, and glucose 212 mg ⁄ dL. Hepatic panel demonstrated an aspartate transaminase of 217 U ⁄ L, alanine transaminase 77 U ⁄ L, alkaline phosphate 159 U ⁄ L, total protein 5.3 g ⁄ dL, albumin 2.3 g ⁄ dL, total bilirubin 2.5 mg ⁄ dL, di...

Urgências e Emergências Oncológicas: Revisão Integrativa da Literatura

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