Ring around the Diagnosis
| العنوان: | Ring around the Diagnosis |
|---|---|
| المؤلفون: | Maria Fernanda Bonilla, Daniel J. Brotman, Carlos M. Isada, Sanjay Saint, Daniel R. Kaul |
| المصدر: | New England Journal of Medicine. 354:1937-1942 |
| بيانات النشر: | Massachusetts Medical Society, 2006. |
| سنة النشر: | 2006 |
| مصطلحات موضوعية: | medicine.medical_specialty, Aspirin, Tuberculosis, Respiratory rate, business.industry, General Medicine, Chest pain, medicine.disease, Surgery, Coronary artery disease, Blood pressure, Internal medicine, Medicine, Endocarditis, Crackles, medicine.symptom, business, medicine.drug |
| الوصف: | The patient’s symptoms are most likely infectious in origin, but they could be due to an inflammatory or neoplastic condition, particularly lymphoma. Elderly patients may not have localizing signs of infection; for example, cholecystitis may develop without right-upper-quadrant pain. Endocarditis is always a concern in an elderly patient with a prolonged, nonlocalizing fever. Depending on this patient’s activities, living in rural Ohio may also have put him at risk for endemic fungal, rickettsial, or other zoonotic diseases. The patient had undergone coronary-artery bypass surgery six years earlier but had not had recent chest pain or dyspnea. His activities included heavy yard work such as cutting down trees with a chainsaw. He had a distant history of hepatitis A virus infection, but no other serious infections. He was taking atenolol, atorvastatin, and an aspirin daily. Three months before his illness, his wife had had an influenza-like febrile illness that left her bedridden for two weeks; she had recovered fully. The patient had had no other recent exposure to sick persons, no known exposure to tuberculosis, and no tick bites; he reported no travel outside the Midwest. He owned a fish, but no other pets. Coronary artery disease may be accompanied by valvular disease, which could predispose a person to endocarditis. Yard work in the central Midwest might have exposed this patient to endemic fungi (e.g., histoplasma) or rickettsial diseases. An aquarium, particularly if it is saltwater, can harbor Mycobacterium marinum, but infection with this organism is generally confined to the skin. The distant history of infection with hepatitis A virus is not relevant to his current illness. Drug fever is unlikely, given his medication regimen. The patient was 180 cm tall and weighed 95 kg. He appeared diaphoretic. The blood pressure was 113/58 mm Hg, the heart rate 66 beats per minute, and the respiratory rate 18 breaths per minute and not labored. The temperature was 38.4°C orally. The lungs had no wheezes or crackles, and the heart sounds were normal. The abdomen, skin, and arms and legs also appeared normal. A random measurement of blood glucose revealed a level of 128 mg per deciliter (7.1 mmol per liter). The serum creati |
| تدمد: | 1533-4406 0028-4793 |
| DOI: | 10.1056/nejmcps053094 |
| URL الوصول: | https://explore.openaire.eu/search/publication?articleId=doi_________::51b25921990b3f5978d0f8270db918c6 https://doi.org/10.1056/nejmcps053094 |
| رقم الانضمام: | edsair.doi...........51b25921990b3f5978d0f8270db918c6 |
| قاعدة البيانات: | OpenAIRE |
| تدمد: | 15334406 00284793 |
|---|---|
| DOI: | 10.1056/nejmcps053094 |