A 36-year-old man showed up to the emergency department of the Massachusetts General Hospital, severely unwell from a puzzling set of conditions. He had abnormalities in his lungs, intestines, blood, liver, and lymphatic system—and, of course, no single clear explanation. His case was such a riddle that a master clinician with an expertise in clinical reasoning was called in to help unravel it.
In a case report published today in the New England Journal of Medicine, the expert and the man’s other doctors lay out the masterful medical deduction that explained his remarkable case—which had an entirely unremarkable cause.
It all started about two weeks before his hospital visit. A mild, dull pain had developed in the patient’s right lower abdomen and back. Nine days later, a fever and body aches also developed. The next day, he went to urgent care, where clinicians gave him intravenous fluids and an intravenous pain reliever. His abdominal pain went away, and he was discharged. But the pain returned over the next few days, and with it came nausea and vomiting. He then started coughing and having trouble breathing.