Journal Article

Still Consider the Source

Bronze, Michael S, Ike, Robert W, Sawalha, Amr H, Saint, Sanjay

2005

Overview

A 50-year-old man presented to the clinic with fever, chills, and generalized weakness that he had had for three weeks. He also noticed pain and swelling in his right hand and left elbow, a weight loss of about 4.5 kg, and occasional upper abdominal pressure. He had no nausea, vomiting, diarrhea, dyspnea, or dysuria. A 50-year-old man presented to the clinic with fever, chills, and generalized weakness that he had had for three weeks. He also noticed pain and swelling in his right hand and left elbow, a weight loss of about 4.5 kg, and occasional upper abdominal pressure. Foreword In this Journal feature, information about a real patient is presented in stages (boldface type) to an expert clinician, who responds to the information, sharing his or her reasoning with the reader (regular type). The authors' commentary follows. Stage A 50-year-old man presented to the clinic with fever, chills, and generalized weakness that he had had for three weeks. He also noticed pain and swelling in his right hand and left elbow, a weight loss of about 4.5 kg, and occasional pressure in the upper abdominal area. He said that he had not had nausea, vomiting, diarrhea, dyspnea, or dysuria. Response Fever is a manifestation of many infectious, collagen vascular, and malignant diseases. The weight loss and generalized weakness probably indicate a systemic disorder; his joint discomfort suggests an inflammatory arthritis. Arthritis can be a sign of either . . .

• Publisher: Massachusetts Medical Society
• Subject: Biological and medical sciences / Disease / Family medical history / Fever / General aspects / Infections / Medical sciences