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Fever curve. Temperatures in Celsius during hospitalization.

Still Febrile After All These Weeks

A previously healthy 28-year-old man was admitted to an outside hospital with fever, pharyngitis, and diarrhea. His symptoms began with generalized fatigue, fever, night sweats, pharyngitis, diffuse myalgias and arthralgias, and 10-pound weight loss. He self-administered a 5-day course of azithromycin. Afterwards, he developed malodorous and watery diarrhea, abdominal cramping, tenesmus, and incomplete evacuation. On […]

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A biopsychosocial model of irritable bowel syndrome pathophysiology. Irritable bowel syndrome is thought to be a multifactorial disorder, deriving from a potential multitude of etiopathogenic factors, including environmental, psychologic, and physiologic factors. This model highlights the complex, often bidirectional interplay of these factors in the experience of irritable bowel syndrome symptoms.

Irritable Bowel Syndrome: Combating a Common Complaint (video)

Irritable bowel syndrome is the most common functional gastrointestinal disorder, manifesting as abdominal pain/discomfort and altered bowel function.  Despite affecting as many as 20% of adults, a lack of understanding of etiopathogenesis and evaluation strategies results in diagnostic uncertainty. In the August 2015 issue of The American Journal of Medicine, Sayuk and Gyawali detail modern […]

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Wretched Excess: Stool-softener Abuse and Cardiogenic Shock

More is never better when patients exceed recommended dosages, but a 62-year-old woman with schizophrenia took self-medication to an extreme that might have proved fatal. She presented with acute-onset chest tightness and dyspnea after taking 40 docusate tablets, 100 mg, for constipation. Subsequently, she developed voluminous diarrhea, which precipitated progressive shortness of breath and angina. […]

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Was It the Zebu?

An exotic vacation was followed by weeks of hospitalization. A 71-year-old Italian man was admitted to the infectious diseases ward after 24 hours of bloody diarrhea. This had been preceded by 3 days of severe watery diarrhea, vomiting, and cramping abdominal pain. The patient’s symptoms began on the day he arrived in Italy from a […]

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The Missing Link

In this case, an extensive evaluation of a patient with chest symptoms identified an unusual etiology amenable to a simple treatment. A 40-year-old man presented to our clinic in Bengaluru, India, because of 15 days of fever, breathlessness, and worsening productive cough. He had been treated for repeated episodes of productive cough with intermittent nebulization […]

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A Childlike Presentation?

“Age merely shows what children we remain,” observes Johann Wolfgang von Goethe in Faust, his celebrated 2-part play. The quote accurately captures the case of an adult who presented with a classic pediatric illness, the diagnosis of which was not initially considered. A previously healthy 32-year-old man with abdominal pain and a rash made his […]

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