In instances of rare disease, clinical suspicion plays a critical role in preventing delays in diagnosis that can lead to unwanted complications and disease progression.A 41-year-old woman presented to an outside medical facility with 4 days of progressive dry cough, fever of 101°F, fatigue, myalgias, and mild exertional dyspnea. After a chest x-ray showed left lower-lobe consolidation with parapneumonic effusion, she was admitted for treatment of pneumonia. Computed tomography imaging of the abdomen performed to evaluate the cause of abdominal pain and distention revealed hepatosplenomegaly and moderate ascites. Thoracentesis demonstrated exudative pleural effusion, and a left chest tube was placed for drainage. A left subclavian central venous line was placed after attempts to install a left internal jugular line failed. The abdominal distention and pain continued to worsen, however, and the patient was transferred to our hospital for further evaluation on day 10 of admission.
The patient’s medical history was additionally notable for mild jaundice over the previous year, with simultaneous onset of intermittent brown-colored urine; 4 years of generalized fatigue; 4 miscarriages; and a normal birth after progesterone treatment.
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— Bibhu D. Mohanty, MD, Carlos M. De Castro, MD
This article originally appeared in March 2012 issue of The American Journal of Medicine.
