Case 7-2011 — A 52-Year-Old Man with Upper Respiratory Symptoms and Low Oxygen Saturation Levels  

Oleh:

Pallais, J. Carl ; Mackool, Bonnie T. ; Pitman, Martha Bishop

Jenis: Article from Journal - ilmiah internasional
Dalam koleksi: The New England Journal of Medicine (keterangan: ada di Proquest) vol. 364 no. 10 (Mar. 2011), page 957-966.
Topik: Headache; Nasal; Sinus Congestion

Ketersediaan

Perpustakaan FK Nomor Panggil: N08.K.2011.01 Non-tandon: 1 (dapat dipinjam: 0) Tandon: tidak ada

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Dr. Roby P. Bhattacharyya (Medicine): A 52-year-old man was seen in the urgent care outpatient medical clinic at this hospital because of upper respiratory symptoms. The patient had been in his usual state of health until 3 days earlier, when subjective fever, fatigue, headache, nasal and sinus congestion, sore throat, and a nonproductive cough developed. Three days later, he came to the outpatient clinic. He did not have chills, gastrointestinal symptoms, shortness of breath, wheezing, night sweats, or chest discomfort, and he reported that his respiratory symptoms were not as severe as those he had had during a previous episode of pneumonia. The patient had had type 1 diabetes mellitus for 17 years, for which he was followed at another hospital. Control of blood glucose levels had been poor, despite low hemoglobin A1c measurements; glycemic control was followed by measuring the levels of plasma fructosamine. Eight years before this evaluation, he had an episode of prolonged altered consciousness and somnolence, associated with a fasting blood sugar level of 49 mg per deciliter (2.7 mmol per liter); his condition improved slowly after the administration of glucagon and intravenous glucose. Eighteen months before this evaluation, he had an episode of transient expressive aphasia and was treated briefly with valproic acid. He also had hypertension, exercise-induced angina, hyperlipidemia, hyperbilirubinemia of more than 8 years' duration, glaucoma, and dermatitis herpetiformis, for which he had taken dapsone for more than 8 years. Testing for serum endomysial antibodies had been positive, and he had briefly tried a gluten-free diet but had not adhered to it. He had migraine headaches, atypical chest pains, and peripheral neuropathy with mildly diminished vibratory sensation in his feet. Episodes of elevated aminotransferase levels had occurred 18 months, 8 months, and 2 months before this evaluation, after the initiation of valproic acid, simvastatin, and atorvastatin, respectively. A screening colonoscopy had revealed diverticulosis and a tubular adenoma (4 mm in diameter), which had been excised.

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