Patient Presenting With Fever, Vomiting, and Abdominal Pain
Patient Presenting With Fever, Vomiting, and Abdominal Pain
A 61-year-old man presented with fever, vomiting, and abdominal pain radiating to the back. He has developed pericardial and bilateral pleural effusion. All relevant blood investigations are normal. What can be the probable cause of his condition?
Chandra Mohank, MBBS, DTCD
With limited clinical and laboratory information, I believe that this man has a systemic condition of sorts. Abdominal pain radiating to the back would suggest a retroperitoneal organ, and the pancreas is a possibility. Effusions are common with pancreatitis, although pericardial effusions are unusual. The fever can be present in up to 60% of patients. Aortitis with inflammation and pain is usually associated with other vascular complaints and signs, and effusions are, again, unusual. An infective process is also a possibility. Although abdominal pain is unusual with tuberculosis (TB), TB peritonitis may be present with pain and most definitely effusions, both pericardial and pleural.
The next group of conditions to consider is the collagen-vascular disorders, such as systemic lupus. Pain in the abdomen is described on a vasculitis and enteritis basis, and the fever and effusions are common, too. Usually a disease of the younger population, lupus can occur at any age. Relevant abdominal scans, blood tests for collagen-vascular disorders, pleural tap and pericardial tap, and work-up for TB are what I think would be relevant diagnostic tests in this patient.
A 61-year-old man presented with fever, vomiting, and abdominal pain radiating to the back. He has developed pericardial and bilateral pleural effusion. All relevant blood investigations are normal. What can be the probable cause of his condition?
Chandra Mohank, MBBS, DTCD
With limited clinical and laboratory information, I believe that this man has a systemic condition of sorts. Abdominal pain radiating to the back would suggest a retroperitoneal organ, and the pancreas is a possibility. Effusions are common with pancreatitis, although pericardial effusions are unusual. The fever can be present in up to 60% of patients. Aortitis with inflammation and pain is usually associated with other vascular complaints and signs, and effusions are, again, unusual. An infective process is also a possibility. Although abdominal pain is unusual with tuberculosis (TB), TB peritonitis may be present with pain and most definitely effusions, both pericardial and pleural.
The next group of conditions to consider is the collagen-vascular disorders, such as systemic lupus. Pain in the abdomen is described on a vasculitis and enteritis basis, and the fever and effusions are common, too. Usually a disease of the younger population, lupus can occur at any age. Relevant abdominal scans, blood tests for collagen-vascular disorders, pleural tap and pericardial tap, and work-up for TB are what I think would be relevant diagnostic tests in this patient.
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