All Journals from Arup Chakraborty
A 76-year-old man was admitted to the acute medical take with a long history of tiredness. He described slowed thinking, constipation, aching thighs, dry skin, a hoarse voice, hair loss and 10 kilograms of unintentional weight loss. He had lived in Spain for 7 years and his daughter had persuaded him to return to the UK for a medical check-up.
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58 year old policeman presented with a 4 week history of cough, haemoptysis, exertional dyspnoea, ear discomfort and sore throat. He was previously healthy and taking no regular medications. He was a non-smoker and had no risk factors for coronary artery disease. He had recently completed two courses of antibiotics for a presumed ear infection. He had also experienced occasional minor epistaxis with constitutional symptoms of weight loss and night sweats over recent months. Clinical examination was unremarkable.
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The patient was initially commenced on intravenous antibiotics, aspirin, clopidogrel and low molecular weight heparin (LMWH) for a putative diagnosis of community acquired pneumonia complicated by acute coronary syndrome. However, following review of the chest x-ray and careful evaluation of the history, the diagnosis of Wegener’s Granulomatosis (WG) was considered and immunological tests were requested (table 1). Prednisolone 60mg daily was commenced pending the urgent Anti Neutrophil Cytoplasmic Antibody (ANCA) result. A palpable purpuric rash then developed over the dorsal aspects of both feet.
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Abstract
We describe a case of a 62 year old man who presented with transient loss of consciousness following exertion. On presentation to hospital, he was haemodynamically stable and was not breathless, tachycardic or hypoxic at rest. The finding of exercise-induced desaturation on pulse oximetry triggered further investigations which confirmed the presence of PE.
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