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Impatient inpatient care

Article Abstract:

The case of a 62-year-old man who was ultimately diagnosed with a fungal infection called histoplasmosis illustrates the necessity of avoiding a hasty diagnosis. He was seen at a hospital for fever, headache, chills, muscle pain and difficulty urinating. A chest X-ray and CT scan revealed lung disease that his doctors first suspected was sarcoidosis. Although a fungal infection was considered, diagnostic tests seemed to rule it out. He was treated with corticosteroids, but blood samples eventually grew Histoplasma. A more accurate urinary test for Histoplasma had been ordered three times but never done.

Author: Gulati, Mridu, Saint, Sanjay, Tierney, Lawrence M., Jr.
Publisher: Massachusetts Medical Society
Publication Name: The New England Journal of Medicine
Subject: Health
ISSN: 0028-4793
Year: 2000
Case studies, Histoplasmosis

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A square peg in a round hole

Article Abstract:

The case of a 51-year-old woman illustrates the dangers of diagnosing a disease based on the pattern of signs and symptoms. She was initially diagnosed with diabetes but her severe weight loss was unexplained. A chest X-ray revealed nodules in her lungs, which her physicians suspected was blood clots from infected heart valves. However, blood cultures revealed no infection and she did not appear that ill. A CT scan of her pelvis showed a kidney mass and she was ultimately diagnosed with metastatic renal-cell carcinoma. This diagnosis could have been made much sooner if her physicians had not focused on the diagnosis of diabetes.

Author: Saint, Sanjay, Tierney, Lawrence M., Jr., Saha, Somnath
Publisher: Massachusetts Medical Society
Publication Name: The New England Journal of Medicine
Subject: Health
ISSN: 0028-4793
Year: 1998
Analysis, Carcinoma, Renal cell, Renal cell carcinoma

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Back to the basics

Article Abstract:

The case of a 34-year-old paraplegic man with abdominal pain reveals the difficulty of diagnosing appendicitis in a person with paraplegia. He had to catheterize himself to empty his bladder so when he developed abdominal pain, fever, and cloudy urine, his doctors suspected a urinary tract infection. However, he remained ill even after antibiotic treatment for urinary tract infection. His doctors still suspected something else and asked a surgeon to evaluate him. Exploratory laparoscopy revealed a ruptured appendix. He was treated surgically and recovered.

Author: Saint, Sanjay, Tierney, Lawrence M., Jr., Fisk, David T.
Publisher: Massachusetts Medical Society
Publication Name: The New England Journal of Medicine
Subject: Health
ISSN: 0028-4793
Year: 1999
Health aspects, Appendicitis, Paraplegics

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Subjects list: Diagnosis, Diagnostic errors
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