The Case of the Clever Composer With Persistent Jaundice

Albert Lowenfels, MD

Disclosures

September 08, 2011

The Case

The patient was a 64-year-old male composer who had previously enjoyed nearly perfect health throughout his life. His only serious illness began with painless jaundice, first detected by his friends about 9 months before his death. Although he felt well and enjoyed his meals, the patient lost weight and became noticeably thinner. His stay at a local health spa was not beneficial. His jaundice persisted for several months, resulting in a deep yellow and eventually greenish discoloration of his skin. Friends noted that his clothes hung on him like on a hanger. His liver was noted to be enlarged. The presence or absence of alcoholic stools was not observed. Despite the persistence of jaundice, he never developed hepatic coma or pruritus and died at age 64 in his home.

Medical and Family History

Medical history. As a child, he suffered from migraine headaches which became less severe as he grew older. As an adult, he was short and somewhat obese. He had 1 known attack of otitis and became transiently ill with influenza. There were no other known diseases or operations.

Personal history. The patient was a heavy user of tobacco, enjoying both cigarettes and cigars. From his teens until his final illness he drank alcohol, sometimes to the point of intoxication.

Family history. There was no known history of cancer, heart disease, or diabetes in his family. Two siblings were healthy except for a sister who also suffered from migraine attacks.

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