The Case of the Soldier-Statesman With a Bloated Belly

Albert B. Lowenfels, MD

Disclosures

March 08, 2012

The Case

The patient was a 56-year-old military veteran and a widely respected statesman, with a chief complaint of fatigue and a reddish rash involving the palms of his hands. He had been feeling tired for several months and had had had several episodes of epistaxis, which were difficult to control. He was seen by several consultants, who recommended a minor abdominal procedure that was performed on at least 2 occasions. Ignoring the advice of his physicians, the patient continued to drink alcohol, often staying up all night to converse and drink with colleagues. On one occasion he lapsed into a coma that lasted about 1 week before he regained consciousness. At age 57 years, he again became comatose and died 18-24 months after the first onset of symptoms.

Medical History

At age 31 years, during a military engagement, the patient suffered a significant injury to the left eye that required treatment for about 1 month. At age 34 years, he was hospitalized with an illness that was thought to be malaria and to be responsible for the frequent febrile episodes occurring in his later life. He developed a painful infection of the left kidney at age 37 years. Other illnesses included an ear infection, influenza, and lifelong constipation and insomnia.

Personal and Family History

The patient was a chain-smoker and a persistent heavy drinker of a popular highly concentrated alcoholic beverage. There were no known familial diseases. Of his many brothers and sisters, only a single sister reached adulthood. The patient was married and divorced, with many adopted children.

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