Diagnose This #20

Hey guys, and welcome back to Diagnose This! Sorry for the late post, we have had some technical difficulties getting this one done :(.

Anyways, to last week’s case. Here is what we were wanting from the history:

Alex Jones, 59 year old male, works as a gardener.

He has presented to the GP with complaining of abdominal pain for the past 3/12. W: Upper right abdomen; W: Approx. 3 months ago, no trauma associated or anything significant. Q: Dull ache that does not radiate; Q: about a 6/10 constantly. A: nausea, a slight itch, low-grade fever; A: Pain killers help, otherwise nothing changes the pain. B: Not sure. I: Impacting on work and home life. C: Concerned it is something serious. E: to figure out what is going on.

Significant positives include, as mentioned above; recent jaundice, abdominal pain, some nausea with no vomiting, a loss of appetite, some muscle aches and pains, and a history of travel to Indonesia recently. Significant negatives include; no haematemesis, no changes in stool, no change in bowel habits, no cardiovascular/resp/urinary symptoms.

PMHx is unremarkable, vaccines are up to date but he is not sure about travel vaccines. FMHx is unremarkable, and his medication Hx is only significant for occasional paracetamol use. He has a 30 pack year smoking history and has approx. 5 cans of beer a week. He has no history of IVDU, but does admit that he did have some unprotected sex with a sex worker whilst on holidays. He asks you not to tell his wife of 35 years. Otherwise, SHx is unremarkable as well; married with 3 kids, financially secure, wife still working, children not at home, BMI of about 27.

On examination you find he has a temperature of 37.5C, HR 89, and BP 145/88. He appears unwell and in pain, and has a slight yellowy tinge to his skin. Positive findings include jaundice, icterus, scratch marks up the arms, a maculopapular rash over his body, and hepatosplenomegaly.

What else would you like to know/what are your differentials? What investigations would you like to see performed? What do you think the results of said investigations would be?

Hopefully you all have a bit more of an idea of what this man has, so tune in next week to see the investigation results!

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