The Writing on the Wall

A CLINICAL PROBLEM-SOLVING article by Brian Wolpin from Brigham and Women's Hospital, Boston.
A 52-year-old man presented to the emergency department with abdominal discomfort. 5 weeks earlier, nonradiating discomfort developed in the epigastric region. The patient's pain became more localized to the periumbilical area and was accompanied by early satiety and multiple episodes of vomiting. He had no fever, diarrhea, tenesmus, melena, or hematochezia.
The medical history included mild intermittent asthma that was diagnosed 20 years earlier, obstructive sleep apnea, hypertension, dyslipidemia, type 2 diabetes mellitus, hypothyroidism, and gout. A diagnosis of chronic idiopathic angioedema–urticaria was established 11 years earlier.
Palpation of the abdomen revealed mild, diffuse tenderness without rebound, guarding, or organomegaly. Laboratory findings revealed eosinophilia.
In this patient, who has gastrointestinal discomfort and a history of asthma, has traveled internationally, and has angioedema, several disorders associated with eosinophilia warrant consideration.
 An Interactive Medical Case related to this article is available at NEJM.org. With this online feature, you, user can direct investigation, select treatment and compare your performance with that of others. [Original Article]