Sum of the Parts

A CLINICAL PROBLEM-SOLVING article by Meeta Prasad from Yale University School of Medicine in New Haven, Connecticut.
A 36-year-old Pakistani woman presented to the emergency room with a 10-day history of a nonproductive cough, dyspnea, and fever. She reported having no night sweats and no contact with anyone who was ill, including anyone with known tuberculosis. She had been seen 1 week earlier at a walk-in clinic, where she received a prescription for moxifloxacin for presumed bronchitis, but her symptoms persisted.
At the emergency room, she presented with petechiae, pulmonary hemorrhage, azotemia, proteinuria, and hematuria.
This case represents an uncommon presentation of a common disease. Recognizing the sum of the parts of this patient's complicated presentation ultimately led to the correct diagnosis and to effective therapy.

参考文献

• 本邦のC型慢性肝疾患におけるクリオグロブリン血症についての検討　日消誌94(4)242-247, 1997