A 29-Year-Old Man with Anemia and Jaundice

Cabot CaseとClinical Problem-Solving、双方の聞き取りを継続することとする。

A CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL by Alberto Puig and colleagues.
A 29-year-old man was admitted to this hospital because of anemia and jaundice. 

The patient had been in his usual health until 4 days before admission, when increasing fatigue, malaise, headache, intermittent testicular discomfort, yellowed eyes, dark urine, nausea, and diffuse body aches developed and chronic leg pain worsened.

The patient had been generally well, with intermittent asthma, acne, and chronic leg pain until 4 months earlier, when he traveled from an urban area of New England to his family's home in North Africa and stayed for 3 months. While he was there, a prolonged cough productive of green sputum developed, associated with fatigue, subjective fevers, chills, drenching night sweats, and intermittent dyspnea at rest, and he reportedly had a weight loss of 9.1 kg. 

There are several features of this case that are potentially important but are not easily correlated with the patient's presentation and, hence, leave us wondering about their clinical significance. Specifically, fever, cough, and weight loss developed while the patient was visiting North Africa, where he encountered a dying brother, was exposed to sheep, and drank unpasteurized milk. In addition, his medical history is notable for a previous episode of acute anemia that occurred after surgery. We must pursue a unifying diagnosis for these findings.

聴き取りをしていて、いまさらながら、Massachusettsの綴りに自信が持てない。これはネイティヴの人も同じらしく、まぁ、日本人だって北海道のアイヌ語の地名が読めなかったりするのと同じようなもんなんだろう。他にも、Cincinnatiとか、Mississippiとか、そんな類の地名で、下のように覚えたりするらしい。

Cincinnati 

Cincinnati is a word
Hard to spell but easy heard.
It need not cause you irritation,
Just drop the ON from CIN CIN NATION. 

Massachusetts 

The simple answer to this little riddle:
Two esses, two tees, with one ess in the middle. 

Mississippi 

Four simple words will get you by:
What you'll never MISS IS SIP PI.

果たしてこれで、次回はまごつかずにMassachusettsを打てますかどうか…

今回の症例は、Wikipediaで、「グルコース-6-リン酸脱水素酵素欠損症」と「ソラマメ中毒」の項目に目を通しておくと良い。