Educational case report

A young woman with persistent nausea, vomiting and hiccups

11.10.2021

11.10.2021: A previously healthy young women developed subacute nausea, vomiting and persistent hiccups. The underlying cause proved to be a known presentation of a rare condition. A young woman was admitted to the medical department of her local hospital after a ten-day clinical history of nausea and vomiting several times a day. The nausea was persistent and without fluctuations in intensity whether the patient was at rest, active or changing position, and she vomited after every meal. The preceding month she had been rather constipated, but otherwise felt well. She was not sensitive to light or dizzy...

A woman in her seventies with acute onset of blindness

30.09.2021

30.09.2021: A woman in her seventies underwent testing owing to pulsatile tinnitus. Two hours later, she suddenly became blind. The woman had a two-year history of pulsatile tinnitus in her left ear. The sound, which was always present, was extremely annoying and made it difficult for her to sleep, with the result that she had to take sleeping tablets and use background music to drown out the sound at night. A brain MRI at a regional hospital had shown non-specific T2 white matter hyperintensities, but no other pathology. The regional hospital had also performed digital subtraction angiography (injection...

A woman in her forties with unilateral blurred vision and pain upon eye movement

03.06.2021

03.06.2021: A woman in her forties presented with subacute onset of unilateral blurred vision with pain upon eye movement. Although findings from MRI and cerebrospinal fluid analysis were typical of demyelinating disease, the final diagnosis was a condition requiring an entirely different therapeutic approach. A previously healthy woman in her forties sought medical attention after three days of blurred vision in her left eye. This had been accompanied by mild headache and transient retrobulbar pain exacerbated by eye movements. Unilateral subacute vision loss with retrobulbar, movement-related pain in a...

A man in his forties with anal tumour and inguinal lymphadenopathy

25.05.2021

25.05.2021: A man in his late forties was examined for suspected cancer of the anal canal with spreading to inguinal lymph nodes. When biopsies failed to confirm malignant disease, other differential diagnoses had to be considered. A previously healthy man in his late forties consulted his doctor about a lump in his anus. He believed it had been there for about a year, but had not been bothered by it and had assumed that it was a haemorrhoid. In recent weeks, however, he had noticed rectal discharge, initially clear but later blood-tinged, and for the past two weeks he had also been aware of a painful...

A pregnant woman with acute abdomen

19.04.2021

19.04.2021: Abdominal pain is common in pregnancy and can be caused by anything from physiological changes to life-threatening illness. Non-obstetric conditions can be challenging to diagnose due to atypical symptoms as well as the tendency to attribute any changes to the pregnancy. There must also be a strong clinical indication for diagnostic imaging that could prove harmful to the fetus. A primigravida was admitted to the maternity ward in week 34 of pregnancy with non-traumatic acute abdomen. She was previously healthy and on no regular medications. The pregnancy had been largely uncomplicated, but...

An apathetic child with hallucinations

22.02.2021

22.02.2021: A child of late preschool age was brought to the hospital due to unexplained changes in his behaviour. The symptoms proved to be temporary, and several possible differential diagnoses were considered. A conclusive, validated diagnosis was obtained the day after admission based on additional laboratory tests. A previously healthy boy of late preschool age was admitted to the hospital because he displayed bizarre behaviour. He had ceased talking and appeared disengaged and subdued. When he left the kindergarten, he had been hyperactive and agitated. The kindergarten had been on an excursion to...

A man in his forties with impaired cognitive and circulatory function after a fall

28.01.2021

28.01.2021: Falls can be dangerous, but sometimes whatever caused the fall can be even more dangerous. Here we present the case of a man who was hospitalised after a fall, but for whom identifying the cause and appropriate treatment took some time. A man in his forties was brought to the trauma unit of a university hospital. According to the information received by the Emergency Medical Communications Centre, he had fallen down a 3–4 m slope, possibly as a result of intoxication. The ambulance team reported both cognitive and circulatory impairment. There was no information to suggest previous illness or...

A man in his seventies with dyspnoea and ataxia after BCG instillation for bladder cancer

05.01.2021

05.01.2021: BCG instillation is a common procedure in Norwegian hospitals as part of the treatment of bladder cancer. We describe a patient who developed complications as a result of the procedure and a rare condition that proved difficult to diagnose. A man in his seventies underwent intravesical instillation of bacillus Calmette-Guérin (BCG) as treatment for bladder cancer. The patient had a history of hypertension and had been a smoker for about 40 years. He had undergone treatment for oropharyngeal cancer five years ago, with no sign of recurrence. Three years ago, he underwent right upper lobectomy...

A man in his twenties with fever and severe abdominal pain below the right costal margin

14.12.2020

14.12.2020: A man in his twenties was admitted to the Department of Surgery after a six-day history of illness with fever and pain that came in waves below the right costal margin. He had known ulcerative colitis, and prednisolone had been gradually reduced and discontinued three weeks previously. The course of his illness was dramatic, and the final diagnosis unexpected. The patient had had low-grade atopic eczema as a child, and six months previously had been diagnosed as having ulcerative total colitis. Treatment had then been started with mesalazine by mouth followed by budesonide by mouth. As this...

An immunocompromised woman in her twenties with abdominal pain and vaginal discharge

09.11.2020

09.11.2020: Abdominal pain and excessive vaginal discharge are common reasons why women of reproductive age present to the primary healthcare service or gynaecological outpatient clinics. The symptoms are often caused by sexually transmitted infections that are easily diagnosed and treated. In some circumstances, however, making the correct diagnosis proves far more challenging. A woman in her early twenties was transferred to the gynaecological department from the gastroenterological department after admission due to abdominal pain and fever. She presented a 12-month history of symptoms (Table 1). For...