02.05.2022: A man in his twenties was admitted to the Department of Surgery for abdominal pain with intermittent worsening over 12 hours. Investigation revealed a disorder rarely seen in Norwegian hospitals. The patient was a man in his twenties from the Middle East who had lived in Norway for the past few years. He did not speak good Norwegian, so the case history was taken in English. He had been previously healthy, had no allergies and was not taking any drugs, medication or dietary supplements. There were no known diseases in the family. The patient was referred from the primary care out-of-hours...

22.03.2022: A woman contacted the emergency medical communication centre in the morning with chest pain and dyspnoea. Her condition rapidly deteriorated and became life-threatening in less than an hour. In an urgent situation with combined respiratory and circulatory failure, it is essential to take a broad approach and not to tie oneself to the initial differential diagnosis. The patient was a woman in her forties with known Crohn's disease, chronic pain and short bowel syndrome following repeated surgery for stenoses. Her remaining small bowel length was 170 cm, and she had also undergone resection of...

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...

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...

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...

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...

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...

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...

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...

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...

08.10.2020: A man in his fifties with advanced Parkinson's disease showed a sudden and marked exacerbation of motor symptoms, and altered mental status. Therapeutic intervention produced only transient improvement. The cause was a rare and serious condition related to both the underlying disease and its treatment. The patient was admitted to the neurological department of the local hospital for adjustment of his Parkinson's disease medication owing to increasing motor fluctuations – bradykinesia and rigidity alternating with dyskinesias – as well as anxiety and impaired sleep. He had been diagnosed with...

22.09.2020: When assessing patients with fever and rash, the patient history, symptoms and the results of the clinical examination and supplementary tests must all be considered in combination. Here we present a patient in whom microbiological findings were crucial for the correct clinical diagnosis. A more thorough anamnesis could probably have led to more rapid clarification. A previously healthy woman in her twenties was referred to the medical ward from the out-of-hours primary health care service after a 3-day history of fever, continuous headache, dizziness and nausea without vomiting. She had no...

29.06.2020: A woman in her sixties sustained a cut to the patella and developed bursitis. The infection was treated and she was followed up as an outpatient. However, the bursitis recurred and the disease course was complicated by sepsis, disseminated intravascular coagulation and multiorgan failure. A previously healthy woman in her sixties fell and hit her right knee, sustaining a 5 cm long cut over the patella. The wound was cleansed and sutured in Accident and Emergency (A&E), and tetanus prophylaxis was administered. One week later, the patient attended A&E again with clinical signs that the wound...

04.06.2020: A girl of early primary school age was admitted to the paediatric department after an acute onset of dizziness, numbness in the right arm, and word-finding difficulties. The symptoms had abated upon admission, but the girl would nevertheless prove to be seriously ill. The girl had a history of constipation and reactive airway disease, and was being monitored by a dentist because of hypomineralised tooth enamel. She was also extremely afraid of healthcare workers, which her parents suspected was the result of previous attempts to take blood samples. Ten weeks prior to the episode in question...

25.05.2020: A man was hospitalised several times with loss of consciousness accompanied by involuntary movements. He would then experience confusion, with episodes of visual and auditory hallucinations. His condition was attributed on several occasions to substance use, but eventually a rare disease was suspected, for which effective treatment is available. The partner of a previously healthy man in his twenties came home one day to an intense and unpleasant smell. She followed traces of vomit into the bedroom where she found her partner on the floor, unresponsive and agitated, and soiled with vomit and...

20.04.2020: Children with neurodegenerative diseases progressively lose skills and develop new somatic and psychiatric symptoms. Recurring obsessive thoughts and compulsive acts may occur. There is effective treatment for this disorder, but it is not known whether this kind of treatment benefits children with neurodegenerative disease. A child was brought by its parents for a consultation at the local hospital after they had observed an increasing need for control over the past year. The child insisted on performing many acts itself, in very definite ways and repeatedly. The acts were particularly...