The Case of the Jaundiced Musician

[aimeee, BSN, RN]

I found this fun little case study on a medical journal site. I'll post the answers tomorrow.

The Case of the Jaundiced Musician

from Medscape Surgery

Posted 08/19/2003

Albert B. Lowenfels, MD

Introduction

Chief Complaint: A 57-year-old white male musician presents with a chief complaint of vomiting and swelling of the legs and abdomen. The patient is short (168 cm), stocky, pale, and deeply jaundiced. He is awake, responds to questions, but is drowsy. The skin is jaundiced with petechial hemorrhages over the abdomen, and there is marked scleral icterus. He has a hearing deficit at all frequencies. On auscultation of the chest there are some basal rales. The abdomen is without scars and there is massive ascites. After abdominal paracentesis, a firm irregular liver is palpated upon deep inspiration. His spleen is palpable below the left costal margin.

Past History: His illness dates back 4 months, characterized over the past few weeks by progressive weakness, increased swelling of the abdomen, marked swelling of the legs, recurrent febrile episodes (fever and chills), and gradually increasing jaundice. He had a long history of gastrointestinal complaints beginning at age 21 years, when he had an initial attack of abdominal pain accompanied by diarrhea, followed by similar attacks every few years. Four years prior to the present illness he experienced abdominal pain, vomiting, and jaundice; the jaundice persisted for a few months. Initially, alcohol alleviated the pain, but as the attacks became more frequent, alcohol exacerbated the symptoms.

At age 17, he had an attack of what appeared to be asthma. He had experienced frequent attacks of joint pain and "gout" and occasional bouts of diarrhea. At age 53, he experienced a painful ocular condition leading to diminished visual acuity. His mother died of tuberculosis when the patient was 16 years old; his father died of complications of alcoholism. He reported being a pipe smoker and consuming alcohol regularly, sometimes as much as a liter of wine per day.

Disease Course: During the 4-month interval from the onset of current symptoms until death, the patient had recurrent attacks of abdominal pain, vomiting, and diarrhea. He also had an attack of pneumonia. His jaundice persisted and he required paracentesis on 4 occasions. About a week before his death, he developed massive edema, fever, and diminished urinary output. About 48 hours before his death, he lapsed into a progressively deepening coma. An autopsy was performed on the day following the patient's death.

1. Who was our mystery patient?

A) Enrico Caruso

B) Wolfgang Amadeus Mozart

C) Kurt Cobain

D) Ludwig van Beethoven

2. Which of the following diseases is least likely to be present?

A) Pancreatitis

B) Cirrhosis of the liver

C) Stomach cancer

D) Inflammatory bowel disease

3. Which of the findings is least likely to be explained by heavy drinking?

A) Hearing deficit

B) Jaundice

C) Ascites

D) Coma

[gwenith, BSN, RN]

HMMMM Interesting well i will give it a bash

1. The only one I can rule out is Mozart because he was younger than 57 when he died. Hmmm Beethoven was deaf so I guess D

Diseases - gotta go for the cirrhosis of the liver

Which symptom is least likely to be explained by the heavy drinking well loss of hearing could CAUSE heavy drinking simply because they cannot hear you saying - YOU HAVE GOT TO STOP DRINKING!

[Ahhphoey]

I ruled out Kurt Cobain and Mozart and also believe it was Beethoven. For question 2, I am guessing D. As for the last question, my answer is A.

[PennyLane, RN]

Who is Enrico Caruso?

Mozart was only 35 when he died.

Kurt Cobain committed suicide.

I have heard theories that Beethovan had lead poisoning from drinking mineral water at spas.

Verrrry interesting thread. I'm interested to see the answer.

[jemb]

I, too, picked Beethoven. Lest likely disease present I'd say is D, and the finding least likely to be explained by heavy drinking - A.

When do we get the answer?

[aimeee, BSN, RN]

Originally posted by jemb

When do we get the answer?

I'll post them tomorrow after a few more people get a chance to read the thread. :)

[CashewLPN, LPN]

um... I say beethoven... ok why?

1) enrico caruso is an opera singer...

2) mozart died too young....

3) Kurt Cobain Shot himself (Suicidal grunge rocker... died in 1991)

4) Mr. Beethoven was crippled with progressive deafness...

next...

ok... least likely illness...

um... I say D....

and.... the last one....

A.... Wasnt he progressively deaf from abusing his ears? like, staying in a way too loud room for way too long...

--Barbara

[pickledpepperRN]

Well Mozart & Cobain died before age 53.

I think Enrico Caruso, the Italian Tenor who recorded from 1902 to 1920 died at age 53. (Do I get extra credit for knowing who he was?)

Beethoven did lose his hearing. (Gwenith I laughed at your " YOU HAVE GOT TO STOP DRINKING!"

Just guessing it wa Beethoven, Inflammatory bowel disease (least likely), Hearing deficit (also least likely).

Anticipating the answers.

[night owl]

Well I picked Beethoven because he was 57 when he died. Least likely disease to be present I'd say D, and hearing loss (A) as least likely to be explained by heavy drinking.

Read an interesting article on Beethoven's death a few months ago that said he most likely died of Sarcadosis.

[gwenith, BSN, RN]

That'll teach me to post late at night - question 2 says LEAST likely disease:rolleyes:

[Katnip, RN]

Beethoven. Caruso died in 1921 at age 48. The others were way too young as pointed out by others.

Least likely, I'd say D, inflammatory bowel disease.

Least likely cause by drinking, hearing deficit.

[PennyLane, RN]

I also heard another theory that Beethovan had a growth problem--like acromegaly??-- but it affected the bones in his head, and that's what lead to his hearing loss.