Question

On December 9th of 2017, I was on the phone with one of my best friends, Katie. Katie called me out of the blue to “pick my brain” about the stomach pain she was having for a few weeks. She said that she couldn’t pinpoint the pain – that it seemed to sometimes be in her lower abdominal area, and sometimes, right underneath her ribs.

Earlier that day, she had gone to her OBGYN for an exam, concerned that it might be uterine fibroids, or an ovarian cyst. Her mother started suffering from these at around her age, and had a hysterectomy at age 45. Nothing was found and all tests were negative. However, the doctor did note that Katie had lost 15 pounds since her appointment only 3 months earlier. She attributed this to starting a new job, and going to the gym more regularly. She also realized that she had skipped her previous two menstrual cycles, despite being on oral birth control that she took faithfully.

I asked Katie when she thought the stomach pain came on. She said she first noticed it when she returned from an overseas trip. I was curious and concerned if Katie had developed gastritis from an infectious organism during her travel. As she thought about it, she realized that she may have been having symptoms for a few months that she was just attributing to stress and anxiety, such as decreased appetite, weight loss and occasional nausea. I encouraged her to see a gastroenterologist. However, I received a text only a day later that Katie was in the ER, as she had thrown up everything she tried to eat in the past 24 hours.

Some stats on Katie at the time:

28 year-old female

5’2”

100 lbs (if that)

Moderate social drinking, but hadn’t for a month

No smoking

Very balanced, healthy diet, rich in fiber and low in fat

Worked in an office as a Clinical Research Coordinator

What is the possible disease Katie has based off of her history. Find the differential diagnosis without any lab tests.

Answer 1

Symptoms: Vague abdominal pain, loss of weight, skipped menstrual cycles, decreased appetite, nausea and vomitting.

What we know: She came back from an overseas trip. No ObsGynae cause. Family history of fibroids and ovarian cyst.

It seems she suffers from abdominal TB. All the symptoms fit in. The only thing is there is no history of fever. In a case of TB there should be a history of evening rise of temperature. Otherwise everything is good and she acquired the infection in her oversea trip if it was to a third world country.

The other differential diagnoses are: Hereditary Non polyposis colorectal cancer(HNPCC), because women with fibroids and ovarian cysts have a predisposition for developing HNPCC due to the susceptible gene associated with these disorders. As her mother had it she may have inherited the gene and hence was predisposed and is now suffering from HNPCC. The other D/D can be Pernicious anemia , metastatic growths in GI tract leading to GI loss of blood and amenorrhea, Or any infectious gastritis leading to GI loss of blood and GIT obstruction