Department of Pathology, University of Oklahoma Health Sciences Center
A 54 year-old Man with Acute Onset Pain, Delusion, and Rapid Deterioration
Clinical information: The decedent was a 54-year-old male who presented in late September, 2000 with pain in his lower right back. Over the next 48 hours following his presentation, his back pain intensified and alternated with abdominal discomfort. The pain was described as sharp and needle-like. He also became restless and apprehensive. Initial evaluation disclosed pain in the flank and lower back with radiation to the groin. The patient was admitted under the clinical impression of bowel obstruction.
On physical examination, his temperature was 37.4°C. There was soft tissue swelling in the right lumbar area. There was also nausea, vomiting, abdominal cramps, and anxiety. Within three hours after admission, his conditions deteriorated and he developed dysphasia, dizziness, shortness of breath and paranoia. On the following morning, the patient became increasingly delusional and combative. There was also frothing and hyperexcitability. He was coded on the following morning and was resuscitated successfully. After a gradual decrease in heart rate, blood pressure, and respirations despite mechanical ventilatory support, he died 13 days after presentation.
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