Infectious Disease
Case 26: A Patient with Abdominal Pain and Vomiting
CASE
A 33‐year‐old man from Somalia presented to A&E with recurrent right upper quadrant abdominal pain and vomiting. He has lived in the UK for 12 years and last visited Somalia 4 years ago. On further questioning he admitted to unintentional weight loss of over 6 kg and occasional night sweats. He denied having any chest symptoms. He was not jaundiced and was free from diarrhoea. On examination a 2 × 2 cm right axillary lymph node was palpable. He was also tender in his right upper quadrant but neither his liver nor spleen was enlarged. He was Murphy's negative.
His blood results showed an abnormal liver function test:
FBC Normal U&Es Normal Clotting Normal Bilirubin 35 µmol/L ALT 400 U/L ALP 190 U/L γ‐GT 100 U/L
Hepatitis A/B/C: negative
HIV: negative
Autoimmune screen: negative
Mantoux test: positive
He had a CT of the liver with contrast which showed intrahepatic duct dilatation and enlarged lymph nodes at the porta hepatis. His common bile duct was normal and he had a normal head of the pancreas and gall bladder. A fine needle aspiration of the lymph node showed features consistent with a caseating granuloma.
QUESTION 1
Your score this session: 0 of 0
This patient was Murphy's negative; what is he likely not to have?