Seeking Insights on a Medical Case
While browsing Instagram, I stumbled upon a video that caught my attention, and as a second-year medical student, I’m curious about the potential diagnosis. I decided to share the information here in hope that someone might shed light on this individual’s condition. **Patient Profile:** - **Gender:** Male - **Age:** 30 years - **Weight:** 33.2 kg (as recorded on January 22, 2026) - **Height:** 165 cm (5'5) **Chronic Symptoms:** - Experience of breathlessness - Sensation of tightness in the chest - Perception of a lump in the throat - Progressive loss of mobility, feeling as if only a fraction of energy (1%) can be produced - Light-headedness with any considerable movement - Smell and taste of burnt smoke at the back of the throat ### History Summary: - The patient was born healthy with no recorded medical issues at birth. - Since childhood, he has had a lack of appetite, often vomiting daily, attributed to poor digestion and motion sickness. - At 16, he suffered from jaundice, which persisted for nearly 14 to 17 months, characterized by two waves separated by a 3-month gap, during which he lost 10 kg. - Post-jaundice, his weight plateaued, leading to difficulty in gaining weight, though no underlying cause was determined. - At ages 19-20, he reported pain in the lower abdomen. Over the subsequent 7-8 years, numerous ultrasounds and CT scans failed to reveal any issues, although the pain gradually decreased but never fully resolved. The pain is sharp and shoots, especially when the stomach is full. - At 20, he was mistakenly diagnosed with celiac disease and eliminated gluten from his diet for the following 7-8 years. - An H. Pylori infection was identified at 28, and he received treatment for it. **Presenting Complaints:** - From **September 2024**, there has been noticeable fatigue and dizziness when laughing, along with a burnt sensation in the mouth and throat. - Beginning in **March-April 2025**, breathing problems, fatigue, dizziness, and the sensation of something lodged in the throat emerged. - **June 2025** saw significant breathing difficulties, prompting a doctor visit where it was addressed as a lung infection due to fluid and an infection in the throat. - **August 2025** marked the onset of chest tightness. - Currently, he is grappling with severe fatigue, inability to move much, chest pain, a runny nose, and fever, with symptoms exacerbating post-meals. ### Blood Test Insights: - **CBC Abnormal Results:** - Eosinophils: 6.9% (Normal range: 0-4%) - RBC count: 6.05 million - Hemoglobin: 12.1 g/dl (Normal: 13.2-17.3 g/dl) - Hematocrit: 38.3% (Normal: 39-49%) - MCV: 63.3 fL (Normal: 80-100 fL) - MCH: 20 pg (Normal: 26-34 pg) - MCHC: 31.6 g/dl (Normal: 32-36 g/dl) - RDW: 15.2% (Normal: 11.6-14.6%) - **Additional Tests Returning Normal:** - Creatinine, SGPT, Serum Electrolytes - Anti-Human Tissue Transglutaminase IgA: 2.1 CU (Threshold: 20) - **Borderline Normal Tests:** - PTT: 39 sec (Normal: 26-40 sec) - PT: 16.2 sec (Normal: 11.7-15.3 sec) - INR: 1.19 (Normal range: 0.8-1.2) ### Previous Biopsy Findings: 1. **Duodenum:** No significant findings from endoscopic biopsy. 2. **Gastric:** Mild chronic gastritis; tested positive for H. Pylori; no signs indicating intestinal metaplasia, dysplasia, or malignancy. 3. **Terminal Ileum:** No significant findings from colonoscopic biopsy. 4. **Colon:** Mild chronic nonspecific colitis; no indicators of glandular distortion, ulceration, cryptitis, or granulomas that could suggest IBD; no signs of specific infection, dysplasia, or malignancy. I would like to gather thoughts on this situation and welcome any insights into possible diagnoses or suggestions for further investigation.
Answers (1)
2/10/2026, 5:20:50 PM
OpenHealth AI
Thank you for sharing this detailed case. The symptoms and history you've provided suggest a complex medical situation that could have multiple contributing factors. While it's impossible to diagnose without proper examination and tests, I can guide you through some potential considerations and next steps.
Main Points
- Potential Diagnosis: Symptoms may be indicative of a chronic gastrointestinal issue or a respiratory condition, possibly linked to past infections or chronic inflammation.
- Blood Test Indicators: The elevated eosinophil count suggests potential allergic responses or parasitic infections, while the anemia indicated by low hemoglobin and MCV could be a consequence of chronic illness or malabsorption.
- Next Steps for Investigation: Consider targeted follow-ups based on the symptoms and blood test results.
Explanation
The symptoms of breathlessness, chest tightness, and gastrointestinal discomfort, combined with ongoing fatigue and unusual blood test results, warrant a thorough evaluation. Here are a few focal points:
- Eosinophilia may indicate allergic reactions (like asthma), parasitic infections, or chronic inflammatory conditions (like eosinophilic esophagitis).
- Low hemoglobin and MCV may suggest anemia, potentially linked to malabsorption issues from the history of gastrointestinal problems, such as the past H. pylori infection or the long-term gluten-free diet following a misdiagnosis of celiac disease.
- The sensations of tightness and 'lump' in the throat could tie to esophageal issues, allergies, or even reflux, particularly given the symptom exacerbation following meals.
Next Steps
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Monitor Symptoms: Keep a detailed diary of symptoms, noting frequency, intensity, and any exacerbating factors (like specific foods).
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Allergy Testing: Consider skin or blood tests to check for allergies affecting respiratory or gastrointestinal systems given the eosinophilia.
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Gastroenterology Follow-Up: A consultation with a gastroenterologist might be beneficial to explore possible causes of the gastrointestinal symptoms, assess for potential complications from past infections, and further investigate for conditions like eosinophilic esophagitis.
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Pulmonology Assessment: Given the respiratory symptoms, a pulmonologist could evaluate for underlying asthma, bronchitis, or other lung conditions. This may include Spirometry tests to assess lung function.
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Nutritional Assessment: Since weight gain has been a challenge, consulting with a nutritionist could help identify deficiencies and create a dietary plan that supports overall health without compromising gastrointestinal comfort.
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Regular Monitoring: Follow up on blood tests periodically to check on eosinophil counts and other parameters, especially focusing on any changes as you investigate further.
Conclusion
This situation certainly calls for a multi-faceted approach. By tracking symptoms carefully and working with specialists in allergies, gastroenterology, and pulmonology, more clarity can be gained towards an accurate diagnosis. Remember to approach each step with patience, and stay engaged with any healthcare providers involved for continuity in care.
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