17. Missing the Forest for the Trees

  1. James C. Pile3,
  2. Thomas E. Baudendistel4 and
  3. Brian J. Harte5
  1. Satish Gopal1,
  2. James C. Pile3 and
  3. Daniel J. Brotman2

Published Online: 21 MAR 2013

DOI: 10.1002/9781118483206.ch17

Clinical Care Conundrums: Challenging Diagnoses in Hospital Medicine

Clinical Care Conundrums: Challenging Diagnoses in Hospital Medicine

How to Cite

Gopal, S., Pile, J. C. and Brotman, D. J. (2013) Missing the Forest for the Trees, in Clinical Care Conundrums: Challenging Diagnoses in Hospital Medicine (eds J. C. Pile, T. E. Baudendistel and B. J. Harte), John Wiley & Sons, Inc., Hoboken, NJ, USA. doi: 10.1002/9781118483206.ch17

Editor Information

  1. 3

    Departments of Hospital Medicine and Infectious Diseases, Cleveland Clinic, Cleveland, Ohio, USA

  2. 4

    Department of Medicine, Kaiser Permanente Medical Center, Oakland, California, USA

  3. 5

    South Pointe Hospital, Cleveland Clinic Health System, Warrensville Heights, Ohio, USA

Author Information

  1. 1

    Department of Internal Medicine, Norwalk Hospital, Norwalk, Connecticut, USA

  2. 2

    Department of Medicine, Johns Hopkins Hospital, Baltimore, Maryland, USA

  3. 3

    Departments of Hospital Medicine and Infectious Diseases, Cleveland Clinic, Cleveland, Ohio, USA

Publication History

  1. Published Online: 21 MAR 2013
  2. Published Print: 15 MAR 2013

Book Series:

  1. Hospital Medicine: Current Concepts

Book Series Editors:

  1. Scott A. Flanders and
  2. Sanjay Saint

ISBN Information

Print ISBN: 9780470905654

Online ISBN: 9781118483206

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Keywords:

  • clinical diagnosis;
  • enteric vasculitis;
  • hepatitis;
  • lupus enteritis;
  • neutropenia;
  • systemic lupus erythematosus (SLE)

Summary

A multisystem disease such as systemic lupus erythematosus (SLE) requires a comprehensive history, physical exam, and review of systems to establish a correct diagnosis. The chapter discusses a case study, where an extensive evaluation was necessary to exclude other etiologies of abdominal pain and systemic illness, particularly as infectious and neoplastic conditions occur far more often than lupus enteritis in the general population. The cohesively abnormal “forest” may have been obscured by erratically abnormal individual “trees”. Abdominal pain occurs in up to 40% of patients with SLE, but mesenteric vasculitis is the cause in fewer than 1%. Neutropenia is often a result of myelotoxicity from immunosuppressive therapy, rather than SLE itself. Enteric vasculitis due to SLE is challenging to diagnose. Serologic tests and routine imaging results are nonspecific, and angiography may be normal. Diagnosis relies on searching for other clues to systemic involvement by SLE and reasonably excluding alternative disorders.