21. In the Face of it all

  1. James C. Pile3,
  2. Thomas E. Baudendistel4 and
  3. Brian J. Harte5
  1. Amit Garg4,
  2. Thomas E. Baudendistel4 and
  3. Gurpreet Dhaliwal1,2

Published Online: 21 MAR 2013

DOI: 10.1002/9781118483206.ch22

Clinical Care Conundrums: Challenging Diagnoses in Hospital Medicine

Clinical Care Conundrums: Challenging Diagnoses in Hospital Medicine

How to Cite

Garg, A., Baudendistel, T. E. and Dhaliwal, G. (2013) In the Face of it all, 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.ch22

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 Medicine, University of California, San Francisco, California, USA

  2. 2

    Medical Service, San Francisco VA Medical Center, San Francisco, California, USA

  3. 4

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

  • amyloidosis;
  • bilirubin;
  • diarrhea;
  • elevated alkaline phosphatase;
  • hepatomegaly;
  • numb chin syndrome (NCS);
  • weight loss

Summary

This chapter presents a case study of a 59 year-old man with chronic diarrhea and an acute elevation in serum creatinine. Acute diarrhea is commonly due to a self-limited and often unspecifed infection and when it extends beyond 2–3 weeks, it warrants consideration of malabsorptive, infammatory, infectious, and malignant processes. Hospitalists should consider systemic amyloidosis in cases of unexplained diarrhea when other clinical features of AL amyloidosis are present, including nephrotic syndrome with or without renal insufficiency, cardiomyopathy, peripheral neuropathy, and hepatomegaly. Hepatic amyloidosis should be suspected when weight loss, hepatomegaly, and elevated alkaline phosphatase are present. Although jaundice is rare in amyloidosis, liver involvement and hyperbilirubinemia portend a poorer prognosis. Numb chin syndrome (NCS), and bilateral facial diplegia are rare manifestations of AL amyloid deposition in peripheral nerves. The chapter also presents a table that indicates the most common findings in patients with AL amyloidosis.