Internal and Emergency Medicine

, Volume 13, Issue 8, pp 1233–1238 | Cite as

An unusual diagnosis in a 31-year-old man with abdominal pain and hyponatremia

  • Federica DepetriEmail author
  • Massimo Cugno
  • Giovanna Graziadei
  • Elena Di Pierro
  • Francesca Granata
  • Flora Peyvandi
  • Maria Domenica Cappellini

Case presentation

Dr. Depetri, Prof. Cugno

A 31-year-old man presented to the emergency department (ED) of Fondazione Ca’ Granda Policlinico Hospital in Milan for abdominal pain and cognitive-motor slowing.

His past medical history was positive for primary syphilis successfully treated with three doses of intramuscular penicillin. Family history was positive for immune-mediated diseases (his father was affected by IgA nephropathy and his sister suffered from autoimmune hypothyroidism). The patient was not a smoker, rarely drank alcohol, worked as an archeologist and was homosexual.

In the prior month, the patient experienced a weight loss of about 9 kg following an episode of fever. One week before presentation, while working abroad, he went to the ED of a hospital in Tubingen, Germany, because of fever, pharyngodinia, diffuse abdominal pain and lower limbs weakness. On that occasion, blood tests and abdominal ultrasound were normal. The clinical picture was considered as a viral...


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Statement of human and animal rights

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.

Informed consent

The patient gave his informed consent to his inclusion in the case report.


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Copyright information

© SIMI 2018

Authors and Affiliations

  1. 1.Medicina Interna, Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Ospedale Maggiore Policlinico, Fondazione IRCCS Ca’ GrandaMilanItaly
  2. 2.Medicina Interna, Dipartimento di Scienze Cliniche e Comunità, Università degli Studi di Milano, Ospedale Maggiore Policlinico, Fondazione IRCCS Ca’ GrandaMilanItaly

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