Take the Case Challenge

Posted by • April 13th, 2014

Peripheral-Blood Smear (Wright–Giemsa stain)

A 59-year-old man was seen in an outpatient clinic because of fatigue, abdominal pain, anemia, arthralgias, and abnormal liver function. What is the diagnosis? Is it alcohol-induced sideroblastic anemia? Lead poisoning? Or something else?

Read the case description for the next Case Record of the Massachusetts General Hospital, and then vote and comment now on NEJM.org. In a few days, find the answer in the full text of the Case Record to be published April 17.

Follow the conversation with #NEJMCases on Twitter or Facebook.

5 Responses to “Take the Case Challenge”

  1. Omar López says:

    Lead poisoning…

  2. Michael HArris says:

    probably the simplest tests be:
    urinary coproporphyrins,
    repeat fbc

    Aim to exclude
    1. Lead poisoning
    2. Acute intermittent porphyria

  3. Khalil says:

    P. Ovale/Vivax

  4. nawras says:

    Chronic lead poisoning

  5. Marcio says:

    1-acute intermittent porphyria
    2-lead poisoning
    3-polyarteritis nodosa