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A 58-Year-Old Man With a Rash and Elevated Creatinine Levels
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F. Gerald Wade, MD; Elie Ghoulam, MD; Thomas Fay, MD; George Vasquez Rios, MD; Kamran Qureshi, MD
October 02, 2019
Editor’s Note:
The Case Challenge series includes difficult-to-diagnose conditions, some of which are not frequently encountered by most clinicians but are nonetheless important to accurately recognize. Test your diagnostic and treatment skills using the following patient scenario and corresponding questions. If you have a case that you would like to suggest for a future Case Challenge, please contact us.
The patient is a 58-year-old man with a medical history of hypertension, untreated chronic hepatitis C virus (HCV) infection, and end-stage renal disease secondary to hypertensive nephropathy. He was on hemodialysis for 3 years while awaiting kidney transplant. After discussion, he agreed that he would accept a kidney from an HCV-positive donor. He underwent deceased donor kidney transplant within a month of agreeing to accept an HCV-positive organ. His surgery was uncomplicated, and he did not need dialysis posttransplant. He followed up with transplant and nephrology specialists for his posttransplant care. About 3 months after transplant, he was noted to have new elevations in his creatinine levels.
The patient reported that he felt generally weaker than usual over the past month and had mild bilateral knee pain. He also has a new rash (Figure 1).
Figure 1.
The patient denied shortness of breath, chest pain, trouble urinating, frequent urination, dysuria, blood in the urine, back or flank pain, lower-extremity swelling, or confusion. He reported drinking plenty of fluids and denied any recent illness. He reportedly adhered to his prescribed medications. His medications include lisinopril, amlodipine, hydrochlorothiazide, tacrolimus, prednisone, and mycophenolate mofetil. He has no known medication allergies. He denied alcohol, cigarette, or illicit drug use.
Medscape © 2019 WebMD, LLC
Any views expressed above are the author’s own and do not necessarily reflect the views of WebMD or Medscape.
Cite this: F. Gerald Wade, Elie Ghoulam, Thomas Fay, et. al. A 58-Year-Old Man With a Rash and Elevated Creatinine Levels – Medscape – Oct 02, 2019.
Internal Medicine Resident, Department of Medicine, Saint Louis University, St Louis, Missouri
Disclosure: F. Gerald Wade, MD, has disclosed no relevant financial relationships.
Internal Medicine Resident, Department of Medicine, Saint Louis University, St Louis, Missouri
Disclosure: Elie Ghoulam, MD, has disclosed no relevant financial relationships.
Resident, Department of Pathology, Saint Louis University, St Louis, Missouri
Disclosure: Thomas Fay, MD, has disclosed no relevant financial relationships.
Internal Medicine Resident, Department of Medicine, Saint Louis University, St Louis, Missouri
Disclosure: George Vasquez Rios, MD, has disclosed no relevant financial relationships.
Assistant Professor, Department of Internal Medicine, Division of Gastroenterology and Hepatology, Transplant Hepatology, Saint Louis University, St Louis, Missouri
Disclosure: Kamran Qureshi, MD, has disclosed no relevant financial relationships.
Figure 1.
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A 58-Year-Old Man With a Rash and Elevated Creatinine Levels
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A note for you if you pursue CPA licence, KEEP PRACTICE with the MANY WONDER HELPS I showed you. Make sure to check your works after solving simulations. If a Cashflow statement or your consolidation statement is balanced, you know you pass right after sitting for the exams. I hope my information are great and helpful. Implement them. They worked for me. Hey.... turn gray hair to black also guys. Do not forget HEALTH?
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