Case: History A well established, 70 year old female with prolong history of controlled hypertension with no complications. She is a smoker and takes clonidine, hctz, and estrogen. Overall, she is well and fully active.
Presentation and Examination Patient presents with fatigue for about 1 month associated with the withdrawal from estrogen because of recently publish data suggesting an increased risk of breast cancer and other complications. Exam, including review of systems, CXR, and PPD, is negative except for the following: cough with minimal sputum , a low grade fever to about 100 o , 5 pound weight loss 30 days later Additional non-specific symptoms surface: * 10 more pounds are lost * Crampy abdominal pain * T max 101 o with worsening at night * On exam, appears ill but with no localized findings Laboratory findings * WBC and differential count normal, Hct 34-30 (41six months…
