This Case Wears Me Out: An Athlete With An Unusual Cause Of Exercise Intolerance - Page #1

Author: Ryan Sprouse, MD
Co Author #1: Ryan A. Sprouse, MD
Co Author #2: Wade M. Rankin, DO
Editor: George Harris, MD, MS, FAMSSM, FAAFP

Patient Presentation:
A 27 year-old Caucasian male recreational athlete with gradually worsening exercise intolerance over two weeks.

A 27 year-old Caucasian male recreational athlete with gradually worsening exercise intolerance presented for evaluation. Over the prior two weeks he noticed worsening fatigue and exercise intolerance. He also noticed scleral icterus, tea colored urine, and increased heart rate at rest over this time period. He denies any fever, recent illness, neurologic symptoms, chest pain, shortness of breath at rest, abdominal symptoms, bleeding, petechiae, muscle or joint pain, rash, or weight changes. There has been no recent increase in the frequency or intensity of his activity level. His medical history is significant for an ACL reconstruction and history of Cryptosporidium-associated diarrhea. His medications include fish oil and a protein supplement. His immunizations are up to date including the annual influenza vaccine. Travel history includes a recent trip a few hours away to see family and to Africa one year prior to symptom onset, but there were no medical issues associated with either trip. He is in a monogamous relationship with his wife. There is no history of any illicit drug use or blood transfusions. Family history is non-contributory.

Physical Exam:
Vital Signs: temperature: 97.9, blood pressure: 149/70, heart rate: 76, height: 6’1”, weight: 180 lbs.
General: Pale, appearing male in no apparent distress.
HEENT: slight scleral icterus, pale buccal mucosa
Neck: no lymphadenopathy or thyromegaly
Cardiovascular: RRR with no murmur noted.
Lungs: clear in all fields.
Abdomen: non-tender, palpable splenomegaly
Neurologic: Intact with no noted deficits.
Musculoskeletal: FROM of all extremities. There were no strength deficits noted.
Skin: no petechiae or purpura were seen.

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