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JAMA Surgery Clinical Challenge
January 2019

Patient With Unexplained Weight Loss, Anorexia, and Back Pain

Author Affiliations
  • 1Henry Ford Macomb Hospital, Charter Township of Clinton, Michigan
  • 2St. John Macomb Hospital, Warren, Michigan
JAMA Surg. 2019;154(1):85-86. doi:10.1001/jamasurg.2018.3191

A 74-year-old man presented to the primary care physician with a 3-month history of weight loss, anorexia, and back pain. His medical history was significant for hypertension, hyperlipidemia, and kidney stones. His surgical history was significant for a bilateral staged carotid endarterectomy in 1999 and 2000 and an open repair of a 7.4-cm transverse diameter juxtarenal abdominal aortic aneurysm with a knitted Dacron tube graft (18 mm) in 2014. Ligation of the left renal vein adjacent to the inferior vena cava was performed to gain proximal control of the aorta. The patient underwent extraction of a tooth secondary to an abscess 4 months earlier. Physical examination revealed poor dental hygiene and findings in the lower extremity suggestive of postthrombotic syndrome. The patient was afebrile with a heart rate of 108 beats per minute and a leukocyte level of 11 600/cm (normal range, 4000-11 000/cm), with 84% polymorphic neutrophils (normal, <75%); erythrocyte sedimentation rate was 57 mm/h (normal range, 0-10 mm/h), and C-reactive protein level was 15.9 mg/dL (normal, <0.6 mg/dL [to convert to nmol/L, multiply by 9.524]). Computed tomography (CT) of the abdomen and pelvis was performed (Figure 1A and B).

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