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Clinical Problem-Solving
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Volume 356:1456-1462 April 5, 2007 Number 14
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Building a Diagnosis from the Ground Up — A 49-year-old man came to the clinic with a 1-week history of suprapubic pain and fever
Brook Watts, M.D., Pushkar Argekar, M.D., Sanjay Saint, M.D., M.P.H., and Carol A. Kauffman, M.D.

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In this Journal feature, information about a real patient is presented in stages (boldface type) to an expert clinician, who responds to the information, sharing his or her reasoning with the reader (regular type). The authors' commentary follows.

A 49-year-old man came to the clinic with a 1-week history of suprapubic pain and fever. On examination, he had a temperature of 38.1°C but appeared well. A urinalysis revealed numerous white cells, two red cells, and more than two bacteria per high-power field. A urinary tract infection was diagnosed, and oral gatifloxacin was prescribed.

Possible causes of this patient's illness include . . . [Full Text of this Article]

Commentary


Source Information

From the Louis Stokes Cleveland Veterans Affairs Medical Center and the Department of Medicine, Case Western Reserve University, Cleveland (B.W., P.A.); and the Veterans Affairs Ann Arbor Healthcare System and Department of Internal Medicine, University of Michigan, Ann Arbor (S.S., C.A.K.).

Address reprint requests to Dr. Watts at the Louis Stokes Cleveland VA Medical Center, 10701 East Boulevard, Cleveland, OH 44106, or at brook.watts@med.va.gov.


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