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Clinical Problem-Solving

Hunting for a Diagnosis

List of authors.
  • Nathan Houchens, M.D.,
  • Sarah Hartley, M.D.,
  • Scott P. Commins, M.D., Ph.D.,
  • Dru Claar, M.D.,
  • and Sanjay Saint, M.D., M.P.H.

A 47-year-old man in Michigan presented to the ED with a 1-day history of presyncope, swelling of the eyelids, and diffuse pruritic rash. He reported a 3-week history of postprandial watery bowel movements and a 5-day history of diffuse, crampy abdominal pain.

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Funding and Disclosures

Disclosure forms provided by the authors are available with the full text of this article at NEJM.org.

Dr. Commins reports receiving fees for serving on a speakers’ bureau from Genentech; and Dr. Saint, receiving honoraria from ISMIE Mutual Insurance Company and advisory board fees from Doximity and Jvion. No other potential conflict of interest relevant to this article was reported.

Author Affiliations

From the Veterans Affairs (VA) Ann Arbor Healthcare System Medicine Service (N.H., S.H, D.C., S.S.), the Department of Internal Medicine, University of Michigan Medical School (N.H., S.H, D.C., S.S.), and the Department of VA Health Services Research and Development Center of Excellence (S.S.) — all in Ann Arbor; and the Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill (S.P.C.).

Address reprint requests to Dr. Houchens at the VA Ann Arbor Healthcare System Medicine Service, 2215 Fuller Rd., Mail Code 111, Ann Arbor, MI 48105, or at .

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