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A 22-year-old woman was admitted to the medicine service with generalised abdominal pain and nausea. Medical history included a recent motor vehicle accident resulting in multiple orthopaedic injuries and development of a chronic pain syndrome. The patient denied other pertinent medical, social or family history. Medications included escitalopram, cyclobenzaprine, and oxycodone 10 mg every 6 hours as needed for pain.
The patient’s initial vitals were temperature 37.3°C, heart rate 81 beats/min, respiratory rate 16 breaths/min, and blood pressure 89/59 mm Hg. Pertinent physical exam included diffuse tenderness to palpation of the abdomen without peritoneal signs and no skin hyperpigmentation. Laboratory evaluation revealed a normal complete blood count, basic metabolic panel, liver function, urinalysis, and lipase. A CT scan of the abdomen and pelvis …
Contributors JF, JC and DB all contributed to the assessment and management of the patient, as well as the conception and drafting of the manuscript.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.