CASE 52: GENERAL WEAKNESS
History
An 82-year-old man is sent up to the emergency department by his general practitioner
(GP). He is complaining of weakness and general malaise. He has complained of general
pains in the muscles and he also has some pains in the joints, particularly the elbows, wrists
and knees. Three weeks earlier, he fell and hit his leg and has some local pain related
to this.
He is a non-smoker who does not drink any alcohol and has not been on any medication.
Twelve years ago he had a myocardial infarction and was put on a beta-blocker but he has
not had a prescription for this in the last 6 years. Twenty years ago he had a cholecystec-
tomy. He used to work as a labourer until his retirement at the age of 63 years.
He lives alone in a second-floor flat. His wife died 5 years ago. He has one son who lives
in Ireland and whom he has not seen for 3 years.
Examination
He is tender over the muscles around his limb girdles and there is a little tenderness over
the elbows, wrists and knees. The mouth looks normal except that his tongue appears rather
smooth. He has no teeth and has lost his dentures. There are no other abnormalities to find
in the cardiovascular, respiratory or alimentary systems. In the legs, he has a superficial
laceration on the front of the right shin. This is oozing blood and has not healed. There is
a petechial rash on some areas of the legs. There are some larger areas of bruising on the
arms and the legs which he says have not been associated with any trauma.
NormalHaemoglobin 10.1 g/dL 13.7–17.7 g/dL
Mean corpuscular volume (MCV) 74 fL 80–99 fL
White cell count 7.9% 109 /L 3.9–10.6% 109 /L
Neutrophils 6.3% 109 /L 1.8–7.7% 109 /L
Lymphocytes 1.2% 109 /L 1.0–4.8% 109 /L
Platelets 334 % 109 /L 150–440% 109 /LINVESTIGATIONS
Questions
- What essential area of the history is not covered above?
- What is the likely diagnosis?