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Speaker 1: Today's case is the mysterious collapse so forty four independent

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journalists forty four years of age, presented to a eternal

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medicine rotation. Chief complaint was fatigue, nausea, and hair loss

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for the past week. Mister v At, previously healthy forty

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four year old male, presents to the emergency department with

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progressive weakness, nausea and abdomen pain and diffuse hair thinning.

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He reports severe fatigue for five days, along with metallic

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test metallic tests, metallic taste, dry mouth, and episodes of vomiting.

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He denies recent travel, drug use, or known sick contacts.

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He has no recent infections or weight loss, though he

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appears mildly cachectic. He has been in the country for

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one month after fleeing political persecution. He has no known

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medical history. Vital signs include temperatures one hundred point six,

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heart rate is ninety two, blood pressure one over four

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over sixty two, respiratory rate is twenty and saturation is

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ninety eight percent on room air. Physical exam general pale, tired, appealing,

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mild alopecia, heaked is, oral mucositis in dry mouth, cardiac

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regular rate and rhythm abdomen, mild tenderness in NLQ, no

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guarding scatter of pittiche in the skin, no rash. Neurological

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is alert oriented times three slight tremor in hands. Initial

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via a differential diagnosis viral syndrome CMV, eb V, hippatitis.

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Another one number two be heymenologic malignancy, so leukemia, heavy

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metal a radiation exposure, autoimmune disease like lupus. Initial labs

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order were CBC, WBC's were low, so we're platelets. WBC

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was two point one times ten to the ninth Power

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play Lists for eighty five CMP I'm sorry. CMP was

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mildly elevated, ast A lts and low albumen. LDH was elevated.

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CRP was mildly elevated. Red account was low. Vitamin B

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twelve was normal. Viral panel was negative for CMV, EBV, HIV,

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and HEP bone marabiopsy, hypercellure marow with aplasia, urine analysis

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trace proteinuria, protein aurea, and otherwise normal over the past.

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Over the next twenty four hours, the patient developed profuse diarrhea,

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persistent nausea, and spiking fever, and then his hair began

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falling on in clumps. Labs revealed worsening penzotitepenia, chest X

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ray and abdimal abdominal ultracent are unremarkable as CT of

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the abdomen reveals mild gas red intestinal wall thickening, but

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no masses. Consults order rhematology, oncology, toxicology for environmental exposures

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and infectious disease for atypical infections, further testing hair sample

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for heavy metals and radioactive isotopes, a whole body gamma syntigraphy,

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and you'ine fecal alpha radiation analysis. Critical live findings. High

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levels of alpha ray detected in urine and hair samples,

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no beta gamma radiation exposure. The diagnosis do you know

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what it is? This actually happened to somebody who I

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think it was a journalist in Russia. The acute diagnosis

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is acute radiation syndrome due to intentional polonium two ten poisoning.

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And the real story the mandataria and succumbed to multi

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organ failures in hospital day nine at least to the

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article of the case study. Again, this happened in Russia.

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I can't remember. I think it was about ten years

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ago or something. It was a while back ago in

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Russia was Alexander Livinenko and he had radioactive polonium two

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ten poisoning. The radiation damages internal organs and jest that

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are put in tea and food. His symptoms were hair loss, vomiting.

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Everything we talked about. It's favored because of its difficulty

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to detect and trace. Well, that was it for today's

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case study. Hopefully that gave you a little bit of

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a challenge. That's it for now.