Speaker 1: Today's case is the mysterious collapse so forty four independent
journalists forty four years of age, presented to a eternal
medicine rotation. Chief complaint was fatigue, nausea, and hair loss
for the past week. Mister v At, previously healthy forty
four year old male, presents to the emergency department with
progressive weakness, nausea and abdomen pain and diffuse hair thinning.
He reports severe fatigue for five days, along with metallic
test metallic tests, metallic taste, dry mouth, and episodes of vomiting.
He denies recent travel, drug use, or known sick contacts.
He has no recent infections or weight loss, though he
appears mildly cachectic. He has been in the country for
one month after fleeing political persecution. He has no known
medical history. Vital signs include temperatures one hundred point six,
heart rate is ninety two, blood pressure one over four
over sixty two, respiratory rate is twenty and saturation is
ninety eight percent on room air. Physical exam general pale, tired, appealing,
mild alopecia, heaked is, oral mucositis in dry mouth, cardiac
regular rate and rhythm abdomen, mild tenderness in NLQ, no
guarding scatter of pittiche in the skin, no rash. Neurological
is alert oriented times three slight tremor in hands. Initial
via a differential diagnosis viral syndrome CMV, eb V, hippatitis.
Another one number two be heymenologic malignancy, so leukemia, heavy
metal a radiation exposure, autoimmune disease like lupus. Initial labs
order were CBC, WBC's were low, so we're platelets. WBC
was two point one times ten to the ninth Power
play Lists for eighty five CMP I'm sorry. CMP was
mildly elevated, ast A lts and low albumen. LDH was elevated.
CRP was mildly elevated. Red account was low. Vitamin B
twelve was normal. Viral panel was negative for CMV, EBV, HIV,
and HEP bone marabiopsy, hypercellure marow with aplasia, urine analysis
trace proteinuria, protein aurea, and otherwise normal over the past.
Over the next twenty four hours, the patient developed profuse diarrhea,
persistent nausea, and spiking fever, and then his hair began
falling on in clumps. Labs revealed worsening penzotitepenia, chest X
ray and abdimal abdominal ultracent are unremarkable as CT of
the abdomen reveals mild gas red intestinal wall thickening, but
no masses. Consults order rhematology, oncology, toxicology for environmental exposures
and infectious disease for atypical infections, further testing hair sample
for heavy metals and radioactive isotopes, a whole body gamma syntigraphy,
and you'ine fecal alpha radiation analysis. Critical live findings. High
levels of alpha ray detected in urine and hair samples,
no beta gamma radiation exposure. The diagnosis do you know
what it is? This actually happened to somebody who I
think it was a journalist in Russia. The acute diagnosis
is acute radiation syndrome due to intentional polonium two ten poisoning.
And the real story the mandataria and succumbed to multi
organ failures in hospital day nine at least to the
article of the case study. Again, this happened in Russia.
I can't remember. I think it was about ten years
ago or something. It was a while back ago in
Russia was Alexander Livinenko and he had radioactive polonium two
ten poisoning. The radiation damages internal organs and jest that
are put in tea and food. His symptoms were hair loss, vomiting.
Everything we talked about. It's favored because of its difficulty
to detect and trace. Well, that was it for today's
case study. Hopefully that gave you a little bit of
a challenge. That's it for now.