Alcohol/Drug Abuse

A 36-year-old man was admitted to the hospital with acute mid-epigastric pain and vomiting. He was a heavy drinker and had smoked between 50 and 60 cigarettes a day for the last 15 years.

The pattern of pleural calcification and the patient's history are helpful in determining the usually remote cause of the calcification. Here, Drs Mahesh Duggal, Achal Dhupa, Krishna Badhey, and Arunabh of North Shore University Hospital of Forest Hills, NY, offer 2 cases that illustrate the importance of these data.

A 41-year-old man complaining of left-sided chest pain for 2 hours was examined in the emergency department (ED). On arrival, his blood pressure was 160/100 mm Hg; heart rate, 90 beats per minute; respiratory rate, 18 breaths per minute; oxygen saturation, 99%; and temperature, 37.2°C (99°F).

A 49-year-old woman with a history of alcoholic cirrhosis, esophageal varices, coronary artery disease, diabetes mellitus, and hypertension presented to the emergency department with a 2-day history of fever, chills, nausea, and back and abdominal pain. The pain began on the right side, progressed to the lower back, and radiated into the right anterior thigh and groin area.

A 32-year-old man presented with a yellow, papular rash on the buttocks and extensor surfaces. His medical history included diabetes mellitus, alcoholism, obesity, and polysubstance abuse. Laboratory results disclosed a serum triglyceride level of 5,793 mg/dL.

A 73-year-old man was admitted to the hospital with pain in his hands, feet, and elbows. The patient, an alcoholic, had a 20-year history of hypertension and diabetes. Deformities of the hands and feet had developed during the past 5 years. Tophi were present over both ear lobes. The serum uric acid level was 15 mg/dL.

An 82-year-old woman was admitted to the hospital with severe dilated cardiomyopathy. The condition was alcohol-induced and had been diagnosed about 12 years earlier. The patient was taking angiotensin-converting enzyme inhibitors and diuretics.

A 60-year-old comatose man was brought to the emergency department (ED). He had a history of diabetes, hypertension, and alcohol abuse. Relatives reported that the patient was noncompliant with his antihypertensive medication regimen.

A 47-year-old woman presented to the emergency department with chest pain of sudden onset. The patient had no history of coronary artery disease, peptic ulcer, gastroesophageal reflux disease, or similar episodes of chest pain. She had not traveled long distances or suffered trauma or injury recently.

Cirrhosis and ascites developed in a 52-year-old man with a history of chronic hepatitis C and ethanol abuse. He was hospitalized because of bleeding esophageal varices, which were successfully treated with elastic band ligation.

A 66-year-old man presented to the emergency department complaining of vomiting “coffee ground” emesis for 3 days. His history revealed chronic alcoholism for the last 30 years.

A 50-year-old man with a history of diabetes, hypertension, seizure disorder, and alcohol abuse sought treatment for a rash and painful ulcerations of the hand, face, and scalp, which had bothered him for 1 month. The patient also complained of pruritus.

An 80-year-old man, who could not walk because of a large mass on his right leg, was brought to the emergency department. The mass had been increasing in size on the anterior region of his right thigh for approximately 6 months. The patient also complained of “lumps” that had developed on his extremities during the past 2 months.

A 27-year-old man presented with intensely pruritic, violaceous, flat-topped papules on the lateral aspect of his left leg. He reported that the lesions developed a few weeks after the area was severely scraped in an accident several months earlier.

A 57-year-old man was brought to the emergency department with fever, chills, and a productive cough of 1-week's duration. He had a history of alcoholism.

The significant palmar erythema seen on the hands of a 60-year-old man with alcoholic cirrhosis is a sign of underlying chronic liver failure.

This contorted hand of a 49-year-old man demonstrates Dupuytren's contracture, a disorder first described by Baron Guillaume Dupuytren in 1831. Although the condition may occur as a completely independent abnormality, it is commonly associated with chronic liver disease, diabetes mellitus, epilepsy, palmar fasciitis, carpal tunnel syndrome, rheumatoid arthritis, pulmonary tuberculosis, and alcoholism. This patient had a history of alcohol abuse.

A 48-year-old man with jaundice, nausea, vomiting, and abdominal pain was hospitalized. The patient-a recovering alcoholic-was afebrile and reported abstinence from alcohol for 6 months.

A 65-year-old man was hospitalized with dyspnea and fever of a few days' duration. He complained of excessive malaise, fatigue, and weight loss but denied any hemoptysis. The patient had a history of alcohol abuse.

The authors describe a patient whose persistent left superior vena cava was first suspected because of difficulty in placing a right internal jugular venous catheter.

For 3 years, a linear plaque had been slowly developing on the left palm of a 47-year-old woman who had difficulty in opening and closing her hand. There was no contributory family history.

Twenty-four hours after a car accident, a 47-year-old man with chronic low back pain-which had been diagnosed years earlier as "arthritis" of the spine-presented with back and chest pain and requested an opioid analgesic. The patient had a history of alcoholism and illicit drug use. Tenderness of the thoracic area was noted.

Bullae had recently appeared on the dorsa of the hands and fingers of a 46-year-old man. His medical history was significant for alcoholism, discoid lupus erythematosus (DLE), and hepatitis C. Systemic lupus erythematosus (SLE) was ruled out; the patient’s symptoms did not meet the American Rheumatism Association criteria for SLE.

The family of a 50-year-oldalcoholic man brings him to youroffice. They are concerned abouthis health and note that they had notseen him for several months beforehe reappeared. The patient complainsof generalized weakness, fatigue, andbleeding gums.

A 41-year-old woman has had a 2-week bout of nausea, vomiting, and diarrhea.Her history includes chronic hepatitis C and alcohol abuse. She also has orthostatichypotension. A baseline ECG is obtained.