The Clinical Problem Solvers Episode 432 – Spaced Learning Series – subacute inflammation
Dec 2, 2025
Explore a compelling case of a 39-year-old woman suffering from subacute abdominal pain and vomiting. The discussion delves into the nuances of abdominal pain history-taking and the importance of recognizing systemic clues. A differential diagnosis unfolds, highlighting infections, malignancies, and autoimmune diseases. The team's diagnostic journey includes targeted lab tests and imaging that reveal significant findings. Ultimately, they narrow down to hepatic sarcoidosis and discuss treatment strategies, showcasing the intricacies of clinical reasoning.
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Start By Excluding Red Flags
- Always rule out immediately life-threatening causes for abdominal pain using the VITAMIN or VIPO frameworks.
- In women of childbearing age, always get menstrual history and a pregnancy test early.
Subacute Systemic Clues Shift Differential
- Subacute weight loss with night sweats suggests systemic inflammatory processes rather than isolated acute disease.
- Combine constitutional symptoms with focal complaints to prioritize diagnostic buckets like infection, malignancy, and autoimmune disease.
Broaden Workup With Reticuloendothelial Signs
- When hepatosplenomegaly and B symptoms appear, broaden testing to include HIV, viral panels, LDH, and cross-sectional chest/abdomen/pelvis imaging.
- Examine for diffuse lymphadenopathy and prioritize PET/CT and tissue diagnosis early.
