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Case Report – A 52-year-old Man with Increasing Fatigue and a Syncopal Episode

Full article: http://www.amc.edu/amr/archives/200606/case1.html

Excerpt:

A 52-year-old male marathon runner with a past medical history significant for glaucoma presented to the emergency department with a two-week history of increasing fatigue after an episode of syncope.

He initially presented to his primary care doctor’s office complaining of flu like symptoms one week after running a marathon and three weeks prior to admission. He described fever, chills, night sweats, increasing fatigue and body aches. He was noted to be an avid runner who had finished within the top five to ten athletes in prior marathons. He stated that despite training intensely, he only finished in 50th place. During this visit, a chest x-ray was obtained which showed no evidence of pneumonia or other abnormalities. He was diagnosed with a minor viral upper respiratory tract infection and over the following week began to notice improvement of his symptoms.

He returned to the office two weeks after the initial visit with worsening fatigue and decreased exercise tolerance. He had become increasingly short of breath after running more than 2 milles. A serologic test for Lyme disease was performed to rule out Lyme carditis after an EKG showed first-degree heart block.