August 11, 2011

The great imitators

You just sent home a patient with a weeks headache but no red flags? Or one with diffuse abdominal pain but normal lab tests? Are you writhing in your bed of remorse? Not sure if you just missed a zebra?

Well you are not alone. Everyone has missed their zebra in the ED. It feels a little relieving then that Wikipedia  has made a list of these diseases that you are about to miss one day. A list of red herrings. Know just a little about the small stuff and you'll have a slight chance of at least thinking of it in your next case of subtle symptoms. The confused patient who turns out to have lupus. Or the atypical parotitis revealing a hidden sarcoidosis. Being a little alert is all you need to do!

From the Wikipedia article:

"The Great Imitator is a phrase used for medical conditions that feature nonspecific symptoms and may be confused with a number of other diseases. Most great imitators are systemic in nature. Diseases sometimes referred to with this name include:

  • Fibromyalgia
  • Lupus erythematosus 
  • Multiple sclerosis
  • Sarcoidosis
  • Infectious diseases
    • Syphilis
    • Lyme disease
    • Nocardiosis
    • Tuberculosis
  • Celiac disease
  • Heavy metal poisoning
  • Addison's Disease"

Oh and also check my previous post about non-surgical causes of abdominal pain, highly recommended for emergency physicians scavenging for zebras in the snowfield.