i-Human Case Study #7 (Class 6512): Evaluation of Loose Stools (Diarrhea) in
a 25- Year-Old Patient : Evaluation of Loose Stools in an Outpatient Clinic
With Laboratory Capabilities:(full Screen shots)
,Patient Overview
Michael Chen is a 25-year-old Asian male graduate student who presented to the
outpatient clinic on June 15, 2023, with a chief complaint of “diarrhea and bad
stomach cramps for four days.” He is otherwise healthy but his symptoms—
extending to four days with significant abdominal pain and fever—introduce
diagnostic uncertainty and elevate the risk of complications such as significant
dehydration or an invasive bacterial infection. The outpatient clinic’s laboratory
capabilities are crucial in this scenario, moving from a purely supportive role to an
active diagnostic one. The clinic must efficiently determine whether this represents
a severe but self-limiting viral illness, a bacterial pathogen requiring targeted
therapy, or the initial presentation of a chronic inflammatory condition.
📝 History of Present Illness (HPI)
Michael’s HPI details a 4-day history of progressively worsening, watery,
non-bloody diarrhea that now occurs 8–10 times per day and is described as
containing mucus. He has constant pain in the left lower quadrant (LLQ) that
becomes sharp with bowel movements. He reports a fever at home of 101.8°F,
chills, night sweats, nausea, lightheadedness, and mild bilateral knee pain. The
patient denies visible blood in the stool, vomiting, or sick contacts. He recently
returned from a trip to rural India 10 days ago, which is a pivotal epidemiological
clue. He has tried over-the-counter loperamide with little relief.
The case presents a higher-acuity variant of the common acute diarrhea
presentation, with the diagnostic paradigm shifting entirely toward bacterial or
parasitic pathogens acquired abroad.
📋 Review of Systems (ROS)
, System Findings
Positive for chills, night sweats, subjective fever, fatigue, lightheadedness,
General
a ~4% weight loss (from ~73 kg to 70 kg).
As per HPI—profuse, watery, mucoid diarrhea (8–10 episodes/day) with L
Gastrointestinal
abdominal pain. Denies hematochezia, vomiting, or sick contacts.
Genitourinary Denies dysuria, frequency, or urgency.
Musculoskeletal Reports mild bilateral knee arthralgia. Denies focal joint swelling.
Positive for fever, chills, night sweats, and fatigue. Afebrile in clinic
Constitutional
(100.8°F).
All other systems reviewed and negative.
📊 Past Medical, Family, and Social History (PMH/PSH/FH/SH)
Category Details
Past Medical History Migraines (controlled with PRN sumatriptan). No chronic GI
(PMH) conditions, surgeries, or hospitalizations.
Allergies Penicillin (rash).
Sumatriptan 50 mg PO PRN for migraine (last dose 2 weeks ago). N
Medications
daily medications.
Past Surgical History
None.
(PSH)
Family History (FH) Non-contributory for GI disorders.
a 25- Year-Old Patient : Evaluation of Loose Stools in an Outpatient Clinic
With Laboratory Capabilities:(full Screen shots)
,Patient Overview
Michael Chen is a 25-year-old Asian male graduate student who presented to the
outpatient clinic on June 15, 2023, with a chief complaint of “diarrhea and bad
stomach cramps for four days.” He is otherwise healthy but his symptoms—
extending to four days with significant abdominal pain and fever—introduce
diagnostic uncertainty and elevate the risk of complications such as significant
dehydration or an invasive bacterial infection. The outpatient clinic’s laboratory
capabilities are crucial in this scenario, moving from a purely supportive role to an
active diagnostic one. The clinic must efficiently determine whether this represents
a severe but self-limiting viral illness, a bacterial pathogen requiring targeted
therapy, or the initial presentation of a chronic inflammatory condition.
📝 History of Present Illness (HPI)
Michael’s HPI details a 4-day history of progressively worsening, watery,
non-bloody diarrhea that now occurs 8–10 times per day and is described as
containing mucus. He has constant pain in the left lower quadrant (LLQ) that
becomes sharp with bowel movements. He reports a fever at home of 101.8°F,
chills, night sweats, nausea, lightheadedness, and mild bilateral knee pain. The
patient denies visible blood in the stool, vomiting, or sick contacts. He recently
returned from a trip to rural India 10 days ago, which is a pivotal epidemiological
clue. He has tried over-the-counter loperamide with little relief.
The case presents a higher-acuity variant of the common acute diarrhea
presentation, with the diagnostic paradigm shifting entirely toward bacterial or
parasitic pathogens acquired abroad.
📋 Review of Systems (ROS)
, System Findings
Positive for chills, night sweats, subjective fever, fatigue, lightheadedness,
General
a ~4% weight loss (from ~73 kg to 70 kg).
As per HPI—profuse, watery, mucoid diarrhea (8–10 episodes/day) with L
Gastrointestinal
abdominal pain. Denies hematochezia, vomiting, or sick contacts.
Genitourinary Denies dysuria, frequency, or urgency.
Musculoskeletal Reports mild bilateral knee arthralgia. Denies focal joint swelling.
Positive for fever, chills, night sweats, and fatigue. Afebrile in clinic
Constitutional
(100.8°F).
All other systems reviewed and negative.
📊 Past Medical, Family, and Social History (PMH/PSH/FH/SH)
Category Details
Past Medical History Migraines (controlled with PRN sumatriptan). No chronic GI
(PMH) conditions, surgeries, or hospitalizations.
Allergies Penicillin (rash).
Sumatriptan 50 mg PO PRN for migraine (last dose 2 weeks ago). N
Medications
daily medications.
Past Surgical History
None.
(PSH)
Family History (FH) Non-contributory for GI disorders.
