History of Present Illness and Examination

A 44-year-old man with a history of HIV, hypertension, diabetes, gastroesophageal reflux disease, thrombotic thrombocytopenic purpura (TTP), and hepatitis C presents to the hospital emergency department with generalized abdominal pain, malaise, subjective low-grade fevers, and a bruise on his left inner shin.  He denies any trauma that might have caused the bruise.  He also denies vomiting, diarrhea, or other complaints.

Upon examination, vital signs were normal, but the patient’s temperature was slightly elevated at 99.4◦F.  Physical exam was normal save for diffuse mild abdominal tenderness and a single area of bruising on the lower leg (Figure).

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Laboratory workup identified elevated liver function tests — which is consistent with the patient’s history —- and a normal lipase level. White blood cell count was normal and platelet count was 85 × 103/μL. Chem-7 revealed a glucose level of 250 mg/dL and a creatinine level of 1.6 mg/dL.

The patient was given an antacid but experienced minimal improvement in his abdominal pain.

What additional laboratory tests should you consider? 

What treatment options would be suitable for the patient?

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