Case Report: Diagnostic Oversight and Subsequent Medical Complications in a 35-Year-Old Male Patient

By SWA

Summary:
A 35-year-old male patient was evaluated by five different healthcare professionals over a period of two years. Despite presenting with legitimate symptoms, he was prematurely labeled as hypochondriac. Subsequent investigations revealed three undiagnosed minor myocardial infarctions and a systemic bacterial infection originating from a dental source, which ultimately led to sepsis.

Clinical Background:

  1. Cardiac Events:
    Retrospective diagnostics confirmed that the patient had suffered three small myocardial infarctions that had gone undetected at the time. It was later identified that Streptococcus bacteria had colonized the endocardium, forming thrombi—a plausible explanation for the infarctions.

  2. Medical History:

    • Dermatological Concern:
      A malignant skin lesion was observed on the patient's forearm by one physician. It was initially mischaracterized as benign desquamation. The patient sought a second opinion, which confirmed malignancy, thereby preventing further progression.

    • Abdominal Symptoms:
      The patient reported diffuse lower abdominal pain and suspected acute appendicitis. A third physician diagnosed it as a non-specific gastrointestinal upset, without further investigation.

    • Dental Complication and Origin of Sepsis:
      Approximately four weeks prior to the final diagnosis, the patient presented with severe upper molar pain. The dentist diagnosed a nerve inflammation in a posterior maxillary molar. A root canal was performed and initial follow-up was unremarkable.
      However, the patient subsequently developed a purulent infection in the affected area. This bacterial infection progressed and spread hematogenously, ultimately affecting the heart and resulting in sepsis. The affected molar and surrounding tissue were surgically removed.

Conclusion:
The cumulative evidence from these events underscores a systemic failure in diagnostic accuracy across multiple specialties. Despite the patient’s persistence and legitimate concerns, he was repeatedly dismissed as psychosomatic. Subsequent findings clearly demonstrate that the patient was not suffering from hypochondria but was the victim of misdiagnosis and underestimation of clinical symptoms.

The patient's resilience through multiple serious but initially unrecognized health events demonstrates the importance of listening to patients, avoiding diagnostic bias, and ensuring thorough follow-up—particularly when symptoms persist. This case highlights the need for improved interdisciplinary communication and vigilance in clinical assessment.

 

© 2000-2025 Sieglinde W. Alexander. All writings by Sieglinde W. Alexander have a fife year copy right. Library of Congress Card Number: LCN 00-192742

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