Man gets drunk, wakes up with a medical mystery that nearly kills him

A 36-year-old man was admitted to Massachusetts General Hospital in a state of severe distress, presenting a baffling array of health issues. His condition involved abnormalities across multiple systems, including his lungs, intestines, blood, liver, and lymphatic system, leaving medical professionals without a clear diagnosis. The complexity of his case prompted the involvement of a master clinician specializing in clinical reasoning to help decipher the underlying cause. This intriguing medical mystery began approximately two weeks prior to his hospital admission. Initially, the patient experienced mild discomfort in his right lower abdomen and back, which progressed over nine days to include fever and body aches. After visiting urgent care, he was treated with intravenous fluids and pain relief, leading to a temporary reduction in abdominal pain, allowing him to return home. However, the relief was short-lived. As the days passed, the patient faced a resurgence of abdominal pain accompanied by nausea and vomiting. His condition deteriorated further, culminating in a cough and breathing difficulties. The day before his emergency visit, he returned to urgent care, displaying alarming symptoms: jaundice, rapid heartbeat, and dangerously low blood pressure, alongside an oxygen saturation level of just 85 percent. Clinicians noted crackling sounds in his lungs and increased tenderness in his abdomen, prompting an immediate transfer to the emergency department. Upon arrival, the medical team confirmed the findings from urgent care, noting that the patient was also coughing up tan mucus. A review of his medical history revealed that he was originally from Central America and had resided in the United States for 16 years. Working in construction and living in a Boston suburb with his partner and two children, he had no significant health problems aside from a history of alcohol use disorder. Despite typically consuming four to five beers nightly and up to a dozen on weekends, he claimed to have abstained from drinking during his illness, leaving doctors to wonder if this lifestyle contributed to his alarming condition.