Episode 456 – RLR – A moving target

This episode of The Clinical Problem Solvers features a deeply personal and clinically rich case presented by host Zobin, who recounts his own experience with undiagnosed brucellosis at age 19. The case unfolds over several days, beginning with acute, severe hip pain in a previously healthy 19-year-old college student, followed by persistent fevers, migratory joint pain, oral ulcers, skin lesions, and systemic symptoms. Despite normal initial exams and negative tests, the clinical picture evolves to include splenomegaly, retroperitoneal lymphadenopathy, and weight loss—key clues that shift the diagnostic focus from a localized joint issue to a systemic infectious or inflammatory process. Through expert discussion, the hosts emphasize the importance of problem representation, pattern recognition, and the critical role of travel history (to Greece, though originally Armenia). The diagnosis of brucellosis, acquired from unpasteurized dairy, is confirmed via serology and treated successfully with doxycycline and streptomycin. The episode underscores the danger of missing subtle, early symptoms like night sweats and the power of re-evaluating the timeline when a case seems atypical. The hosts reflect on how AI and structured clinical reasoning can accelerate diagnosis once the correct problem is identified.