20th July 2023

A 45-year-old man presents to the emergency department with a 2-month history of watery

A 45-year-old man presents to the emergency department with a 2-month history of watery, non-bloody diarrhoea. This is associated with occasional generalised abdominal pain and dizziness without loss of consciousness. He has a history of anxiety but takes no regular medications. On examination, his face is noted to be flushed. Chest auscultation reveals vesicular breath sounds throughout. He has a pansystolic murmur heard loudest at the left sternal edge. Abdominal, neurological and mucosal examinations are normal.

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