“Fred, it’s our shared job to see if we can uncover a cause. I want you to keep a daily diary of all you eat or drink and notes about locations or other observations. Let’s see if we can find the culprit.”
Fred brought his diary with him on his next visit. There was nothing on the list that suggested it as a cause of the skin lesions. Suddenly Fred sat up straight with a new thought. “I think I may have it. I drank a lot of cinnamon schnapps this past year. We called it the “gold drink.” Do you suppose it’s really got gold in it?”
Dr. Jenkins told Fred to bring in a bottle and they would find out. Later, when several bottles were analyzed there were 8 to 17 metallic flakes per 750 liter bottle. The metallic flakes were 75% gold by weight, with 280 micrograms of gold per deciliter dissolved in the liquid.
Measurements of Fred’s blood and urine showed a serum level of gold to be 0.4 mg per liter (normal range 0 to 0.1). His 24 hour urine specimen showed 86 micrograms of gold (normal range 0 to 1.0 microgram). These measurements were made three months after Fred’s last drink of gold schnapps. Three months later the blood and urine gold levels were within the normal range.
The skin lesions and itching gradually disappeared as Fred avoided drinking the gold schnapps.
Fred was heard to say, “I didn’t know drinking ever got that serious.”
Russell MA, King LE, and Boyd, AS. Lichen Planus after Consumption of a Gold-Containing Liquor. New England Journal of Medicine, 1996; 334:603.
Case shared by:
Lloyd King, M.D.
Professor of Medicine
Vanderbilt University School of Medicine
Michael Zanoli, M.D.
Dermatologist
Heritage Medical Group
Nashville, Tennessee
Chapter Notes
Chapter 1. A Puzzling Paralysis
1. Diaz, JH, A 60-year meta-analysis of tick paralysis in the United States; a predictable and often misdiagnosed poisoning. J. Med. Toxicol. 2010. Mar; 6 (1): 15-21.
Chapter 3. The Cause of Some Symptoms Can Be Illusory
Feldman, Marc. Playing Sick, Brunner-Rutledge, New York, New York. 2004.
In Puzzling Symptoms (C.K. Meador, Cable Publishing, Brule, Wisconsin. 2008), I report additional case reports of several patients with self-harm.
Chapter 12. A Drug to Prevent a Complication Causes the Complication
1. Tomkin GH, Hadden DR, Weaver JA, and Montgomery DAD. Vitamin-B12 Status of Patients on Long-term Merformin Therapy. British Medical Journal, 1971, 2; 685 – 687.
Chapter 14. An Uncommon Cure
1. Endocr Pract. 2012 Nov 1;18(6):1038. Insulinoma in a patient with type 2 diabetes mellitus proved at autopsy.
Kunieda T, Yamakita N, Yasuda K.
2. Dtsch Med Wochenschr. 1988 Nov 4;113(44):1714-7.
[Hypoglycemia caused by insulinoma in diabetes mellitus].
[Article in German]
Heik SC, Klöppel G, Krone W, Iben G, Priebe K, Kühnau J.
3. Diabetes Complications. 2012 Jan-Feb;26(1):65-7. doi:
10.1016/j.jdiacomp.2011.12.003. Epub 2012 Mar 6.
A rare cause of hypoglycemia in a type 2 diabetic patient: insulinoma.
Cander S, Gül OÖ, Yıldırım N, Unal OK, Saraydaroğlu O, Imamoğlu S.
4. Diabet Med. 2012 Jul;29(7):e133-7. doi: 10.1111/j.1464-5491.2012.03603.x.
Type 2 diabetes mellitus in a patient with malignant insulinoma manifesting following surgery.
Ademoğlu E, Unlütürk U, Ağbaht K, Karabork A, Corapçioğlu D.
Chapter 16. What You Don’t Know Can Kill you.
Howard MA, Hibbard AB, Terrell DR, Medina PJ, Vesely SK, and George JN; Quinine allergy causing acute severe systemic illness: report of 4 patients manifesting multiple hematologic, renal, and hepatic abnormalities. Proc (Baylor University Medical Center). 16 (1): 21-26. 2003.
Chapter 21. Gut Reaction
1. Niederhofer H, Pittschieler K. A preliminary investigation of ADHD symptoms in persons with celiac disease. J Atten Disord.;10(2):200-204. Nov 2006.
2. Addolorato G, Mirijello A, D’Angelo C, et al. Social phobia in coeliac disease. Scand J Gastroenterol. 43(4):410-415. 2008.
3. Ludvigsson JF, Reutfors J, Osby U, Ekbom A, Montgomery SM. Coeliac disease and risk of mood disorders—a general population-based cohort study. J Affect Disord. 99(1-3):117-126. Apr 2007.
Chapter 28. Strange Intuition
1. Johns ME, Moscinski LC, and Sokol L. Phenytoin-associated Lymphadenopathy Mimicking a Peripheral T-cell Lymphoma. Mediterr. J. Hematol. Infect. Dis.: 2(2): e20 10028. September 7, 2010. (Published on line).
Biography of
Clifton K.Meador, M.D.
For over fifty years, Clifton K. Meador has been practicing and teaching medicine. This, his thirteenth book, complements his published writings and his well-known satiric articles noting the clinical excesses of modern American medicine, including “The Art and Science of Nondisease,” published in the New England Journal of Medicine (1965), “The Last Well Person” also in the New England Journal of Medicine (1994), “A Lament for Invalids” in the Journal of the American Medical Association JAMA 1992) and “Clinical Man: Homo Clinicus,” published in Pharos (2011).
His last book True Medical Detective Stories (2012) was dedicated to Berton Roueche, writer for the New Yorker and creator of the genre of medical detective stories.
A graduate of Vanderbilt University in 1955, Dr. Meador has served as executive director of the Meharry Vanderbilt Alliance since 1999, and is an emeritus professor of medicine at both Vanderbilt School of Medicine and Meharry Medical College. Past posts include chief of medicine and chief medical officer of Saint Thomas Hospital (then a major teaching hospital for Vanderbilt) and dean of the University of Alabama School of Medicine.
Dr. Meador lives with his wife, Ann, in Nashville. He is the father of seven, and has seven grandchildren and one great granddaughter.
Fascinomas- Fascinating Medical Mysteries Page 11