Case Presentation

An 81 year-old male who resides in Florida presents to theemergency department (ED) with complaints of weakness,20 pound weight loss, and decreased appetite over the last sixmonths. He is currently in the Philadelphia area to visit hisson, and after his concerned son heard of these complaints, hebrought his father to the ED. The patient indicates that he hasbecome progressively weak over the last six months. He hasalso been increasingly fatigued, finding it difficult to walk eventwo blocks. A year ago, the patient walked two to three miles aday without a problem. Past medical history is significant forcoronary artery disease, although he reports a normal stress testthree months ago, stroke in 2004 with residual dysarthria, andmelanoma on chest wall diagnosed in 2005 status-post resection.He lives with his wife and is a retired interior architect. He hasnot drunk alcohol in two years, has not smoked cigarettes in20 years, and has never used illicit drugs. There is no historyof cancer in his family, but significant history of stroke in hismother and sister. He saw his primary care physician for thesesymptoms in Florida, and a diagnosis had not been reached,but the patient indicates that he had a PET scan and a needleaspiration done on his right lung in the last month. He does notknow the results of these tests.