Angel's Trumpet 25F
ADMIT: 3/6/26
TEAM: LAVENDER

CODE: FULL
DX: Undifferentiated abnormal physiological presentation of unknown etiology

• admitted overnight for abnormal physiological phenomena of unclear etiology
• pt reported that her body occasionally produces substances that should not exist in human physiology, including honey, fine sand, and occasionally small glass beads when coughing. ED staff originally suspected factitious disorder, but several events witnessed overnight have made the situation unclear.
• pt intermittently coughs up small translucent beads, skin temperature fluctuates between 95°F and 104°F within minutes, telemetry intermittently shows brief rhythms that do not correspond to known cardiac conduction patterns
• pupils occasionally dilate asymmetrically in response to sounds rather than light
• here for rule out factitious disorder vs. rare metabolic/toxicologic condition

ACTIVITY: Ambulatory
DIET: Regular
IV: R AC 20 G
NEURO: A & O x4
PULMO: Room air w/cough producing small spherical glass-like beads
CARDIAC: Tele: NSR w/occasional waveforms not matching any known arrhythmia. At 0317, Tele read asystole 6 seconds, pt asymptomatic
GI: BRP
GU: BRP
SKIN: Pale w/fine crystalline residue from pores intermittently
V/S: Temp fluctates 35°C – 40°C, occasionally bradycardic 30's
PLAN: ID consult, Neuro consult, psych consult, Notify MD of unexplained foreign body production, 1 : 1 sitter for constant observation d/t possible factitious disorder

LABS:

• Skin swabs: pending
• Chest XR: multiple small rounded radiopaque densities scattered throughout the segmental bronchi of the right middle lobe and bilateral lower lobes. appearance is atypical for calcified granulomas or aspirated food particles.
• CT Chest: Within the segmental and subsegmental bronchi, there are numerous small spherical structures appearing perfectly spherical, uniform size, with high attenuation (similar to glass or quartz. The objects are free within bronchial lumens, rather than embedded in lung tissue. notably, several spheres appear aligned in linear chains, resembling beads on a filament within the bronchi. no surrounding inflammation, mucus plugging, or airway edema is seen. There is no evidence of aspiration injury. during respiratory motion, several spheres appear to shift position within the bronchial tree, consistent with mobile intraluminal objects. Radiology cannot explain this finding and recommends correlation with artifact or repeat imaging. Multiple ribs demonstrate fine internal crystalline structures along marrow cavities, forming geometric patterns resembling dendritic mineral growth. This is not consistent with typical bone mineralization patterns.
  Clinical significance unknown.
• CBC: Normal
• CMP: Normal
• Lactate: Normal
• ABG: Normal
• Serum osm: Normal