Docs divulge the most alarming 'catastrophic misses' from their career
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Several weeks later, the patient comes walking into the store and says to me, 'My neurologist told me to thank you for saving my life. I had a bleeding aneurysm.'
—Reddit user @WillieM96, an ophthalmologist
She came in with a UTI and left with an ostomy bag... That was my first week on floors as an intern.
—Reddit user @nightswatchman, a family medicine physician
In a recent Reddit discussion in r/medicine, physicians recounted harrowing diagnostic oversights—cases that underscore how subtle clues can spiral into life-altering consequences.
From missing an aneurysm to not properly diagnosing Huntington's disease, these cases reinforce the criticality of clinical vigilance.
Albuminocytologic dissociation
A neurologist, Reddit user @210-110-134, remembered his encounter with a rehab patient—a 28-year-old man who was labeled as having “alcoholic neuropathy” after previously presenting to the ED with numbness and burning in his toes. Despite only drinking moderately on weekends, his symptoms progressed to paraplegia, but the diagnosis was repeatedly attributed to alcohol use.
"Everybody just kept saying it was alcohol related. We did the EMG/NCS when the patient came to rehab, which showed sural sparing and heavy demyelination. He did not get IVIG or plasmapharesis, so we just started it recently. We did the LP here too, which showed the classic albuminocytologic dissociation. Crazy to think he might have been spared if he got IVIG earlier in his course," he said.
Ischemic bowel
User @nightswatchman, a family medicine physician, discussed an encounter with a patient with dementia. The woman was admitted after a fall, altered mental status, and a UTI. She initially improved on antibiotics, but then suddenly developed hematemesis, melena, and leukocytosis. Imaging was perplexing, he said: CT angiogram of the abdomen looked completely normal, with patent mesenteric vessels and no signs of bleeding or colitis, while chest CT revealed only a diaphragmatic hernia. An EGD ruled out an upper GI bleed or gastric strangulation.
"This whole time she keeps deteriorating with worsening anemia/hypotension and the WBC jumps to 48, but with a normal [abdominal] CT and the EGD showing no upper GI cause of acute bleed," the doc explained. "We make the call to transfer to ICU and do an exploratory surgery to figure out what the hell is going on. Turns out she had a dead bowel from cecum to sigmoid. So it was an ischemic bowel even though the CT showed patent arteries and not even any of the nonspecific signs of ischemic colitis, like BRBPR or bowel wall thickening on imaging."
She came in with a UTI and left with an ostomy bag... That was my first week on floors as an intern.
—Reddit user @nightswatchman, a family medicine physician
Huntington's disease
"One case I should not have been the one to catch early in my career was a lady referred to me for asthma. The asthma wasn't difficult to treat, but I was very distracted during the interview by her constant squirming and erratic jerking movements. She told me her rheumatologist had diagnosed her with 'neuropsychiatric lupus,'" said Reddit user @Mobile-Entertainer60.
She was not bothered because her mother acted the same way and this had been going on for years. I insisted she see neurology and refused to take no for an answer. They both had Huntington's chorea. She's been doing amazingly on tetrabenazine.
—Reddit user @Mobile-Entertainer60
Cerebellar lymphoma
A middle-aged patient had recurrent episodes of dizziness and was evaluated in the ED at least 10 times, recounted @VertigoDoc, an ENT physician. Each visit led to nonspecific diagnoses such as dizziness, nausea, anxiety, or migraine. Over time, the symptoms worsened to the point that the patient lost weight, couldn’t work, and was admitted to psychiatry due to suicidal ideation.
@VertigoDoc gave a clinical timeline: "Two negative CT heads. Seen by neurology, possible vestibular migraine. Seen by one of my colleagues who did a Dix-Hallpike test. Asked me to have a look. [The patient] had persistent vertical downward nystagmus on supine roll test. 'Get an MRI' was my advice. Shortly after, admitted to neurosurgery for cerebellar lymphoma."
Necrotizing fasciitis
This may be the worst one yet: @No_Technician4348, an emergency medicine physician, described a patient with diabetes who presented to an outside facility with non-traumatic thigh pain. The patient was diagnosed with a muscle strain before being discharged.
I saw them a couple days later in florid sepsis from necrotizing fasciitis of the thigh/perineum.
—@No_Technician4348, an emergency medicine physician
But another emergency medicine doc, user @halp-im-lost, made some solid points about a case like this: "Necrotizing fasciitis spreads extremely quickly and with an otherwise normal looking leg with some tenderness it would be hard to make the jump to nec fasciitis, even in a diabetic. This is why return precautions are extremely important and not making your patient feel like an idiot for coming back," they replied.
Bleeding aneurysm
Amid the missteps, a doc shared a career-defining save—"my one shining moment," wrote user @WillieM96, an ophthalmologist. He shared about a patient who presented for an eye exam after complaining of double vision. The patients had already been evaluated by a neurologist with a normal MRI, and was referred for further assessment. During the exam, it soon became clear the patient wasn't actually seeing double, but was seeing images flicker in and out of his blind spot, which he was misinterpreting as double vision.
"It occurred to me that, if he was complaining of double vision, the neurologist may have done the MRI with extra resolution in the brain stem when the lesion was most likely in the right parietal lobe," @WillieM96 wrote. "I faxed a letter to [the neurologist] with my findings and called him first thing Monday morning... then I didn't hear anything for a while."
Several weeks later, the patient comes walking into the store and says to me, 'My neurologist told me to thank you for saving my life. I had a bleeding aneurysm.' I have no idea how the visual complications were his only symptom.
—Reddit user @WillieM96, an ophthalmologist
