(BMJ)—A previously healthy 35-yo man presented w/ 5 days of fever, cough, rash, and sore throat. Exam: fever, tachycardia, hypoxia, conjunctivitis, maculopapular rash including palms and soles. A blood test confirmed the diagnosis. What is it?
Reiter syndrome
Meningococcemia
Syphilis
Coxsackievirus
Measles
You are correct. Serology confirmed measles. This pt made a good clinical recovery after receiving ribavirin and noninvasive respiratory support. Measles should be included in the differential dx of any pt presenting w/ a palmar or plantar rash.
(BMJ)—A 40-yo healthy man presented w/ 15 days of red eye w/ worsening pain and photophobia despite using prednisolone eye drops. Slit-lamp exam w/ fluorescein stain revealed multiple lesions of varying shapes. What is the diagnosis?
Keratoconjunctivitis sicca
Traumatic corneal abrasions
Herpes simplex keratitis
Cogan syndrome
Staphylococcal corneal ulcer
You are correct. Exam revealed the classic lesions of herpes simplex keratitis: epithelial dots, dendritic pattern, and geographical epithelial keratitis. This case highlights the dangers of prescribing topical steroids for red eye w/o a clear diagnosis. The pt was treated w/ topical acyclovir eye ointment, and the prednisolone drops were discontinued.
(BMJ)—A 68-yo pigeon keeper w/ CLL on alemtuzumab who had a traumatic amputation 40 yrs prior presented w/ a 3-mo hx of a nonhealing ulcer on his arm amputation stump. He wore no prosthesis. It began as a tender red nodule and did not respond to abx tx. Biopsy confirmed the dx. What is it?
Lymphoma
Candidiasis
Histoplasma capsulatum
Psittacosis
Cryptococcus neoforman
You are correct. Cryptococcus was isolated from a skin biopsy. Pigeon excreta may contain Cryptococcus neoformans. Cryptococcal disease occurs in immunosuppressed pts and can be fatal. This pt had complete resolution after tx w/ amphotericin B and flucytosine.
By vgreene, 24 March, 2015

VSD

By vgreene, 24 March, 2015

PDA

By vgreene, 24 March, 2015

ASD