Allergic rhinitis hay fever

ID CC A 45-year-old male Peace Corps volunteer who recently spent two years in rural Mexico complains of a spiking fever, malaise, headache, and right upper quadrant abdominal pain. HPI He admits to having had bloody diarrhea with mucus ( DYSENTERY) and tenesmus that disappeared with some pills that he took several months ago. PE VS fever (39.6 C). PE pallor slight jaundice tender 3+ hepatomegaly with no rebound tenderness pain on fist percussion of right lower ribs. Labs CBC leukocytosis with...

Neurocysticercosis

Imaging Gross Pathology Micro Pathology Treatment Discussion A 3-year-old male, the child of recent African immigrants, is brought to the local health center because of asymmetrical legs. His parents give a history of incomplete immunization. They add that five months ago the boy had fever and diarrhea that subsided spontaneously a few weeks later they noted that he could not use his right leg. Right leg thin, short, wasted, weak, and flaccid absent deep tendon reflexes in right leg no sensory...

Acute Rheumatic Fever

Gross Pathology Micro PoHiology Treatment Discussion A 35-year-old woman complains of fever and pain in the face and upper teeth (maxillary sinus), especially while leaning forward. She has had a chronic cough, nasal congestion, and discharge for the past few months. VS fever. PE halitosis greenish-yellow postnasal discharge bilateral boggy nasal mucosa bilateral percussion tenderness and erythema over zygomatic arch clouding of sinuses by transillumination dental and cranial nerve exams...

Mumps

Imaging Gross Pathology Micro Pathology A 20-year-old male college student presents with a productive cough, headache, malaise, runny nose, and fever. He has a history of sore throat preceding the onset of the cough, which initially was nonproductive. VS fever. PE mild respiratory distress auscultation reveals fine to medium rales over right lower lobe. Gram stain of sputum negative routine cultures of both blood and sputum negative. CBC leukocyte count normal. Fourfold rise in complement...

Meningococcemia

A 24-year-old white female with insulin-dependent diabetes mellitus (IDDM) is hospitalized for ketoacidosis following a night out drinking on the fifth day she develops right periorbital swelling and mucopurulent postnasal discharge that (ails to respond to antibiotics. She admits to irregular adherence to glucose control and insulin dosing. Right periorbital and paranasal edema swelling of conjunctiva ( CHF.MOSIS) exophthalmos black ulceration of nasal mucosa third cranial nerve (CN III)...

Gonorrhea

Micro Pathology Treatment Discussion A 25-ycar-old homosexual male visits a health clinic complaining of headache, low-grade fever, and a painful skin rash in the perianal area. He has no history of penile ulcerations and admits to unprotected anal sex with multiple partners. Perianal vesicular rash in clusters on erythematous base no penile ulceration painful inguinal lymphadenopathy. Multinucleated giant cells with intranuclear inclusions surrounded by clear halo on Pap-stained section of...

Acute cystitis

A 28-year-old black woman who is in her 27'h week of pregnancy complains of right flank pain, high-grade fever, Thus far her pregnancy has been uneventful. VS fever. PE no peripheral edema right costovertebral angle tenderness acutely painful fist percussion on right lumbar area ( POSITIVE GIORDANO'S SIGN). CBC leukocytosis with neutrophilia. UA proteinuria hematuria abundant WBCs and WBC casts pyocytes on sediment alkaline pH urine culture > 100,000 colonies of E. coli. Kidney enlarged,...

Leprosy tuberculoid

Imaging Gross Pathology Micro Pathology A 2-week-old female is brought to the emergency room because of high fever and convulsions. She also has an extensive skin rash on her legs and trunk. VS fever. PE generalized hypotonia extensive maculopapular skin rash nuchal rigidity involuntary flexion of hips when flexing neck ( BRUDZINSKl'S SIGN). CBC neutrophilic leukocytosis. LP elevated CSF cell count 750 cells mL), mostly neutrophils elevated CSF protein low CSF sugar. Gram-positive, facultative,...

Orchitis

ID CC A 25-year-old sexually active female complains of burning on urination. HPI She also complains of pain in the lower abdomen and increased frequency of urination. Labs UA mild proteinuria hematuria WBCs but no casts seen. Urine culture reveals > 100,000 E. colt organisms present. Gross Pathology Infection ascends the urinaxy tract (urethritis, cystitis, pyelonephritis) mucosal hyperemia and edema. Micro Pathology Urothelial hyperplasia and metaplasia. Discussion Eighty percent of UTIs...

Diphtheria

Micro Pathology Treatment Discussion A 56-year-old male professor of veterinary medicine from New Zealand experiences sudden high fever with chills, jaundice, and right upper quadrant pain while attending a His past history is unremarkable. He has been healthy and has been physically active working in the field with sheep and breeding dogs. VS fever hypotension (BP 90 50). PE hepatomegaly jaundiced sclera on palpation of epigastrium and right hypochondrium, abdomen is tender with no rebound...

Molluscum contagiosum

A 6-year-old male presents with fever, intense headache, myalgia, dry cough, and a rash that began peripherally but now involves the entire body, including the palms and soles. The child lives in North Carolina and indicates that he was bitten by an insect a few weeks ago while playing in the woods near his home. VS fever. PF. lethargy ill appearance petechial rash all over body, including palms and soles. CBC thrombocytopenia prolonged bleeding and clotting time. Positive Hess' capillary test...

Pasteurella multocida

A 44-year-old male archaeologist presents with high fever, malaise, intense headache, severe myalgia, and painful swelling in the inguinal region. He recently returned from a trip to Arizona. VS tachycardia. PE drowsy looking no meningeal signs pustule seen at site of an insect bite on left upper arm inguinal lymph nodes enlarged, fluctuant, and tender ( BUBOES) no lesion on external genitalia. CBC PBS normal no malarial parasites. Gram-negative bacilli with safety pin appearance seen in...

Scarlet Fever

Micro Pathology Treatment Discussion A 27-year-old Peace Corps volunteer working in the Congo is sent home after developing fever, sweats, and abdominal pain that have not responded to antimalarial treatment. Five weeks ago, he developed severe itching and a macular rash ( SWIMMER'S ITCH) after swimming in a nearby pond. VS fever, PE moderate enlargement of liver and spleen tender abdomen but no peritoneal irritation. CBC PBS marked eosinophilic Characteristic large parasite eggs with lateral...

Ci esterase inhibitor deficiency

Imaging Gross Pathology Micro Pathology Treatment A 3-year-old aJbino male is referred to a specialist for an evaluation of a suspected immune deficiency. His parents report recurrent respiratory, skin, and oral infections with gram-negative and gram-positive organisms. He also has a history of bruising easily. Partial albinism light-brown hair with silvery tint nystagmus photophobia on eye reflex exam chronic gingivitis and periodontitis purpuric patches over areas of repeated minimal trauma...

Herpes simplex type

A 27-year-old white female complains of mouth ulcers, prolonged fever, flulike symptoms, and increasing fatigue and weight loss over the past two months. She recently moved from a large metropolitan area to a farm in Ohio, where she spent one week cleaning a pigeons* loft. VS fever (38.5 C). PE pallor weight loss enlarged liver and spleen generalized lymphadenopathy scattered, sibilant rales over lung fields. CBC PBS anemia leukopenia. Small, budding fungus found intracellularly in...

Info

A 5-year-old white male presents with golden-yellow, crusted lesions around his mouth and behind his ears. He has a history of intermittent low-grade fever, frequent nose picking ' and purulent discharge from his lesions. He has no history of hematuria (due to increased risk of poststreptococcal glomerulonephritis). Characteristic honey-colored crusted lesions seen at angle of mouth, around nasal orifices, and behind ears. Gram-positive cocci in chains ( STREPTOCOCCI) in addition to pus cells...

Xlinked hypogammaglobulinemia

Imaging Gross Pathology Micro Pathology Treatment A 7-year-old male is brought to his family physician complaining of a thick yellowish discharge in his eyes that prevents him from opening his eyes in the morning for the past few days, his eyes have been blood-red, painful, and watery. His eye pain is exacerbated by exposure to light ( photophobia). Three of his classmates and a neighbor had a similar episode about seven days ago (suggesting a local epidemic of such cases). VS no fever. PE...

Chagas disease

Imaging Gross Pathology Micro Pathology Treatment A 30-year-old man has sudden severe, profuse several liters per day watery diarrhea, protracted vomiting, and abdominal pain. He has just returned from a trip to rural India. Severe dehydration low urine output generalized mild abdominal tenderness with no signs of peritoneal irritation stools have characteristic rice-water appearance no blood or mucus in stools. Stool culture reveals gram-negative rods with darting motility Ol antigen detected...

Nongonococcal urethritis

Imaging Gross Pathology Micro Pathology A 15-year-old male presents with painful bilateral swelling of the parotid glands, left-sided scrotal pain, and fever. Nothing in the patient's history suggests that he had childhood mumps. He has not received a measlcs-mumps-rubella MMR vaccination. VS fever. PE bilateral parotid gland enlargement with obliteration of mandibular hollow hyperemia and edema of Stensen's duct parotid duct orifice retroauricular lymphadenopathy left-sided scrotal and...

Tinea corporis ringworm

A 28-year-old male presents with a red, pruritic skin eruption on his trunk and his upper and lower limbs of a few hours' duration. One day earlier, he was prescribed cotrimoxazole for a UTI. He has not experienced any dyspnea. Erythematous, warm, urticarial wheals hives seen over trunk, legs, and arms no angioedema or respiratory distress. CBC leukocytosis with eosinophilia. No parasites revealed on stool exam. Linear or oval, raised papules or plaque-like wheals up to Wide separation of...