Adenovirus Pharyngitis

ID CC A 28-year-old male homosexual complains of continuous low-grade fever, weight loss, and diarrhea of one month s duration. HPI He also complains of an extensive skin rash, mucous membrane eruptions, recurrent herpes zoster infection, and oral ulcerations. He reports practicing receptive anal intercourse. PE VS low-grade fever. PS cachectic generalized lymphadenopathy maculopapular rash severe seborrheic dermatitis oral thrush white confluent patch with corrugated surface ( ORAL HAIRY...

Endemic Typhus

Imaging Gross Pathology Micro Pathology Treatment A 3-day-old female neonate presents with a thick eye discharge. The mother admits to having multiple sexual partners and complains of a vaginal discharge. She did not receive adequate antenatal care. Exam of both eyes reveals a thick purulent discharge and marked conjunctival congestion and edema conjunctival chemosis is so marked that cornea is seen at bottom of a crater-like pit corneal ulceration noted. Conjunctival swabs on Gram staining...

Bartonellosis

A 32-year-old male is referred to a tertiary care center with chronic pneumonia and warty lesions on his left upper limb. The patient is from the southeastern United States. His skin lesions arc nonpruritic and painless. He also complains of malaise, weight loss, night sweats, chest pain, breathlessness, and hoarseness. VS fever tachycardia mild tachypnea. PE bilateral rales and rhonchi raised, verrucous, and crusted lesions with serpiginous border located on left upper extremity small...

Graftversushost Disease

Imaging Gross Pathology Micro Pathology An 8-year-old child with sickle cell anemia is seen with complaints of sudden-onset pallor of the skin and mucous membranes, fatigue, and malaise. The child suffered a mild prodromal illness before developing severe pallor. VS no fever tachycardia tachypnea normotension. PE severe pallor mild icterus no lymphadenopathy, splenomegaly, or hepatomegaly noted. CBC severe anemia (Hb 2 gm dL) reduced leukocyte and platelet counts mild hyperbilirubinemia absent...

Progressive Multifocal Leukoencephalopathy

A 30-year-old male is seen with complaints of a rash along with pain in his left ear and inability to move the muscles of his face with accompanying asymmetry. He suffered an attack of chickenpox during childhood but has no history either of a similar rash over his face or of any visual symptoms (to rule out herpes zoster ophthalmicus). Vesicular rash over left pinna ( OTITIS EXTERNA) left-sided lower motor neuron-type facial nerve palsy (patient is unable to frown and unable to blink left eye...

Vibrio Vulnificus Food Poisoning

Imaging Gross Pathology Micro Pathology An 8-year-old male is brought to a physician with complaints of impairment of vision in the left eye, urticarial skin rashes, and ill-defined muscle aches. The child's mother has caught the child eating dirt or soil on many occasions ( PICA). The family also has a pet dog at home. Rounded swelling near the optic disc seen on fundus exam of left eye urticarial wheals observed on extremities and trunk mild hepatosplenomegaly noted. Leukocytosis with marked...

Hemorrhagic Fever Renal Syndrome

Labs Imaging Gross Pathology Micro Pathology Treatment Discussion A 7-year-old male complains of a High fever and a very sore throat. l'hc pain is so severe that the child refuses to swallow. He is adequately immunized and achieved normal developmental milestones. VS fever. PE characteristic vesicular lesions scattered over soft palate, tonsils, and pharynx. Coxsackievirus A isolated from mucosal lesions. In hand, foot, and mouth disease (HFMD), in addition to the oral lesions, there are...

Cellulitis

Imaging Gross Pathology Micro Pathology Treatment Discussion A 30-year-old slaughterhouse worker presents with a painful, red swelling of the index finger of his right hand. The swelling developed four days after he was injured with a knife while slaughtering a pig. Well-defined, exquisitely tender, slightly elevated violaceous lesion seen on right index finger no suppuration noted right epitrochlear and right axillary lymphadenopathy noced. Biopsy from edge of lesion yields Erysipelothrix...

Staphylococcus Aureus Gastroenteritis

Imaging Gross Pathology Micro Pathology Treatment A 25-year-old male U.S. citizen on vacation in Mexico presents with abrupt-onset watery diarrhea, abdominal cramps, and a low-grade fever and chills. The patient does not complain of tenesmus or passage of blood or mucus in his stools, but he docs complain of a feeling of urgcncy to defecate. VS low-grade fever. PE unremarkable. No erythrocytes, WBCs, or parasites seen in stained stool bioassays for enterotoxigenic E. coli (ETEC) reveal presence...

Reyes Syndrome

Imaging Gross Pathology Micro Pathology A 30-year-old male presents with a high fever, neck stiffness, and drowsiness. He also complains of nausea and vomiting. He recently traveled along the Mississippi-Ohio River basin. VS fever. PE neck stiffness and Kernig's sign positive (due to meningeal irritation) right oculomotor nerve palsy noted mild papilledema. IgM enzyme immunoassay done on paired sera, and CSF confirms the diagnosis of St. Louis virus infection. LP CSF exam reveals pleocytosis...

Tubercular Meningitis

Imaging Gross Pathology Micro Pathology Treatment A 25-year-old recently married woman is conccrncd about a scanty, offensively malodorous vaginal discharge. She states that the discharge is thin, grayish-white, and foul- smelling. She does not complain of vulvar pruritus or soreness. Pelvic exam confirms presence of a homogenous, grayish-white, watery discharge adherent to the vaginal walls that yields a fishy odor when mixed with KOH no injection and excoriation of the vulva, vagina, or...

Traumatic Gas Gangrene

Imaging Gross Pathology Micro Pathology Treatment A 10-year-old child who lives in tropical Africa presents with multiple papillomatous skin lesions and pain in both legs. The first lesion had appeared on the leg as a small indurated papule that ulcerated into a granulomatous papilloma. Multiple papillomatous skin lesions seen, especially in intertriginous areas lesions were painless and exuding a serous fluid painful hyperkeratotic lesions seen on palms and soles both tibia were tender to...

Ramsay Hunt Syndrome

ID CC A 6-year-old boy is brought by his parents to the emergency room in a comatose state. HPI The child was suffering from cbickenpox and had been given aspirin for fever by the family physician. PE VS fever. PE comatose with papulovesicular rash all over body fundus shows marked papilledema no icterus hepatomegaly. Labs Impaired liver function blood ammonia concentration increased AST and ALT levels elevated PT prolonged serum bilirubin normal. LP (done after controlling raised ICT) normal...

Blastomycosis

ID CC A 26-year-old female presents to the ER with intense, acutc-onset left lower quadrant crampy abdominal pain, foul-smelling stools with streaks of blood, urgency, tenesmus, and fever. HPI For the past two days, the patient has also had hcadachcs and myalgias. She frequently drinks unpasteurized (raw) milk that she buys at a health-food store. PE VS fever (39 C) tachycardia normal RR and BP. PE no dehydration diffuse abdominal tenderness more marked in left lower quadrant. Labs Stool smear...

Gonococcal Ophthalmia Neonatorum

S Pathology o Pathology Treatment A 56-year-old hospitalized male is found to have an abrupt-onset high-grade fever with chills a few hours after he underwent nephrolithotomy. He was diagnosed with chronic nephrolithiasis with recurrent UTls a surgery intern also noted poor urine output. VS fever tachycardia hypotension tachypnea. VS confused and disoriented hyperventilating diaphoresis hands warm and pink with rapid capillary refill pulse bounding on chest auscultation, air entry found to be...

Breast Abscess

Imaging Gross Pathology Micro Pathology Treatment A 28-year-old primigravida at 36 weeks' gestation presents with a high fever. She was being monitored following a premature rupture of the membranes. VS fever fetal tachycardia. PE uterine tenderness. Elevated maternal total lymphocyte count vaginal swab culture revealed colonization with group B streptococcus. Presence of group B streptococcus in vagina after premature rupture of membranes was an indication for immediate delivery and treatment...

Salmonella Food Poisoning

Imaging Gross Pathology Micro Pathology Treatment Discussion A 25-year-old male presents with sudden-onset, severe vomiting, nausea, abdominal cramps, and diarrhea. He had returned home about two hours after attending a birthday party at which meat and milk were served in various forms. The friend who was celebrating his birthday reported similar symptoms. VS no fever. PE mild dehydration diffuse abdominal tenderness increased bowel sounds. Toxigenic staphylococcus recovered from culturing...

Vibrio Parahaemolyticus Food Poisoning

Imaging Gross Pathology Micro Pathology Treatment Discussion A 35-year-old male presents to the emergency room with high-grade fever, marked weakness, and a vesiculobullous skin eruption. He had just returned from the Gulf of Mexico, where he had consumed large quantities of seafood. He has been diagnosed with chronic liver disease (due to hemochromatosis). VS fever hypotension tachycardia. PE icterus vesiculobullous skin lesions seen on an otherwise-bronzed complexion. Hyperglycemia blood...

Allergic Bronchopulmonary Aspergillosis

Gross Pathology Micro Pathology Treatment Discussion A 50-year-old alcoholic male presents with a high-grade fever, cough, copious, foul-smelling sputum, and pleuritic right-sided chest pain. His wife reports that he was brought home in a semiconscious state a few days ago, when he was found lying on the roadside heavily under the influence of alcohol. VS fever. PE signs of consolidation elicited over right middle and lower pulmonary lobes. Sputum reveals abundant PMN leukocytes and mixed oral...

Crimeancongo Hemorrhagic Fever

ID CC A 2-year-old male is brought to the ER by his parents with sore diroat, inspiratory stridor, and a barking cough of one day's duration. HPI The patient has no significant past medical history. PE VS fever (38.6 C) tachypnea. PE respiratory distress nasopharyngeal discharge diffuse rhonchi and wheezes examination of extremities reveals some cyanosis. labs Throat and nasal swabs isolate parainfluenza virus serodiagnosis and hemagglutinin inhibicion tests reveal type 2. CXR air trapping. XR-...

Kawasaki Syndrome

ID CC A 30-year-old male from India presents with slowly progressive hypopigmented skin patches and nodules together with a peculiar deformity of the nose. HPI The patient has a history of nasal stuffiness and bloody nasal discharge he also complains of loss of libido. PE Leonine facies loss of eyebrows ( MADAROSIS) scleral nodules depressed nasal bridge ( SADDLE-NOSE DEFORMITY) gynecomastia testicular atrophy numerous symmetrical, hypopigmented macules with vague edges and erythematous,...

Colorado Tick Fever

Imaging Gross Pathology Micro Pathology Treatment A 35-year-old male who works as a UN health worker presents with a high-grade fever and massive hematemesis. He recently returned from Zaire, where he worked in a tick-infested forest. VS fever. PE extensive ecchymosis. CBC leukopenia severe thrombocytopenia. Crimean-Congo virus isolated. Supportive platelet transfusions avoid salicylates barrier nursing and containment of infected sccretions, since airborne infection may occur in hospital...

Actinomycosis

Imaging Gross Pathology Micro Pathology Treatment Discussion A 6-ycar-old male presents with complaints of a mild sore throat and eye irritation. His mother says that he has spent hours at the community swimming pool this summer. Mild rhinopharyngitis bilateral conjunctival congestion with scanty mucoid discharge. Viral culture of conjunctival and nasopharyngeal swab yields adenovirus. No specific treatment self-limiting illness. Adenovirus infections occur most often in infants and young...

Overwhelming Postsplenectomy Sepsis

Gross Pathology Micro Pathology Treatment A 25-year-old HIV-negative homosexual male presents with rectal burning, itching in the anal region, tenesmus, and a bloody, mucopurulent discharge per rectum. One month ago he was hospitalized with severe febrile proctocolitis that was diagnosed as lymphogranuloma venereum. He has also been treated several times in the past for amebiasis and shigella colitis and admits to having receptive anal intercourse. Further history reveals that his most recent...

Neutropenic Enterocolitis

Imaging Gross Pathology Micro Pathology Treatment A 4-year-old male is brought to the physician by his parents, who complain that the child has had intense perianal itching, especially during the night. The child is otherwise healthy, and his developmental progress is normal. Cellulose adhesive tape secured to perianal area during the night reveals presence of Etiterobius vermicularis eggs that were flattened on one side, were embryonated, and had a thick shell no parasites found on stool exam....

Hsv Keratitis

Imaging Gross Pathology Micro Pathology Treatment A 2-day-old neonate is evaluated for an eye discharge. The baby's mother is a prostitute who did not receive any prenatal cervical cultures during pregnancy. Normal full-term male neonate mucoid eye discharge, conjunctival congestion, and chemosis noted in both eyes nonfollicles seen on palpebral conjunctiva (due to absence of subconjunctival adenoid layer at this age) mild superficial keratitis also present. Gram stain of swab reveals increased...

Brain Abscess With Cyanotic Heart Disease

A 30-year-old male presents with a high fever and chills, headache, nausea, vomiting, and muscle aches. Yesterday he had an episode involving abnormal movements of his right hand and face ( FOCAL SEIZURE). He also has difficulty comprehending speech and has olfactory hallucinations. He has no history of psychiatric illness. VS fever tachycardia mild tachypnea normotension. PE confused and disoriented papilledema mild nuchal rigidity Kernig's sign positive paraphasic errors in speech deep tendon...

Yersinia Enterocolitis

ID CC A 4-month-old male presents with chronic diarrhea and failure to thrive. HPI The infant was diagnosed with extensive mucocutaneous candidiasis in the early neonatal period and shordy thereafter developed a fulminant Pseudomonas septicemia that required intravenous antibiotic therapy for an extended period of time. A paternal cousin had developed similar and equally devastating bacterial and fungal infections in the neonatal period and subsequently died. PE Emaciated mucocutaneous...

Dengue Hemorrhagic Fever

ID CC A 58-year-old man who was hitchhiking through central and southern Africa was admitted to a hospital in Zaire in a state of shock following massive hemorrhage from the GI tract (hematcmesis and melena) he died within six hours of admission. Ten days later, a male doctor who had attended this patient and had attempted resuscitation became ill with a similar disease syndrome. HPI At admission, he gave an eight-day history of progressive fever, myalgias, and watery diarrhea. He also reported...

Pityriasis Versicolor

Imaging Gross Pathology Micro Pathology Treatment Discussion A 20-year-old male from India presents to the ER with severe nausea and vomiting. Careful history reveals that two hours ago he ate some unrefirigerated fried rice that his wife had cooked the night before. He does not complain of any fever or diarrhea (may or may not be present). VS no fever. PE mild dehydration diffuse mild abdominal tenderness. Fecal staining reveals no RBCs, WBCs, or parasites Bacillus cereus, a gram-positive rod,...

Tetanus Neonatorum

Imaging Gross Pathology Micro Pathology Treatment A 40-year-old male who recently went hiking in a forest in the western U.S. presents with symmetric weakness of the lower extremities that has now progressed over the past few days to involve the trunk and the upper arms. The patient does not report any sensory symptoms. Higher mental functions intact symmetric flaccid paralysis with an ascending pattern of spread noted no sensory loss demonstrated on careful examination of hairy areas of the...

Granuloma Inguinale

Imaging Gross Pathology Micro Pathology Treatment A 60-year-old male presents with cough productive of mucopurulent sputum together with mild fever and worsening breathlessness. He is a chronic smoker who has been diagnosed with COPD. VS fever. PE in moderate respiratory distress emphysematous chest with obliterated cardiac and liver dullness wheezing and crepts heard over both lung fields H. influenzae organisms seen as small, pleomorphic gram-negative bacilli on Gram stain of sputum...

Gramnegative Sepsis

Imaging Gross Pathology Micro Pathology A 28-year-old male immigrant presents with inguinal swelling and a painless penile ulcer. He admits to unprotected intercourse with multiple sexual partners, many of whom were prostitutes. Soft, painless, raised, raw, beef-colored, smooth granulating ulcer noted on distal penis multiple subcutaneous swellings ( PSEUDOBUBOE5) noted in inguinal region, some of which have ulcerated. Giemsa-stained smear from penile and inguinal regions demonstrate...

Rsv Pneumonia

A 14-year-old male who is known to have sickle cell anemia presents with throbbing pain, redness, and swelling of the right thigh. The patient also complains of fever and chills of one week's duration. He has a few pet turtles at home. VS fever tachycardia. PE pallor redness, swelling, and tenderness over right thigh effusion demonstrated in right knee joint limitation of range of motion of right knee. CBC leukocytosis elevated ESR. PBS irreversible sickling blood culture reveals Salmonella...

Amebic Meningoencephalitis

A 10-year-old female presents with a high fever, headache, vomiting, and impaired consciousness. She suffered a generalized seizure about 45 minutes ago. She was previously diagnosed with cyanotic congenital heart disease (ventricular septal defect with Eisenmenger's syndrome). VS fever. PE altered sensorium papilledema nuchal rigidity clubbing central cyanosis cardiac auscultation suggestive of VSD with severe pulmonary arterial hypertension. Blood culture reveals mixed infection with...

Epididymitis

ID CC A 10-year-old child presents with complaints of acute-onset voiding of tea-colored urine and reduced urinary output. HP) The child was treated one week ago for streptococcal pyoderma that was confirmed by culture. He also complains of puffiness around the eyes and mild swelling of both feet. PE VS hypertension (BP 140 96) fever tachycardia. PE periorbital swelling mild pitting pedal edema no ascites or kidney mass palpable. Labs CBC mild leukocytosis. Elevated BUN and creatinine elevated...

Lymphocytic Choriomeningitis

ID CC A 26-year-old nurse presented with headaches and recent- onset seizures she also complained of increasing right-sided numbness and blurring of vision. HPI A clinical diagnosis of HSV encephalitis had previously been made, for which the patient was treated with two courses of acyclovir without any amelioration of symptoms the disease continued to progress both radiologically and clinically. On serology she tested HTV positive. PE Neurologic exam reveals cognitive mental impairment visual...

Urinary Schistosomiasis

Imaging Gross Pathology Micro Pathology Treatment Discussion A 25-year-old sexually active woman presents with burning during micturition ( DYSURIA), increased frequency and urgency of micturition, and low-grade fever. UA abundant WBCs mild proteinuria but no casts staining of sediment reveals presence of gram-positive cocci. Urine culture isolates coagulase-negative 5. saprophytics. Antibiotics (ampicillin, cotrimoxazole, or ciprofloxacin). Enterobacteriaceac like E. coli, Klebsiella species,...

Hiv Transmission In Pregnancy

A 28-year-old sexually active woman presents widi crampy lower abdominal pain, yellowish vaginal discharge, and general malaise. She also complains of continuous low-grade fever and reveals that the pain is exacerbated during and immediately after menstruation ( CONGESTIVE DYSMENORRHEA). She uses a copper intrauterine device for contraception. VS low-grade fever. PE lower abdominal tenderness bimanual pelvic exam demonstrates purulent vaginal discharge, bilateral adnexal tenderness, and pain on...

Psittacosis

Gross Pathology Micro Pathology Treatment Discussion A 30-year-old dairy farm worker presents with complaints of fever, cough, pleuritic chest pain, and malaise. His work at the dairy involves milking cows and looking after parturient cattle. VS fever tachypnea, PE mild icterus bilateral crackles on chest auscultation. CBC normal WBC count. Mild elevation of serum bilirubin and liver enzymes greater than fourfold increase in complement-fixing antibody (against Coxielia burnetii) titer between...

Hantavirus Pulmonary Syndrome

Imaging Gross Pathology Micro Pathology Treatment A 25-year-old male woodcutter, residing in S. Korea, is admitted to the ER in a state of shock and massive epistaxis. The patient had been complaining of fever, malaise, headache, myalgias, back pain, abdominal pain, nausea, and vomiting for the past week he also complained of extremely reduced urine output. Careful history revealed that before he fell ill, he and his friend were cutting wood in the forest when they accidentally disturbed a...

Pelvic Inflammatory Disease

Imaging Gross Pathology Micro Pathology Treatment A 30-year-old woman presents to the ER with an abrupt-onset high fever, vomiting, profuse diarrhea, severe muscle aches, and disorientation. One day ago she developed an extensive skin rash all over her body. Her husband says she used a vaginal sponge for VS fever tachycardia hypotension. PE extremely toxic-looking drowsy but responding to verbal commands extensive scarlatiniform rash seen involving entire body pharyngeal, conjunctival, and...

St Louis Encephalitis

ID CC The case of a 12-year-old boy who died of a progressive degenerative neurologic disease was discusscd at an autopsy meeting. HPI The child had been developing normally up to 10 years of age, when his teachers noted a progressive deterioration in intellect and personality this was followed by the development of seizures akin to myoclonus, signs of pyramidal and extrapyramidal disease, and finally a state of decerebrate rigidity. The child died seven months after the onset of symptoms. His...

Pinworm Infection

ID CC -A- 30-year-old hospitalized male presents with profuse watery diarrhea with mucus, crampy periumbilical abdominal pain, nausea, and vomiting. HPI He has been receiving oral ampicillin for five days for a lower respiratory tract infection. PE VS fever tachycardia. PE dehydration abdominal distention diffuse rebound tenderness reduced bowel sounds. Labs CBC leukocytosis (15.000 uL) with predominantly polymorphonuclear leukocytosis. Fecal staining reveals few RBCs and leukocytes (< 10...

Acute Prostatitis

ID CC A 65-year-old male complains of recurrent burning, urgency, and frequency of micturition together with vague lower abdominal, lumbar, and perineal pain. HPI He also complains of a mucoid urethral discharge. He was previously diagnosed via ultrasound with benign prostatic hypertrophy but does not report any severe symptoms of prostatism his medical history reveals frequent UTIs due to E. coli. VS stable no fever. PE rectal exam reveals enlarged, nodular prostate biopsy obtained to rule out...

Scabies

Imaging Gross Pathology Micro Pathology Treatment A 15'day-old infant is brought by his mother to the pediatric emergency room in a state of marked muscle rigidity and spasm. The mother is illiterate and did not receive any prenatal care the delivery was conducted at home and, according to her, was uneventful and full term. The child did not receive any immunizations directed questioning reveals that he has been crying excessively for the past two weeks and has not been feeding normally....

Severe Combined Immunodeficiency Syndrome Scid

Imaging Gross Pathology Micro Pathology Treatment A 10-year-old male complains of generalized weakness, faintness on exertion, and occasional epigastric pain His mother has noticed that he often eats soil and other inedible things ( PICA). Pallor puffy face and dependent edema. CBC microcytic, hypochromic anemia eosinophilia. Low serum iron and ferritin elevated scrum transferrin reduced bone marrow hemosiderin hypoproteinemia stool exam revealed eggs of Ancylostoma duodenaU (ovoid eggs with...

Parvovirus B1 9 Aplastic Crisis

A 34-year-old male presents to his primary care physician with a hard, red, painless swelling on his left mandible that has slowly been growing over the past few weeks and has now begun to drain pus. The patient recently had a tooth extraction. No acute distress no other significant findings. Gram stain of exudate reveals branching gram-positive filaments and characteristic sulfur granules non-acid-fast and anaerobic (distinguishes actinomyces from Nocardid). Sinus tracts from region of...

Proctocolitis

Imaging Gross Pathology Micro Pathology A 35-year-old male presents with high fever, inalaise, headache, and a hacking cough productive of a small amount of mucoid sputum. He has two pet parrots at home who have recently shown signs of illness. VS fever bradycardia. PF. auscultation of chest reveals crepitant rales over both lower lung fields splenomegaly with mild hepatomegaly noted multiple purpuric macules seen over abdomen ( HORDER's SPOTS). Greater than fourfold rise in complement-fixing...

Herpangina

Labs Imaging Gross Pathology Micro Pathology A 60-year-old male presents with swelling and a vesicular skin eruption on the left side of his face. The patient reports that before the rash developed, he had severe radiating pain on the left side of his face. He also recalls having suffered an attack of chickenpox during his childhood. Unilateral vesicular rash accompanied in places by suppuration, bleeding, and small pitted scars over left forehead, nasal bridge, including tip (indicating...

Chronic Prostatitis

A 28-year-old man comes to the ER with gradually worsening and now severe scrotal swelling and pain radiating to the inguinal area. The patient has no significant medical history. He reports pain on urination due to concomitant urethritis and notes that he is sexually active with multiple partners. He also notes that the pain is greater on standing and walking and is relieved by rest and elevation of the legs. VS normal. PE scrotal edema and erythema right epididymis enlarged and tender...

Otitis Externa

Imaging Gross Pathology Micro Pathology Treatment A 9-year-old male is admitted for an evaluation of a suspected underlying immune deficiency. He has been hospitalized and treated several times for recurrent life-threatening septicemia due to S. pneumoniae, meningococcus, and H. influenzae. Careful history reveals that a few years ago he underwent an emergency splenectomy following traumatic splcnic rupture in a motor vehicle accident. Left paramedian postsurgical scar seen on abdomen. Reduced...