Histoplasmosis

Imaging Gross Pathology Micro Pathology A 38-year-old white female visits her gynecologist for a routine Pap smear. She admits to early sexual activity, many sexual partners, and unprotected sex. Pallor cervical tenderness a few small, raised, flat lesions on cervix genital warts also seen on vulva ( CONDYLOMATA ACUMINATA). Presence of HPV in cervical cells revealed on DNA hybridization and immunofluorescent antibody assays for Rounded basophilic cells on Pap smear with large nuclei occupying...

Cytomegalovirus cmv pneumonitis

ID CC A 5-year-old white male presents with malaise, anorexia, low-grade fever, sore throar of three days' duration, and dyspnea on exertion. HPI The child was raised abroad. His immunization status cannot be determined. PE VS fever tachycardia with occasional dropped beats. PE cervical lymphadenopathy ( BULL'S-NECK APPEARANCE) smooth, whitish-gray, adherent membrane over tonsils and pharynx no hepatosplenomegaly diminished intensity of Labs Metachromatic granules in bacilli arranged in Chinese...

Bacterial meningitis

Micro Palhology Treatment Discussion A 4-year-old female presents with a one-week history of fever, severe headache, irritability, and malaise two days ago she developed neck stiffness, and her parents report projectile vomiting over the past 24 hours. The child is also very sensitive to light ( PHOTOPHOBIA). She is fully immunized and has no history of ear, nose, and throat infection, skin rashes, dog bites, or foreign travel. VS fever. PE irritability resistance to being touched or moved...

Typhoid fever enteric fever

A 5-year-old male presents with malaise, anorexia, fever, and a pruritic rash on his scalp, face, and trunk. He also complains of a hcadache. Six of his classmates recently missed school because of similar symptoms. VS fever (39 C). PE skin lesions consist of macules, papules, vesicles, pustules, and scabs, all present at same time, predominandy over trunk, face, and scalp. Multinucleated giant cclls on scraping samples fro m vesicles. CBC leukopenia. Macular, papular, vesicular, and pustular...

Human tcell leukemia virus type 1 htlv

A 20-year-old male college student complains of sore throat, fever, swollen lymph nodes on the back of his neck, anorexia, cough, and malaise of 10 days' duration. He was initially given ampicillin by his school nurse, after which he developed an extensive skin rash. VS fever. PE enlargement of submaxillary and cervical lymph nodes exudative tonsillitis petechiae on soft palate slightly enlarged spleen and liver. CBC PBS anemia thrombocytopenia leukocytosis with absolute lymphocytosis (50 )...

Varicella zoster chickenpox

Labs Imaging Gross Pathology Micro Pathology A 45-year-old HIV-positive male is seen by his family doctor following the appearance of a painful, burning skin rash on the left side of his chest that is accompanied by a headache and low-grade fever. The patient had chickenpox as a child. He had been well until one year ago, when he was diagnosed with non-Hodgkin's lymphoma, for which he is currently undergoing che mo therapy. Vesicular rash on erythematous base in dermatomal distribution (left T6...

Infection

Imaging Gross Pathology Micro Pathology A 30-year-old man wirh AIDS presents with chronic, recurrent profuse, nonbloody, watery diarrhea. The diarrhea has recurred over the past two months with intermittent cramping, and previous treatments have not been effective. VS no fever. PS moderate dehydration thin generalized lymphadenopathy. Acid-fast staining demonstrates oocysts of Cryptosporidium in fresh stool. Blunting of intestinal villi mixed inflammatory cell infiltrates with eosinophils in...

Pneumococcal pneumonia

A 32-year-old HIV-positive male presents with progressively increasing dyspnea over the past three weeks. He also complains of a dry, painful cough, marked fatigue, and a continuous low-grade fever. He has been noncompliant with cotrimoxazole prophylaxis. VS fever marked tachypnea. PE pallor generalized lymphadenopathy respiratory distress intercostal retraction mild central cyanosis nasal flaring coarse, crepitant rales auscultated at both lung bases. ABGs hypoxemia out of proportion to...

Subacute Bacterial Endocarditis

Imaging Gross Pathology Micro Pathology A 25-year-old male complains of increasing shortness of breath and ankle edema that have progressively worsened over the past two weeks. He also complains of fatigue, palpitations, and low-grade fever. His symptoms followed a severe URL He denies any history of joint pain or skin rash (vs. rheumatic fever). JVP elevated pitting pedal edema fine inspiratory crepitations heard at both lung bases mild heparosplenomegaly. ASO titers not elevated. CBC...

Otitis media

Gross Pathology Micro Pathology Treatment A 12-year-old girl arrives in the emergency room with pain, swelling, and limited motion of her left hand she also complains of fever and chills. The girl was bitten by a cat three days ago while playing at a friend's house. Hand is erythematous, shiny, and markedly edematous on palpation, hand is tender with fluctuation (cellulitis) limited passive and active motion yellowish-green purulent fluid drains from wound left epitrochlear and axillary...

Info

A 25-year-old female complains of low-grade fever and myalgia of three weeks1 duration. She has a history of rheumatic heart disease (RHD). One month ago, she underwent a dental extraction and did not rake the antibiotics that were prescribed for her. VS fever. PE pallor small, peripheral hemorrhages with slight nodular character ( JANEWAY I.HSJONS) small, tender nodules on finger and toe pads ( OSLER'S NODES) subungual linear streaks ( SPLINTER HEMORRHAGES) petechial hemorrhages on...

Chronic granulomatous disease

Gross Pathology Micro Pathology Treatment A 25-year-old white female is referred to an internist by her family doctor for a workup of recurrent sinusitis, chronic otitis media, one episode of pneumonia that required hospitalization, and recurrent bouts of watery diarrhea. She has seen an allergy specialist for several years and has received desensitization shots for multiple allergies, including pollen, dust, and cat hair. Normal except for hypopigmented spots on neck and arms Markedly...

Acute sinusitis

A 48-year-old missionary who has lived in Cameroon, West Africa, for 20 years is airlifted home because of lethargy, nuchal rigidity, persistent headache, and drowsiness that have not responded to antibiotics and supportive treatment. He states that over the years he has been bitten in the neck several times by a mutumutu, or tsetse fly ( GiOSSINA PALPALIS). He has also had intermittent, generalized erythematous rashes accompanied by fever. Alert but somewhat incoherent and confused sometimes...

Brucellosis

Micro Pathology Treatment Discussion A 49-year-old morbidly obese, diabetic woman presents with pruritus in the skin folds beneath her breasts. She admits to having this problem chronically, especially in the warm summer months, when she perspires more heavily. Superficially denuded, beefy red areas beneath breasts with satellite vesicopustules and whitish curd-like concretions on Clusters of budding cells with short hyphae seen under high-power lens after skin scales have been put in 10 KOH...

Roseola infantum

Labs Imaging Gross Pathology Micro Pathology Treatment A 2-month-old female infant presents with extensive bullae and large areas of denuded skin. Her mother had suffered from staphylococcal mastitis one week ago. VS fever. PE large areas of red, painful, denuded skin on periorbital and peribuccal areas flaccid bullae with easy dislodgment of epidermis under pressure ( NlKOLSKY'S SIGN) mucosal surfaces largely uninvolved. Vesicle fluid sterile 5. aureus on blood culture. IV...

Bronchiolitis

Imaging Gross Pathology Micro Pathology A 28-year-old white male visits his family doctor complaining of acute pain in both hip joints together with weakness, backache, myalgias, arthralgias, and undulating fever of two months' duration this morning he woke up with pain in his right tcsticlc. For the past three years he has worked at the largest dairy farm in his state. He enjoys drinking crude milk. VS fever. PE pallor marked pain on palpation of sacroiliac joints mild splenomegaly generalized...

Whooping cough

ID CC A 24-year-old white South American male develops sudden high fever, chills, generalized aches and pains, retro-orbital headache, nausea, and vomiting. HPI He gradually improves, but the fever returns four days later along with a yellowing of his skin and eyes and an episode of fainting and abundant coffee-ground emesis. VS fever (39 C) hypotension (BP 90 60). PE jaundice petechiae on lower legs swollen, bleeding gums cardiomegaly hepatomegaly. CBC leukopenia. UA oliguria albuminuria...

Congenital

Micro Pathology Treatment Discussion A 10-year-old female Asian immigrant presents with a low-grade fever and cory7.a of three days' duration. She also complains of arthralgias and a skin rash that began on her lace and spread to her trunk. Her mother says she cannot remember any details of her vaccination history. VS fever. PE maculopapular rash over face and trunk enlarged postauricular, posterior cervical, and occipital lymph nodes. CBC leukopenia thrombocytopenia. Rubella virus...

Rubella german measles

A 10-year-old white female complains of difficulty swallowing, pain in both ears, and fever of one week's duration she also complains of an extensive skin rash. The child is fully immunized and has been well until now. VS fever. PE extensive erythematous rash ( goose-pimple sunburn) on neck, groin, and axillae desquamation and peeling of fingertips circumoral pallor lines of hyperpigmentation with tiny petechiae ( pastia's sign) in antecubital fossae bright red lingual papillae superimposed on...

Yellow fever

Micro Pathology Treatment Discussion A 50-year-old white male develops sudden fever with chills, pain in the back and extremities, and neck stiffness he vomited six times and had a convulsion prior to admission. The patient is a heavy smoker and is diabetic. Two weeks ago, he had a URI. He is also very sensitive to light ( photophobia). Markedly reduced mental status ( obtunded) petechial rash over trunk and abdomen nuchal and spinal rigidity positive Kernig's and Brudzinski's signs no focal...

Varicella zoster

A 2-year-old female is brought to the emergency room because of paroxysms and multiple coughs in a single expiration, followed by a high-pitched inspiratory whistle or whoop. For the past two weeks she has had a runny nose, low-grade fever, muscle pains, and headache. Her immunization schedule is incomplete. VS fever. PE child apprehensive and becomes cyanotic during cough paroxysm thick green mucus expelled with cough conjunctival injection. CBC marked leukocytosis with lymphocytosis....

Cholera

A 19-year-old migrant worker from the southwestern U.S. is brought to the family doctor complaining of cough, pleuritic chest pain, fever, and malaise. He also complains of a backache and headache along with an erythematous skin rash (due to hypersensitivity reaction) in his lower limbs, VS fever tachypnea. PE central trachea coarse, crepitant rales over both lung bases tender, erythematous nodules over shins ( ERYTHEMA NODOSUM) periarticular swelling of knees and ankles. Positive skin test...

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...

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...