QUIZ: Not so typical...

Friday, 06 November 2009 00:00

Case description: The patient complains about an increasing fever over the last few days, a headache and a cough. Apart from this he noticed a rash on his abdomen.

QUIZ questions: What procedures will you use? What diagnosis would you suggest? What are differential diagnoses are there? How will you treat this patient?

Comments

0 #1 diabeł 2009-12-14 20:27

I'm asking for description of those abnormalities on the abdomen and full history, particularly about his profession, use of medicines, allergies, circumstances preceding his condition and physical examination, later we will think ;-)

0 #2 aniamos 2009-12-15 11:52

and the patient's age...

0 #3 Gonzo 2009-12-15 14:36

The patient is 35 years old. He doesn't use any drugs chronically , doesn't have any allergies diagnosed. He works in travel agency as an offer tester. He mentioned, that he came back from India 1 or 1,5 month ago.

Physical examination: grey deposit on his tongue, enlarged spleen, macular rash on his abdomen.

-1 #4 MMader 2009-12-16 00:40

Let's do a morphology with smear, abdomen USG, ESR and CRP
Because of enlarged spleen and macular rash we can expect thrombocytopeni a.
Clinical picture may fit into many diseases. From India he could bring for example leishmaniosis (visceral type), but we need more diagnostics...

0 #5 Gonzo 2010-03-19 14:36

Morphology:
leucopenia, in smear left shift, toxic granules, total eosinophiles deficiency
OB - normal
CRP - slightly increased

0 #6 Emily 2010-12-20 14:46

Is the grey despoit on the tongue localised or does it extend to the oropharynx? It is a true discolouration or the result of a membrane over the tongue?

0 #7 Emily 2010-12-20 14:51

Additionally, would counsel for HIV testing. Possible seroconverison syndrome?

0 #8 katia 2011-04-20 09:10

typhoid fever

+1 #9 dr.premanand@gmail.com 2011-05-11 20:07

typhoid with step ladder fever , spleen, rose spot is agreeable.i would do widal test.enquire into his food and water consumption too.

0 #10 dr.premanand@gmail.com 2011-05-11 20:11

this may be due to ascariasis.loffler syndrome.cough goes in handy.

+1 #11 eleonora 2011-05-13 21:16

did the patient mention anything about joint paints?

0 #12 katia 2011-05-15 19:11

Hi eleonora
what is your diagnosis if patient had joint pain?

0 #13 eleonora 2011-05-17 11:21

Hello Katia! When I asked this question I was thinking of something quite extreme- Chinkungunya. It is common in India and matches with the patient's history and PE. Unfortunately, at that time I didn't consider the incubation period. It was mentioned by Gonzo that the patient came back from India 1 or 1,5 mo ago but the incubation period for chinkungunya is less than a week. Now, I am mostly oriented towards secondary syphilis. The patient may have had a chancre all this time which he didn't notice since it is painless. An examination of the genitalia or the anus could perhaps reveal a scary lesion. Further tests like FTA-Abs and TPHA could also be ordered. I would also definitely check for HIV with ELISA and Western-blot for confirmation in case of a positive result. RT-PCR can also be used,if there are not any cost issues.

0 #14 Gonzo 2011-05-17 19:08

The patient has no joint pain. There is white-grey despoit in central part of his tongue, but periferal parts are reddened. dr.premanand@gmail .com - the widal test is positive. You and katia have right - this is thypoid. Congratulations :)

Refresh comments list
RSS feed for comments to this post

JComments

Medical procedures

Medical books

Medical movies

Medical cases

Last comments

Recommended

Comments