Monday, September 26, 2011

Two Sides of the Same Coin

Back to real hardcore diagnosis:

Case 1: A soldier returning from Afghanistan presents with the skin lesion shown below.

It began as a red papule and evolved to the lesion shown above. There is no surrounding induration. The lesion is completely (and surprisingly) painless. There is some local adenopathy. Without treatment, this lesion will resolve spontaneously, leaving only a residual hypopigmented depressed scar.

Case 2: A photographer who travels worldwide presents with subacute insidious fatigue, malaise, fever, and weight loss over months. The spleen is markedly enlarged but minimally tender. Labs show a severe anemia. The patient notes his skin has "darkened" over the last few months. Without treatment, this disease is lethal. Bone marrow aspirate is shown below.

Challenge: Maybe these serve as hints: What is the Hindi name for the second disease? What insect acts as a vector? What's the diagnosis in each case?

First image is in the public domain; the second image is shown under Creative Commons Attribution Share-Alike License.


Anonymous said...

cutaneous leishmaniasis
visceral leishmaniasis (kala-azar)

Dr.Manjunath.Y.C said...

Leishmaniasis (Kala-Azar)

Anonymous said...

Leishmaniasis (Kala-Azar)

jimmy said...

#1)=Leishmaniasis ?

sid said...

Kala Azar?

Craig Chen said...

wow! and i thought that would be a hard one...
Two Sides of the Same Coin

The first case describes cutaneous leishmaniasis; the second case describes visceral leishmaniasis. This is caused by a heterogeneous group of protozoans spread by the sandfly; the geography is mostly Saudi Arabia, Iran, Afghanistan, Brazil, and Peru. The first image shows a cutaneous lesion beginning as a red papule and enlarging to an ulcer with granulomatous tissue at the base and raised, heaped-up margins. The second case of visceral leishmaniasis is most commonly caused by Leishmania donovi or infantum. It is also called kala-azar (Hindi for “black fever”). The second image shows amastigotes.

Sources: UpToDate; Wikipedia.