Thursday, November 29, 2012


This used to be a disease that peaked every few years in the winter and early spring, mostly in school age children. Most of them are asymptomatic or only have mild fever and lymphadenopathy (posterior cervical, posterior auricular, suboccipital). The rash began on the face, but generalized within 24 hours.

Challenge: What's your diagnosis?

Image is in the public domain.

Monday, November 26, 2012


This patient has AIDS. He developed poorly defined erythematous patches that quickly developed a prominent scale. The scalp, hands, and feet are the worst. Note the warty scales, fissures, and crusts.

Challenge: Eww. You double glove and wear a gown. Even so, you take a shower when you get home. What does he have?

Image is in the public domain.

Thursday, November 22, 2012


In Turkey, there was an outbreak of this disease in 98 patients. (It's Thanksgiving! Though in actuality, this disease is most prevalent in China, Thailand, Mexico, Argentina, and Bolivia). In the first week after exposure, patients complain of abdominal pain, nausea, vomiting, and diarrhea. Lab tests at this time are unrevealing.

After the first week, patients develop the cardinal symptoms of muscle pain, joint pain, and subjective muscle weakness. The most common muscle groups include the calves, upper arm, neck and shoulder girdle, and forearms. The pain can be so bad, patients do not want to move at all. On exam, they can have fever, subungual splinter hemorrhages, conjunctival or retinal hemorrhages, periorbital edema or chemosis, visual disturbances, and ocular pain. Lab tests show leukocytosis and eosinophilia (which peaks in the third or fourth week of disease). A light micrograph of a muscle biopsy is shown below.

Challenge: What's your diagnosis?

First image is in the public domain, second image is shown under Fair Use.

Monday, November 19, 2012

Skull and Crossbones

Challenge: What are those white things going into the skull? P.S. Ignore the metal dentures.

Image shown under Creative Commons Attribution Share-Alike License.

Thursday, November 15, 2012


The white bar marks 50 nanometers.

This bug haunts nursing homes, retirement facilities, cruise ships, airplanes, schools, and daycare. It hangs out with shellfish, especially oysters. The incubation time is a day or two and the illness lasts 18-72 hours. Patients develop abrupt onset vomiting and non-bloody diarrhea, accompanied by myalgias, malaise, headache, and fever.

Challenge: What's the bug?

Image is in the public domain.

Monday, November 12, 2012


A 60 year old postmenopausal woman with obesity, chronic smoker's cough, chronic constipation, diabetes, and psoriasis on infliximab undergoes a laparoscopic hysterectomy for uterine cancer. She appears to do well postoperatively; she tolerates a diet, ambulates, urinates, and has adequate pain control. Six months after her surgery, however, she presents with pelvic pain, vaginal bleeding, and vaginal pressure. Palpation on a bimanual exam feels like bowel is extruding from the vagina.

Challenge: What happened?

Image of a total laparoscopic hysterectomy shown under GNU Free Documentation License, from Wikipedia.

Thursday, November 8, 2012

Picture This

This patient has seen doctors for years without a diagnosis. She has crampy abdominal pain, fatigue, nonbloody diarrhea, weight loss, and fever. She attributes her weight loss to mouth pain and pain with swallowing. A colonoscopic image is shown below as are two interesting skin rashes.

Challenge: What's the diagnosis?

First two images shown under GNU Free Documentation License. Last image is in the public domain.

Monday, November 5, 2012

Store at Room Temperature

Ever since this child was one year old, he has had an "allergy to cold." Exposure to cold environments, even an air-conditioned room, triggers the rash shown above in around seven hours. This is followed by a fever. If blood is drawn 10 hours after the exposure, then the leukocyte count can be over 30,000/microL. This CBC abnormality declines about 12-14 hours later. The baby also develops a red eye and complains of joint aches. All these symptoms usually resolve within 24 hours. In between episodes, the patient's exam is completely normal.

Challenge: What's your diagnosis?

Image shown under Fair Use.

Thursday, November 1, 2012


A 60 year old man presents with 6 weeks of back pain. It has been progressively worsening and is worse at night. On examination, there is local tenderness to gentle spinal percussion and decreased range of motion of the back. Neurologic examination of the lower limbs is normal. WBC is normal. ESR and CRP are markedly elevated. Radiographs are shown above.

Challenge: What's your diagnosis?

Image shown under Fair Use.