Hang Ten

A young otherwise-healthy man is learning to surf for the first time. After his first lesson, he begins to develop progressively worsening low back pain, followed by lower extremity paresthesias. On arrival to urgent care, he has normal vital signs, normal cardiopulmonary exam, no spinal deformity, and a neurologic exam significant for decreased sensation and strength in the lower extremities. Two hours later, he lost complete sensation and motor function of his legs as well as rectal tone. Labs and CSF are unremarkable. Lumbar spine films are unremarkable. CT of the lumbar spine showed no evidence of spondylolysis, spondylisthesis, fracture, or soft tissue abnormalities. Brain MRI is normal. A non-contrast spine MRI (T1w sagittal image) four weeks later shows this:

Challenge: What happened?

Axis of Awesome

Challenge: What does the echo show?

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Burrito

Challenge: What's being shown here?

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Everything but the Kitchen Sink

This is a poor child in a developing country. He gets recurrent infections because of a depressed immune system. He has impaired taste and smell as well as diarrhea. He has a bullous pustular rash. If untreated, he may develop night blindness, alopecia, and decreased spermatogenesis. The treatment, though, is fairly easy.

Challenge: What's he missing?

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Taking a Break

Hi everyone,

Thanks for following along Case of the Day. I'm going to take a break this week. I have my oral board exams coming up in a month so things are looking quite busy; I'll probably take a breather then as well. I feel a little like a hamster running on a wheel, always playing catch-up so hopefully this will give me a chance to get on top of things.

Craig

Names

This rash begins in the second or third trimester. The erythematous excoriated nodules or papules are seen on the extensor surfaces of limbs and the trunk. It should resolve in the immediate postpartum period. Labs are unrevealing.

Challenge: What is one of the many names for this disease?

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Remember 1897?

You are on a cruise ship well-known for its crazy seafood buffets. When passengers start getting sick, a call for, "Is there a doctor on board?" rouses you. Alas, you seem to be working every vacation. At first, you think this is just a viral GI bug because the passengers complain of diarrhea and abdominal cramps. But what's more remarkable is that this is followed by headache, memory loss, and disorientation. In severe cases, you note diminished reflexes, ophthalmoplegia, coma. One person is sent to shore because he needs an intensive care unit.

Challenge: What's the cause of this?

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Slides

Back to basics! I pulled out Robbins ad Cotran for this one.

Challenge: This is the buzzword for which diseases?

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Misleading

Challenge: What's the problem here?

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Big Cat

This adolescent girl started developing these spots during infancy and early childhood. They mostly involve the face, upper trunk, and neck. These were expected since she has some characteristic facial features of a particular syndrome, with abnormally wide set eyes, deafness, and growth retardation. Her astute pediatrician checked an EKG and found conduction abnormalities. A subsequent echocardiogram showed pulmonic stenosis.

Challenge: What's this autosomal dominant disease?

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