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New presentation shows real case from infection diseases hospital and allow you to challenge your knowledge in medicine. After presentation of each case you will see a slide with a question about diagnosis. Try to answer and if you would have problems go to next slide where you will find a hint. Goodluck! If you would interested in new cases please contact Dr Andrey Dyachkov [email protected]
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Clinical cases from infection diseases hospital
Part 2Pavlov State Medical University,
St-Petersburg, Russia
Dr. Andrey Dyachkov
E-mail: [email protected]
Botkin's hospital was found in 1882
Clinical cases - Whatch it!
Case 4: 26 y.o. men with lymphadenopathy Time of admission: 24 of October 2010 Complains at admission: enlargment of 2
lymphnodes: left inguinal and left femoral. Movement are causing a little discomfort at a site of enlarged lymphnodes.
Anamnesis morbi: at 8 of Sept 2010 patient had a sudden attack of fever (37,5 C) and noticed an small edema in his left inguinal zone. He visited his GP who had reffered him to a surgeon for consultation about inguinal hernia.
Patient was examined by surgeon and he prescribed patient doxicyclin for inguinal lymphadenopathy.
Patient took doxicyclin for 5 days (1 tabl. (0,1 g) once a day). After 2 days his temperature dropped to normal and after 5 days his lymphnodes desapeared. For 7 days after that he had no complaints.
After 7 days his had a new increase of fever up to 38,5 C and his lymphnodes became enlarged again. From 24 of Sept till 30 of Sept 2010 patient was treated in surgical hospital where he received metronidazol i.v. 3 times a day (no surgical treatment). He was discharged with normal temperature but his lymphnodes was still enlarged. He was recomended to have a follow-up by surgeon in ambulatory clinic.
From 1 of October his lymphnodes became slightly painful. He was able to walk and continuing to work but in order to decrease discomfort he drove to work by car everyday and walked at work and at home as little as possible.
Case 4: 26 y.o. men with lymphadenopathy
Instead of visit a surgeon he himself decided to visit phthisiatrician who sugested to do a biopsy of lymphnodes. Patient was afraid of operation and didnt show up for biopsy.
His temperature was normal but he took 2 courses of antibiotics in order to treat lymphadenopathy: ciprofloxacin per os and amoxiclav per os, but these courses had no effect. More over after treatment skin above his left inguinal lymphnode became hyperemic.
Patient was refered to infection diseases hospital at 47 day of disease.
Case 4: 26 y.o. men with lymphadenopathy
Physical examination: 192 cm/89 kg, scleras and skin were normal in color and have no rush. In a left inguinal region skin was hyperemic above 4 cm large lympnode, left femoral lymphnode was 3 cm in diameter with normal skin above it. Palpation of these lymphnodes was slightly painful. Other lymphnodes as well as other organs examination found no abnormalities. Patient was active, have good apetite and look generally well.
Laboratory tests:
- CBC count HGB 15,6 g/dl, RBC 5,26, WBC 8,1, neut count — normal, lymphocytes slightly elevated, eosinophyl — normal, ESR 21 mm/hour
- Urine analysis — normal
Case 4: 26 y.o. men with lymphadenopathy
Apperance of patients left inguinal zone
Case 1: 26 y.o. men with lymphadenopathy
Ultrasound examination: moderate hepatomegaly, 2 lympnodes in left inguinal zone was 25*18 mm in diameter and surrounded by slightly edematosous soft tissues.
According to his epidemeological anamnesis patient refused to have contact with any febrile patient, had no contact with animals and didnt travel abroad. He mentioned 2 visits to his summer cottage in Novgorod' region at 7 and 30 of August 2010 with his family. They dug potatoes together and suffered a heavy attacks of different flyes and moskitous, thought all his relatives have no symptoms of disease.
Case 4: 26 y.o. men with lymphadenopathy
What is a diagnosis?Case 1: 26 y.o. men with lymphadenopathy
Case 4: Tularemia
Case 4: Tularemia Tularaemia is a bacterial zoonotic disease of the northern hemisphere. The bacterium (Francisella tularensis) is highly virulent for humans and a range of animals such as rodents, hares and rabbits. It was described by american doctor JW McCow in a basin of Tulate lake in 1912. F. tularensis is transmitted to humans: (i) by arthropod bites, (ii) by direct contact with infected animals, infectious animal tissues or fluids, (iii) by ingestion of contaminated water or food, (iv) by inhalation of infective aerosols.There is no human-to-human transmission.
Case 4: Tularemia Tularemia has 5 clinical forms: (i) Ulceroglandular,(ii) Glandular (our case),(iii) Oculoglandular, (iv) Oropharyngeal(v) Pneumonic
Our patient had serum aglutination reaction 1:400 and reaction of nondirect aglutination 1:10240
He had received streptomycin 0,5 g twice a day i.m. for 14 days with positive effect
Case 4: Tularemia
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More cases - http://www.slideshare.net/drandreyst-p/clinical-cases-from-infection-diseases-hospital
