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حالات سريرية


12th case of the year: generalized rash, facial edema, fever, and severe fatigue |

حالة سريرية

الوصف الكامل Background

A 51-year-old woman is evaluated for generalized rash, facial edema, fever, and severe fatigue that have developed over the past week. She was recently diagnosed with rheumatoid arthritis. She currently takes prednisone, hydroxychloroquine, and sulfasalazine. She has no previously known allergies.

On physical examination, temperature is 39.1 °C (102.3 °F), blood pressure is 110/78 mm Hg, pulse rate is 108/min, and respiration rate is 25/min. The face is edematous. Skin examination reveals a generalized morbilliform eruption. The skin is not painful, and no blisters are present. There is no ocular or mucosal involvement. Lymphadenopathy is noted in the cervical and axillary regions. Laboratory studies show a serum alanine aminotransferase level of 330 U/L and a serum aspartate aminotransferase level of 355 U/L. Results of a complete blood count are normal except for 16% eosinophils.

كتابة حرة وطرح موضوع النقاش!
Which of the following is the most likely diagnosis?

A) Drug reaction with eosinophilia and systemic symptoms (DRESS)
B) Erythema multiforme
C) Stevens-Johnson syndrome
D) Toxic epidermal necrolysis

المرجع

Later


حكة جلدية أسفل البطن وعلى الفخذ مع bulla |

حالة سريرية

الوصف الكامل Background
A 72-year-old man presents with large, tense, pruritic bullae on the lower abdomen, groin, and inner thighs. Skin biopsy reveals IgG antibodies with linear immunofluorescence at the epidermal basement membrane. To what cell junctions are the antibodies binding?

A. Adherens junctions
B. Desmosomes
C. Gap junctions
D. Hemidesmosomes
E. Tight junctions


حكة .. |

حالة سريرية

الوصف الكامل Background
A 7-year-old elementary school child presents with her mother to the clinic for evaluation of
itching. They deny any exposure to new soaps or detergents, pollens or grasses, or new foods.
On physical examination, there are small papules, pustules, lichenified areas, and excoriations.
Using a magnifying lens, you identify a burrow on the finger webs. What is the most likely
diagnosis?
(A) Scabies
(B) Atopic dermatitis
(C) Acne
(D) Telangiectasias

a 10-year old boy wth rasied-firm papules |

حالة سريرية

الوصف الكامل Background
A mother came to ur office wth her 10-year-old boy wth these raised-firm papules on the hand:
[img]
http://www.hakeem-sy.com/main/files/derm.JPG[/img]

what is the Dx????

and The Tx???


أفة جلدية |

حالة سريرية

كتابة حرة وطرح موضوع النقاش!

مريض يبلغ من العمر 65 سنة يقضي الشتاء بفلوريدا راجع بأفة متقرحة غير مؤلمة على الخد الأيمن .
ظهرت الأفة منذ سنة , الفحص السريري لم يظهر ضخامة عقد لمفية رقبية , ما التشخيص الأكثر احتمالا ؟
1- ميلانوما
2- كيسة زهمية
3- سرطانة قاعدية الخلايا
4- سرطانة شائكة الخلايا


طفح جلدي خمجي |

حالة سريرية

الوصف الكامل Background

رجل ياباني 25 سنة عائد لليابان بعد إجازة قضاها في جامايكا, تم تحويله من أحد المطارات المحلية الأمريكية على طريق العودة بسبب آفة رقبية ملاحظة من أحد الركاب المجاورين .
القصة السريرية : لا يوجد أي أعراض مرضية أو تماس مع الحيوانات لكنه ذكر أنه قد أقام علاقتين جنسيتين في جامايكا.
الفحص السريري : أظهر وجود بقع حمراء صغيرة عليها حويصلات رائقة مع جلبات صفراء عسلية على الصدر و البطن و الإبط و أعلى الظهر و الرقبة (كما هو موضح بالشكل المرافق)
ما هو التشخيص الأكثر احتمالاً ؟
ما هو الاختلاط الأهم الذي قد ينجم عن هذا المرض ؟
كيف تتم المعالجة؟


PEDIATRIC RASH |

حالة سريرية

كتابة حرة وطرح موضوع النقاش!
I think this is a nice case, the purpose of this case is to know the disease and to add it to the list of rashes in pediatric, please try to answer the questions , multiple choises as you see, discussion is to come!!!

AN 11-MONTH-OLD BOY is referred for a rash of three weeks duration that began in the right antecubital region and
gradually spread to involve the proximal right arm, right upper trunk and right lateral abdomen.
The eruption was treated initially with a topical antifungal and low-potency topical corticosteroid, without improvement. The mother has noticed that the child seems bothered by mild pruritis, but he is otherwise well without any fevers, recent history of travel or known exposures.

Examination reveals erythematous macules and papules in the distribution noted above, as well as a small focus on the left inner arm Figures 1 and 2). He is on no medications and has an unremarkable past medical history except for mild respiratory symptoms five days prior to the onset of the rash.

The most likely diagnosis is:
A. Atypical pityriasis rosea
B. Unilateral laterothoracic exanthem
C. Lyme disease
D. Tinea corporis

The most appropriate next step is:
A. Potassium hydroxide preparation and fungal culture
B. Serology for Borrelia burgdorferi
C. Education and reassurance
D. Parvovirus exposure precautions

The most appropriate therapy includes:
A. Amoxicillin
B. Griseofulvin
C. Emolliation
D. Topical ketoconazole


A common skin lesion |

حالة سريرية

الوصف الكامل Background
This 3 month old child was born with no remarkable lesions. a Few days thereafter, he developed a red, raised lesion in his lower eyelid which is becoming larger..
what's the likely dx?
What is the expected outcome for this lesion?

painful ,erosive ,expanding sore |

حالة سريرية

الوصف الكامل Background
A 54 year old diabetics patient reports to his physician's office complaining of an unresolved skin lesion on his foot .This lesion began several weeks ago as a blister
and has since become a painful ,erosive ,expanding sore.On examination,the affected site is now 5 cm in diameter with black necrotic center and raised red edges.which of the following toxins has a mechanism of action most similar to the toxin responsible for tissue damage in this patient??

a-Anthrax toxin
b-botulinum toxin
c-cholera toxin
d-clostridium perfringens alpha toxin
e-diphtheria toxin
f-Escherichia coli labile toxin
g-Pertussis toxin
h-shigatoxin
i-streptococcal erythrogenic toxins
j-tetanus toxin


non-painful circumoral rash |

حالة سريرية

الوصف الكامل Background
Alina is a 12 year-old HIV-infected girl complaining of a non-painful circumoral rash as seen in the picture below. She has had the rash for several weeks, despite treatment with acyclovir.

What is your diagnosis?


Aphthous Stomatitis |

حالة سريرية

الوصف الكامل Background
31-year-old HIV-infected man presents with painful sores in his mouth
His medications consist of tenofovir-DF (Viread), lamivudine (Epivir), and efavirenz (Sustiva); his CD4 count is 328 cells/mm3 and his HIV RNA is less than 50 copies/ml.
الفحص السريري Clinical Exam
The oral examination shows several moderately sized ulcerated lesions on the tongue and buccal mucosa (Figure 1).
الاستقصاءات Investigations
He has previously experienced several similar but less severe episodes. A fluorescent antibody and culture for herpes simplex virus are negative and the diagnosis of aphthous stomatitis is made.
كتابة حرة وطرح موضوع النقاش!

أحياء دقيقة 19: طفح على الرقبة والجذع انتشر إلى الذراعين Microbiology 19: Rash on Trunk and Neck has spread to Arms |

حالة سريرية

الوصف الكامل Background
A young girl is brought to her doctor because of a rough-apperaing rash on her trunk and neck that has spread to her arms.
Physical exam reveals that her axilla are most affected but her palms and soles are spared.
Her parents say that she has been suffering from fever and sore throat.
Lab studies reveal her serum is ASO+.

What's the diagnosis? What's the treatment?

اُحضِرَت فتاة إلى طبيبها وهي تعاني من طفح خشن المظهر على جذعها ورقبتها وقد انتشر إلى ذراعيها.
وبالفحص السريري تبين أن إبطها هو أكثر مكان متأثر بالإصابة ولكن راحتي يديها وأخمصي قدميها غير مصابة.
والداها قالا أنها كانت تعاني من حمى والتهاب بلعوم.
الفحوص المخبرية أظهرت أن مصلها إيجابي مضاد الستريبتوليزين O.

ما هو التشخيص؟ وما هو العلاج؟


MICROBIOLOGY-9 |

حالة سريرية

الوصف الكامل Background
You and ur friends won a free journey to Africa.
Today, you visit a remote riverside village and Shocked discover that most of the older village inhabitants are blind.
On physical exam of some the members, you note skin nodules and hyperpigmented rashes.
What is the Diagnosis Question What do you have to do to prevent other village members from becoming blind (Traetment)Question
If u were in a hospital what other Investigations can support your diagnosis Question

ربحت انت ورفقاتك رحلة مجانية إلى أفريقيا.
واليوم وانتوا عم تزوروا قرية مجاورة لنهر تفاجأتوا Shocked انو أغلب سكان القرية الكبار مصابين بــالعمى.
كل واحد فيكن عمل فحص سريري لبعض سكان القرية وولاحظتوا انو الكل عنده عقيدات جلدية وطفح جلدي مفرط التصبغ.
ما هو التشخيص Question شو لازم تعمل مشان تحمي باقي سكان القرية من الاصباة بالعمى (يعني شو العلاج) Question
وإذا كنت بمستشفى شو الاستقصاءات الأخرى اللي ممكن تدعم تشخيصك بهاQuestion

Question


scaly alopecia |

حالة سريرية

الوصف الكامل Background
A 10-year-old HIV-infected boy presents with scaly alopecia.

What is your diagnosis?
what is the treatment ?


CAN YOU IDENTIFY THIS CONDITION? |

حالة سريرية

الوصف الكامل Background
A 25-year-old woman had had annular migratory patches on her tongue for 3 years. She complained of a burning sensation when she ate acidic or spicy foods.

The most likely diagnosis is:

1. Geographic tongue
2. Herpes gingivostomatitis
3. Oral candidiasis
4. Aphthous stomatitis


short case |

حالة سريرية

الوصف الكامل Background

Joey is a 7 year-old boy with HIV infection who comes to the clinic with a painful, vesicular, crusting rash across the left side of his face, neck and upper chest. The rash does not extend across the midline of his body. Prior to the appearance of the rash he experienced burning pain and itching in the area where the rash subsequently appeared.

كتابة حرة وطرح موضوع النقاش!

What is your diagnosis?


skin 'rash' of 2 months duration |

حالة سريرية

الوصف الكامل Background
A 35-year-old man presented with a skin 'rash' of 2 months duration. This had started as a single, small spot on his trunk, followed later by crops of similar lesions, all over; they were painless and did not itch.
القصة المرضية HPI
He had no other symptoms; in particular, no cough, chest symptoms, fever, weight loss or lymphadenopathy. He was apyrexial, with bilateral axillary and inguinal lymphadenopathy. About 20 purplish-red nodules were present on his trunk, face and palate as well as at the anal margin. His nose showed similar discoloration and swelling. White, wart-like projections of 'oral hairy leucoplakia' were present on the sides of his tongue.
الوضع الصحي والاجتماعي SH
He was homosexual, with one regular sexual partner over the preceding 2 years. He also participated in casual, unprotected sexual intercourse whilst on holiday. He had never used intravenous drugs.
الاستقصاءات Investigations
Investigations showed a normal haemoglobin, a normal white-cell count (4.9 x 109/l) and normal absolute lymphocyte count (1.8 x 109/l). After counselling, blood was sent for an HIV antibody test which was positive by enzyme-linked immunosorbent assay (ELISA) and confirmed by Western blotting . A second test was also positive. Immunological studies (Table C3.7) showed a raised serum IgA and analysis of lymphocyte subpopulations showed absolute depletion of CD4+ cells.
كتابة حرة وطرح موضوع النقاش!
what is the right diagnose?

Fulminant Cutaneous Eruption in a 51-Year-Old Man |

حالة سريرية

الوصف الكامل Background
A 51-year-old African American man presented with a 2-month history of a painful, nonpruritic, worsening cutaneous eruption that had started on his lower extremities and had spread over his entire body.
القصة المرضية HPI
The patient, whose medical history was otherwise unremarkable, denied systemic symptoms and had not taken any medications before the onset of the eruption. His condition initially improved on a regimen of high-dose oral steroids (prednisone, 60 mg/d) but flared when the dosage was tapered.
الفحص السريري Clinical Exam
Physical examination revealed crusted erosions, flaccid bullae with pus, well-circumscribed shallow ulcers, and dusky, erythematous circinate plaques on the scalp, face, trunk, and extremities (Figure 1).
الاستقصاءات Investigations
A complete blood cell count revealed an elevated white blood cell count (24.1×103/μL [reference range, 4.5-11.0×103/μL]) with 89 segmented neutrophils (reference range, 31-76), 4 band cells, and 1 lymphocytes (reference range, 24-44). Bone marrow biopsy and flow cytometry revealed no abnormalities. All body fluid and skin cultures showed no growth of organisms. A serum chemistry profile showed hypocalcemia and hypoalbuminemia. Serologic tests were negative for human immunodeficiency syndrome, hepatitis, and syphilis and positive for Epstein-Barr virus. Biopsy specimens were obtained from the chest and right thigh (Figure 2 and Figure 3).

Angioedema |

حالة سريرية

الوصف الكامل Background
A 45-year-old man presents to the emergency department with swelling of the tongue that started about 30 minutes before his arrival. The patient denies having shortness of breath, a sore throat, drooling, or globus sensation. He also denies ingestion of new foods, pills, or supplements and any exposure to new items such as soap, tooth paste, deodorants, and laundry detergents. The patient is not taking any medications and is allergic to penicillin. He reports a history of urticaria and 1 episode of an allergic facial swelling that was successfully treated with antihistamines and steroids.

On physical examination, the patient's vital signs are a temperature of 37.2°C, blood pressure of 140/67, heart rate of 77 beats per minute, respiratory rate of 18 breaths per minute, and an O2 saturation of 99% while he is breathing room air. The patient appears well and is in no acute distress. Head, eyes, ears, nose, and throat examination reveals marked swelling of the right side of the tongue and the floor of his mouth (see Image). Of note, the patient has no difficulty opening his mouth, and the floor of his mouth is soft to palpation. The uvula is visualized by using a tongue depressor; it is midline and not swollen.

The lungs are clear to auscultation without any wheezing or rales, and hearts sounds are regular and without murmurs. The abdomen is soft and not tender. The extremities show no signs of cyanosis or edema. Detailed skin examination fails to demonstrate any abnormal lesions; in particular, no urticarial lesions are identified.

What is the diagnosis?
Answer
Idiopathic unilateral angioedema of the tongue: The image shows angioedema limited to the right side of the tongue. Urticaria and angioedema may appear separately or together as cutaneous manifestations of localized nonpitting edema. The process may also occur on mucosal surfaces of the upper respiratory or GI tract.

Angioedema is a well-demarcated, localized edema involving the deep layers of the skin, including the subcutaneous tissue. The pathology of urticaria is usually characterized by edema of the dermis in urticaria; that of angioedema is characterized by edema of the subcutaneous tissue and dermis. In affected areas, collagen bundles are widely separated, and the venules are sometimes dilated. The perivenular infiltrate may consist of lymphocytes, eosinophils, and neutrophils that are present in various combinations and numbers throughout the dermis.

The 5 major etiologic groups for urticaria with or without angioedema are the following:

Immunoglobulin E (IgE)–dependent group, which may involve specific antigens (eg, foods, drugs, pollens, venoms), physical stimulation (eg, cold, vibration, exercise), or certain autoimmune disorders (eg, lupus erythematosus, cryoglobulinemia, juvenile rheumatoid arthritis, autoimmune thyroid disease)
Bradykinin-mediated group, which may involve hereditary or acquired C1 esterase inhibitor (C1INH) deficiency or malfunction or angiotensin-converting enzyme (ACE) inhibitors
Complement-mediated group, where patients may have serum sickness, necrotizing vasculitis, or a reaction to a transfusion of blood products
Nonimmunologic group, in which disease is related to direct mast-cell activators (eg, opiates, antibiotics, radiologic contrast material) or agents that alter arachidonic acid metabolism (eg, nonsteroidal anti-inflammatory drugs, azo dyes, benzoates)
Idiopathic
The initial goal of therapy is airway management and attention to the patient's ventilation and oxygenation. The most skilled person available must handle airway interventions if they are necessary because oral obstruction is often massive. The treating physician should be ready to perform a surgical airway intervention when attempts to secure an oropharyngeal and/or nasopharyngeal airway fail.

After the patient's airway is secured, pharmacotherapy for nonhereditary angioedema usually involves a short course of H1 and H2 blockers as well as steroids. In advanced or progressive cases with airway compromise or in cases that are progressing despite adequate conservative pharmacotherapy, subcutaneous epinephrine can be given. Hereditary angioedema is more refractory to subcutaneous epinephrine, antihistamines, and steroids than nonhereditary angioedema. Stanozolol (anabolic steroid) and danazol (gonadotropin inhibitor) may be used in the acute phase of an episode of hereditary angioedema. C1INH should be replaced during moderate-to-severe episodes of hereditary angioedema; it is transfused as a C1INH concentrate or as fresh-frozen plasma.

The patient in our case was treated with intravenous H1 and H2 blockers as well as glucocorticoids. He was observed in the emergency department for 4 hours, when and his tongue swelling markedly improved. At discharge, a 5-day course of antihistamines and prednisone and self-injectable epinephrine (Epi-Pen) were prescribed. C1INH levels and function studies were ordered from the emergency department, and the results were reported to be within normal limits. The patient was referred to an immunologist.

المرجع

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