Interesting Cases

On call today (Tuesday)...overall it's been quite a hectic day which has brought in a slew of fascinating array of medical diseases gone unchecked...

Interesting Case #1: (actually a case from yesterday, but who's counting?) 27 year-old man with HIV+ with a CD4 count of 0 (the CD4 count is a measure of how advanced the HIV is...in general, a CD4 count of less than 200 is when you start seeing a lot of infections...a CD4 count of zero...well, that's the lowest you can go) comes in with a rash over his face and trunk. It's a painless rash of small white, raised spots a few mm in diameter, some of which have central umbilication. Grossly, it seemed to resemble something called "molluscum contagiosum", a benign condition for which there is not really any treatment, but doesn't really cause any harm. However, our attending Dr. Gluckman brought up the fact that it's possible it COULD be a rare manifestation of cryptococcal infection--a yeast which can cause a disastrous brain infection which can be fatal. We did a scraping of the lesion, did a gram strain, and looked under the microsope in our own little ghetto-style lab on the ward. Guess what? Teeming with cryptococcal organisms! While it feels pretty cool to make a suprise diagnosis like this, the thrill of discovery was unfortunately offset by the fact that the dude declined to have a spinal tap performed (to exclude cryptococcal meningitis), which would be a crucial step in his further management, and bolted from the hospital as soon as possible. I just hope he has the sense at least to take his fluconazole...

Interesting case #2: 53 year old man who comes in with profuse nose bleeding since 2 in the morning. Has been healthy his whole life and had an HIV test 1 year ago which was negative. His blood count was significant for a white blood cell count of 229,000....which is about 50 times higher than what is normal! Sadly, this gentleman has leukemia (more specifically, he has chronic myelogenous leukemia) and will be starting chemotherapy shortly.

Interesting case #3 actually comes from our own Penn medicine posse! One of the medical students in our group came down last weekend with fever, diffuse weakness, and lymph node swelling in her upper thigh. A couple of days later she developed a single small red rash with an overlying eschar (area of black skin necrosis). The diagnosis? An interesting bug called "Rickettsia africae", which is transmitted by a tick bite. Kind of like the Lyme Disease of Africa, I suppose. Fortunately, it is very easily treated with a short course of the oral antibiotic doxycycline... Get well soon!!!

Only 2 more hours of call left...then we are heading home for what is certain to be a scrumptious bry (the word for barbecue here in Botswana).