87

CASE 87


In late September, a 51-year-old man with a one-week history of fever, headache, and muscle aches was taken to a clinic. He noted an ulcer on his right hand that had not healed and pain in his right axilla.


The patient lived in Oklahoma and had a hobby of sewing together tanned rabbit hides to make blankets. In the week before the onset of his illness, he had skinned and tanned a rabbit killed by the family dog.



PHYSICAL EXAMINATION



VS: T 39.4°C, P 112/min, R 16/min, BP 142/70 mmHg

PE: Remarkable physical findings included an indurated erythematous rash with an ulcerated lesion on the dorsal skin of the right hand and painful axillary adenopathy (Fig. 87-1).

image

FIGURE 87-1 A painful, massively enlarged axillary node (glandular adenopathy).


(Courtesy of Dr. Paul Southern, Departments of Pathology and Medicine, University of Texas Southwestern Medical Center, Dallas, TX.)



LABORATORY STUDIES



Blood



Hematocrit: 38%

WBC: 14,200/μL

Differential: 72% PMNs, 18% lymphs

Blood gases: Normal

Serum chemistries: Normal


Imaging


No imaging studies were done.



Diagnostic Work-Up


Table 87-1 lists the likely causes of the man’s illness (differential diagnosis). Investigational approach may include


• Gram stain of aspirates or biopsies from the ulcerative lesion and the suppurated lymph nodes

• Cultures of blood, pus, or exudates

• Serology. Acute- and convalescent-phase sera are collected for investigation of species-specific IgG levels.

TABLE 87-1 Differential Diagnosis and Rationale for Inclusion (consideration)






Brucellosis (Brucella spp)

Bubonic plague (Yersinia pestis)

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Aug 25, 2016 | Posted by in MICROBIOLOGY | Comments Off on 87

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