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)

Related posts:

  1. 13
  2. 61
  3. 37
  4. 60

Stay updated, free articles. Join our Telegram channel
Tags:
Aug 25, 2016 | Posted by in MICROBIOLOGY | Comments Off on 87

Full access? Get Clinical Tree

 Get Clinical Tree app for offline access