7 Year Old Male Child Presents With Pallor and Dark Urine While On Treatment For Malaria

A 7 Year old child who presented with high grade fever about 5 days back and is now on treatment for malaria now presents to the emergency with severe, sudden onset of pallor and dark colored urine. He feels very weak and is frightened by the appearance of his urine. Although he is afebrile now, he is breathing rapidly and on examination he looks pale and there is yellowish discoloration of his skin and sclera. On abdominal examination, spleen is enlarged and palpable.

Labwork shows:
Hb = 5 gm/dl
Increased reticulocyte count
Increased billirubin levels.

The peripheral blood film has the following picture:

Numerous destroyed red blood cells ( Arrows shows bite cells following removal of Heinz bodies).


What is the Diagnosis?
.
.
.
Hemolytic anemia due to G6PD deficiency, in this case hemolysis triggered due to antimalarial drugs.

A 27 Year Old Woman Complains Of Dysuria And Suprapubic Pain

A 27 year old woman presents to her primary care physician with the complains of increased urinary frequency, pain and burning on urination as well as pain in the supra pubic area for the last 2 days. She also noticed that she had fever last night. She took acetaminophen which gave her temporary relief. Patient remembers having similar symptoms a few months back. She is sexually active with her husband. Her menstrual cycle is normal and regular.
On Examination patient is febrile with a temperature of 101 F. On abdominal examination she feels discomfort on palpation in the supra pubic region.

She is advised to get some lab workup done including a urine dipstick which revealed +ve  nitrites and + leukocytes. Her urine is sent for culture which showed the following picture in the lab.

Culture in the laboratory showing growth of Escherichia Coli.

Patient is diagnosed as a case of Urinary tract infection.

Case Discussion:

A 25 Year Old Man Complains Of Occasional Blood In Stool

A 25 year old man comes to his primary care physician and complains of seeing blood in his stool occasionally. He has fairly regular and normal bowel habits but he is concerned because he has lost his father at a young age due to colon cancer and his initial symptoms were also blood in stool. He has no other symptoms and is living a healthy life style.
The patient was referred for a colonoscopy which showed the following in the sigmoid colon.

Multiple polyps carpeting the mucosa of the colon.

Based on the history and the above picture what is the most probable diagnosis?
.
.
.

Familial adenomatous polyposis

Case Discussion:

A 43 Year Old Hospitalized Man Complains Of Sudden Episodes Of Dizziness and Lightheadedness

A 43 year old man who is hospitalized with Symptoms of heart failure complains of sudden episodes of dizziness and lightheadedness, he was otherwise fine and was responding to the treatment for heart failure. An ECG was done and shows the following appearance:

What is the diagnosis on the basis of characteristic appearance on the ECG.
?
?
?
Atrial Flutter ( Saw tooth waves on ECG )

Case Discussion:
Atrial Flutter is an abnormal heart rhythm and is one of the types of supraventricular tachycardia. It is similar to atrial fibrillation and sometimes both may occur one after the other.

Risk Factors: Certain underlying medical conditions increase the risk of developing atrial flutter, theses may include:

• Heart failure
• Previous heart attack
• Valvular abnormalities
• High blood pressure
• Recent surgery
• Thyroid disorders
• Diabetes
• Alcoholism 
• Chronic lung disease

A 30 Year Old Man Presents With A Bloody Diarrhea, Fever and Abdominal Pain

A 30 year old man presents to his primary care physician with the complains of severe abdominal pain, high grade fever and a bloody diarrhea that started 2 days ago. Initially the symptoms were mild but now he is feeling very sick and weak. He gives a history of passing more than 5 watery stools mixed with blood today. He has no history of vomiting but his appetite has decreased. He remembers eating at a road side restaurant while he was coming home from work. On examination he looks pale and mildly dehydrated.
Hos fresh stool specimen is collected and examined under the microscope which shows the following picture:

The above picture shows the shigella species under microscope in a stool specimen.

The patient was diagnosed as a case of Bacillary dysentery or Shigellosis

A 50 Year Old Man Who Has Been Chronically Sick Presents With Weight Loss, Cough And Weakness

A 50 year old man who has been sick for the past 5 years with fever, cough and fatigue and has been taking incomplete treatments from different primary care physicians presents with a cough, fever, weight loss, night sweats, extreme body weakness and pain through out the body. He was taking some cough syrups recently with no improvement in his symptoms.
On Examination patient is a thin man with poor hygiene and signs of weight loss. He is anemic and has palpable lymph nodes in his neck and axilla. He is coughing most of the time during the examination. He has decreased breath sounds through out the lung filed and on abdominal examination the spleen is enlarged.

His Chest X ray is shown below:

Based on the above history and the X ray picture what is the most probable diagnosis?
.
.
Miliary Tuberculosis.

Case Discussion:
Miliary Tuberculosis is an uncommon manifestation of pulmonary tuberculosis and it represents hematogenous dissemination of uncontrolled tuberculous infection.