Infectious Disease

The parents of a 2-year-old boy with a 3-day history of fever took him to the emergency department. The child’s temperature fluctuated between 38°C (100.4°F) and 39°C (102.2°F).

For 3 days, a 23-yearold woman had been bothered by pruritic vaginal and vulvar lesions. A cheesy white vaginal discharge was associated with the itching. She denied being sexually active.

Levofloxacin, 500 mg/d, had been prescribed for a 74-year-old woman who had a urinary tract infection. The patient had type 2 diabetes and hypertension. She was allergic to sulfa drugs. Two hours after taking the first oral dose of the antibiotic, painful blisters developed on the lower lip and soft palate.

A 33-year-old man with AIDS presented to the emergency department with fever, dyspnea, cough, and pleuritic chest pain of 3 days’ duration. He had had a Pneumocystis carinii infection 3 years before recently emigrating from the Dominican Republic to the United States.

Numerous plaques, some with yellow crusting and central scarring, had erupted primarily on the face and neck of a 46-year-old man. A single lesion had developed on his left elbow as well. The lesions were initially diagnosed as impetigo, but they failed to resolve after 2 courses of oral cephalexin.

For 3 weeks, a 14-year-old boy had been aware of an enlarging lesion on the back of his hand. He recalled no trauma to the affected area. Further questioning by Dr D. Keith Cobb of Savannah, Ga, revealed that a 4-mm verruca, or wart, had been removed from the same site 6 months earlier with cryosurgery by a different physician.

This condition involves the invagination of a proximalsegment of bowel (the intussusceptum) into a more distalsegment (the intussuscipiens) (A). It occurs mostfrequently in infants between the ages of 5 and 12months and is a leading cause of intestinal obstructionin children aged 2 months to 5 years. Intrauterine intussusceptionis associated with the development of intestinalatresia. The male to female ratio is approximately3:2. Intussusception is slightly more common in whitethan in black children and is often seen in childrenwith cystic fibrosis.

The mother of an 8-year-old girl sought medical care for her daughter who had complained of intermittent chest pain for 3 days. The patient denied nausea, vomiting, and diarrhea. There was no shortness of breath, chills, fever, or diaphoresis.

Persistent bloating, epigastric discomfort, and increased gastric acidity prompted a 47-year-old woman to seek medical care. Gastroesophageal reflux disease was diagnosed; antacids and H2-blockers were prescribed but provided no relief.

Painful erosions developed on the sole of a 14-year-old girl's foot several weeksearlier. Within the last few days, the condition has spread to the other sole.The patient is otherwise healthy and takes no medications. She enjoys playingsoccer and has no history of trauma.

Adhesions (A) can form within theperitoneal cavity after abdominalsurgery, especially if there is an underlyinginflammatory condition suchas appendicitis (B) or inflammatorybowel disease. The incidence of adhesiveintestinal obstruction following alaparotomy is approximately 2%. Mostadhesive obstructions occur within 3months of the laparotomy, and 80%occur within 2 years. Adhesive obstructionstend to be more commonin children than in adults.

Is soaking the feet in an aluminum salt solution an effective therapy fordyshidrosis?

A middle-aged woman had had alow-grade fever, sore throat, and malaisefor 1 week. Her physician prescribedamoxicillin. Three days afterstarting the medication, an asymptomaticerythematous and petechialeruption developed over the patient’sentire body.

A 49-year-old woman was admitted tothe hospital with a high fever ofabrupt onset, rigor, headache, myalgias,and profound prostration. Hertemperature was 41ºC (105.8ºF);blood pressure, 60/40 mm Hg; respirationrate, 30 breaths per minute;and pulse rate, 130 beats per minute.

A 55-year-old woman had a 10-day historyof a nonproductive cough and apainful rash on both palms for 5 days.The eruption subsequently spreadover her entire body.

A pruritic, erythematous rash developed in a 6-year-oldboy over 5 days. The rash erupted in crops; the lesions appearedinitially as rose-colored macules, progressed rapidlyto papules and vesicles, and finally crusted (A). The distributionof the lesions-with the greatest concentrationon the trunk-is typical of chickenpox.

A generalized pruritic, vesicular eruption on an erythematousbase developed in a 34-year-old man. His palms andsoles were not involved

A 30-year-old man presented with a few-day history of aviral prodrome, including a low-grade fever, mild headache,muscle and joint aches, and malaise, accompaniedby a vesiculopapular rash. The mildly pruritic eruptionbegan on the head and neck and progressed within 36hours to the trunk and proximal extremities; the palmsand soles were spared.

A 67-year-old woman was admitted to the hospital with fever, chills, unilateral flank pain, dysuria, and urinary frequency and urgency. Her past medical history included several febrile relapses of infection.

Following a motor vehicle accident, a 28-year-old man was admitted to the hospital burn unit. He had sustained third-degree burns on his left h and left proximal forearm. Intravenous colloid solution was administered, and wound dressings were changed twice daily.

Occasionally, protective splinting with plaster of Paris splints can create problems, particularly in patients with diabetes and loss of protective sensation who are readily susceptible to pressure sores.

Infection of the “simple” open fractureof the distal radius is a significant-but fortunately rare-complication ofimmobilizing musculoskeletal injuriesof the upper extremity. Cliniciansoften underestimate the extent towhich this type of fracture can be contaminated,particularly if the patientpresents with a small puncture wounddirectly over the fractured distal radiusthat conceals the degree of contaminationat the fracture site. If openfractures of the distal radius are simplywashed out in the emergency department and temporarily splinted, overwhelming sepsis fromclostridial myonecrosis may develop, leading to amputation.

24-year-old woman had experienced perianal itching and a small amount of rectal bleeding for 6 months. She also complained of a perianal protrusion.

One week after redness and swelling arose on the left second finger, a 33-year-old man sought medical evaluation. He reported some tenderness and difficulty in flexing the digit but could not recall injuring the finger. The medical history included treatment of seborrheic dermatitis and acne.

Seen here are asymptomatic papillary growths on the gingiva of a 31-year-old homosexual man who is seropositive for HIV. The diagnosis of human papillomavirus (HPV) lesions can be based on appearance and history. Condylomas may also appear flat and smooth or nodular, resembling fibromas. Because cross infection is common, patients who have these lesions-and their partners-are at increased risk for contracting anal and genital condylomas.