Catching Infections-A Photo Quiz

July 19, 2013

Identification of infections often presents a major challenge because there may be significant overlap in clinical findings. This week's photo essay takes the form of a quiz to test your ability to meet the challenge and hone your diagnostic skills.

Question 1:
A 65-year-old man has inflammation on his leg. Note the raised, well-demarcated edge and brilliant salmon-red color. His disorder is characterized by an abrupt onset of fiery red swelling of the face. Patients often experience intense pain.

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Question 2:
A slightly pruritic rash characterized by uniformly distributed 3- to 5-mm papules is shown in the right axillary area of a 55-year-old man in whom secondary syphilis was diagnosed. Syphilis has diverse clinical manifestations.

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Question 3:
A 51-year-old man whose past medical history included numerous bouts of folliculitis involving the trunk complained about a solitary painful lesion on his back. An exquisitely tender, bright red, fluctuant nodule was found.

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Question 4:
A 46-year-old woman presented with a history of 7 days of productive yellow-green sputum and subjective fevers, chills, and nocturnal sweats. She complained of right-sided, pleuritic chest pain; dyspnea; and myalgia and had lost 60 lb during the previous 6 months. She had HIV infection. Candidal infection (thrush), shown here, is an oral lesion often found with later-stage chronic HIV infection.

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Question 5:
This rash in the pretibial area was noted in a 44-year-old man with suspected streptococcal toxic shock syndrome (TSS). TSS caused by group A streptococcus (GAS), or Streptococcus pyogenes, stems from severe, invasive infections, such as bacteremia, pneumonia, necrotizing fasciitis, and spontaneous gangrenous myositis, and is associated with acute onset of shock and organ failure.

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Question 6:
A 61-year-old male physician complained about a solitary, slightly painful lesion on the right hand. A single, linear erythematous and indurated plaque was present on the dorsum of the hand. Further questioning revealed that the patient had a fish tank at his home; he often submerged his right hand in the water to perform maintenance. A biopsy revealed non-caseating granulomata, and culture revealed an infection.

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ANSWER KEY:



Question 1. Answer: a

Question 2. Answer: d

Question 3. Answer: b

Question 4. Answer: d

Question 5. Answer: e

Question 6. Answer: b