Clearing Up Infections-A Photo Quiz

September 27, 2013

Some of the signs of infection are pathognomonic, but not many, so careful patient evaluation often is needed. This week's photo quiz offers a variety of presentations to test your diagnostic acumen.

Question 1:
This example of facial erysipelas shows an indurated and erythematous lesion that might be mistaken for cellulitis.

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Question 2:
A young man sought medical attention after a motorcycle mishap that led to multiple leg abrasions. One such lesion (shown here) expanded rapidly and became progressively painful. The center of the lesion turned dark. The black, hard center represents an eschar.

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Question 3:
After returning from a skiing trip, a 24-year-old woman sought medical attention for an eruption of sudden onset on her lip. She also had a sore throat and low-grade fever.

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Question 4:
A sample of muscle tissue from a patient with group A streptococcal (GAS) necrotizing fasciitis/myonecrosis shows an abundance of gram-positive cocci and extensive muscle destruction. The patient was a 65-year-old man in whom toxic shock syndrome (TSS) developed. TSS caused by GAS stems from severe, invasive infections.

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Question 5:
A 24-year-old man with a recent diagnosis of HIV infection presented with left ear pain. The pain worsened and the ear became red and swollen. He also felt dizzy and vomited. There was unilateral nystagmus on rightward gaze, subtle weakness of the left side of the face, and 1+ erythema and swelling of the entire left auricle with multiple areas of superficial vesicles. The diagnosis was Ramsay-Hunt syndrome.

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ANSWER KEY:



Question 1. Answer: E

Question 2. Answer: B

Question 3. Answer: C

Question 4. Answer: D

Question 5. Answer: B