Infections On the Spread-A Photo Quiz

April 25, 2014

Diagnosing and managing infectious diseases can be challenging. This week’s photo quiz offers a variety of presentations to test your acumen.

Question 1:

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 2:

A 5-year-old boy presented with an asymptomatic lacy, reticular rash of 4-days duration. It began with the appearance of a solid red rash on his cheeks. The next day the lacy rash covered his entire body and the solid rash on his cheeks also became lacy. The diagnosis was fifth disease.

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Question 3:

A 51-year-old man complained about a solitary painful lesion on the back. His past medical history included numerous bouts of folliculitis that involved the trunk. A solitary, exquisitely tender bright red, fluctuant nodule was found on the back. Incision allowed drainage of copious seropurulent material. He also was given a 2-week course of oral doxycycline. Culture verified methicillin-resistant Staphylococcus aureus (MRSA).

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Question 4:

A 31-year-old man presented with asymptomatic, malodorous discoloration of the toe web spaces. Extensive maceration and a green tinge between the toes were noted. He reported that his feet perspire heavily in the boots his work requires him to wear. A diagnosis of foot intertrigo was made after the results of a bacterial culture were positive for Pseudomonas aeruginosa, Morganella morganii, and normal skin flora.

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Question 5:

Facial erysipelas is seen in an indurated and erythematous lesion that might be mistaken for cellulitis.

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Question 6:

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.

This type of morphology often is caused by a virulent organism-bacterial or fungal.

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ANSWER KEY:

Question 1. A

Question 2. D

Question 3. D

Question 4. C

Question 5. F

Question 6. D