Infectious Disease

Suspicious Skin Lesion in an 11-Year-Old Male

Rachel E Bonczek, MSN^*, Kimberley M Farr, MD^{^} and Corrie E Chumpitazi, MD, MS^‡

DOI: https://doi.org/10.21980/J8JK9TIssue 4:1 No ratings yet.

The patient had a 5 cm ulcerative lesion with raised borders and a yellow, “fatty” center. There was no active drainage, site tenderness, or lymphadenopathy.

Visual EM Dermatology Infectious Disease

Endocarditis

Sara Arastoo, BS^* and Sari Lahham, MD, MBA^*

DOI: https://doi.org/10.21980/J8JP73Issue 3:4 No ratings yet.

Upright frontal radiograph of the chest demonstrated large pleural effusion on the left and moderate pleural effusion on the right as shown by the visible menisci on both sides (red arrows) with diffuse bilateral nodular densities (yellow dotted lines), consistent with septic pulmonary emboli. Computed tomography (CT) of the chest demonstrated multiple scattered lung nodules bilaterally containing internal foci of air cavitation (green dotted lines).

Infectious Disease Cardiology/Vascular Visual EM

Fournier Gangrene

Joseph Zakaria, BS^*, Steve Bunch, MD^* and Victor Cisneros, MD, MPH^*

DOI: https://doi.org/10.21980/J89626Issue 3:4 No ratings yet.

The computed tomography (CT) of the abdomen and pelvis revealed significant subcutaneous gas tracking along the perineum and right gluteal region (orange outline) into the scrotum with associated scrotal edema (yellow arrow) and subcutaneous inflammatory fat stranding of 0.92 cm (red arrow) consistent with Fournier’s gangrene. There is early fluid loculation along the right medial gluteal cleft of 5.85 cm (green arrow) without a sizeable drainable abscess seen.

Infectious Disease Visual EM

Sepsis Secondary to an Abdominal Wound Infection

Alisa Wray, MD^*

DOI: https://doi.org/10.21980/J8PS60 Issue 3:2 No ratings yet.

At completion of this case learners should be able to: 1) Recognize and differentiate between systemic inflammatory response syndrome, sepsis, severe sepsis, and septic shock. 2) Prepare an appropriate differential diagnosis for a patient with sepsis. 3) Demonstrate appropriate fluid resuscitation and antibiotic therapy for a septic patient. 4) Demonstrate appropriate vasopressor therapy for a septic patient. 5) Understand and apply the Surviving Sepsis Guidelines.

Infectious Disease Abdominal/Gastroenterology Simulation

Necrotizing Soft Tissue Infection

Sahil Aggarwal, BS^* and Jonathan Peña, MD^*

DOI: https://doi.org/10.21980/J8X92TIssue 3:2 No ratings yet.

Computed tomography (CT) of the abdominal and pelvis with intravenous (IV) contrast revealed inflammatory changes, including gas and fluid collections within the ventral abdominal wall extending to the vulva, consistent with a necrotizing soft tissue infection.

Infectious Disease Visual EM

A Case of Otomastoiditis

Chad Correa, BS^* and Claire Thomas, MD^{^}

DOI: https://doi.org/10.21980/J8RK89Issue 3:2 No ratings yet.

The patient underwent computed tomography (CT) of the head which revealed opacification of the left middle ear (red arrow) and mastoid air cells (red circles). Additionally, there was thickening of the soft tissues of the external auditory canal (blue arrowhead), likely reflecting concurrent otitis externa. Based on the imaging, he was admitted for findings consistent with acute otomastoiditis.

ENT Infectious Disease Visual EM

Pediatric Pulmonary Abscess

Kyle Barbour^* and Jonathan Peña, MD^*

DOI: https://doi.org/10.21980/J83S6QIssue 3:2 No ratings yet.

Upright posterior-anterior plain chest films show a left lower lobe consolidation with an air-fluid level and a single septation consistent with a pulmonary abscess (white arrows). A small left pleural effusion was also present, seen as blunting of the left costophrenic angle and obscuration of the left hemidiaphragm (black arrows).

Respiratory Infectious Disease Visual EM

Severe Sepsis Manifesting as A-Fib with Rapid Ventricular Rate

Paul Nicholson, MD^* and Jennifer Yee, DO^*

DOI: https://doi.org/10.21980/J8WG9W Issue 3:1 No ratings yet.

By the end of this simulation session, the learner will be able to: 1) Recognize severe sepsis (please note – Centers for Medicare and Medicaid Services (CMS) Sepsis-I and II definitions are used throughout the case, as Sepsis-III has not been adopted by any emergency medicine organizations), 2) recognize atrial fibrillation, 3) review the importance of a thorough history and physical exam, 4) discuss the sepsis spectrum, 5) discuss the acute management of severe sepsis, 6) discuss common and uncommon sources of sepsis, 7) discuss appropriate empiric antibiotic options, 8) discuss common causes of newly-diagnosed atrial fibrillation, 9) review the different emergency medicine-based treatment modalities for uncomplicated atrial fibrillation, specifically atrial fibrillation with rapid ventricular rate.

Infectious Disease Simulation

Hutchinson’s Sign

Lawrence Lau, MD^*, Hannah Mirzakhani, BA^{^} and Nicholas Governatori, MD^*

DOI: https://doi.org/10.21980/J8N040 Issue 3:1 No ratings yet.

The unilateral distribution of vesicular lesions over the patient's left naris, cheek, and upper lip are consistent with Herpes zoster reactivation with Hutchinson's sign. Hutchinson's sign is a herpes zoster vesicle present on the tip or side of the nose.1 It reflects zoster involvement of the 1st branch of the trigeminal nerve, and is concerning for herpes zoster ophthalmicus.1 Herpes zoster vesicles may present as papular lesions or macular vesicles on an erythematous base.2,3 Emergent diagnosis must be made to prevent long-term visual sequelae.4

Infectious Disease Dermatology Visual EM

Viridans streptococci Intracranial Abscess Masquerading as Metastatic Disease

Brandon Ruderman, MD^*, Traci Thoureen, MD^*and Joshua Broder, MD^*

DOI: https://doi.org/10.21980/J8CH05 Issue 3:1 No ratings yet.

A non-contrast CT (Figure 1) revealed a large hypoattenuating left parietal lesion. When the CT was enhanced with intravenous contrast (Figure 2), the same lesion showed peripheral rim enhancement, suggestive of a brain abscess.

Infectious Disease Neurology Visual EM