Infectious Disease

Erythema Migrans

Daniel Polvino, MD^* and Grant Wei, MD^*

DOI: https://doi.org/10.21980/J8QW7QIssue 2:4 No ratings yet.

History of present illness: A 28-year-old male presented to the emergency department with a chief complaint of two weeks of headache, chills, and numbness in his hands. He reported removing a tick from his upper back approximately two weeks ago, but did not know how long the tick had been embedded. His review of symptoms was otherwise unremarkable. Significant findings:

Chancre of Primary Syphilis

Adnan Riaz MD^* and Grant Wei MD^*

DOI: https://doi.org/10.21980/J83342 Issue 2:4 No ratings yet.

Physical examination revealed a non-tender, erythematous lesion on the glans penis, two similar adjacent satellite lesions, as well as tender inguinal lymphadenopathy. No penile discharge was noted.

Infectious Disease Dermatology Genitourinary Visual EM

Using Bedside Ultrasound to Rapidly Differentiate Shock

Mohamad Moussa, MD^*, Jacob Willen, BS^* and Sudipa Biswas, BS, MS^*

DOI: https://doi.org/10.21980/J8S047 Issue 2:3 No ratings yet.

A RUSH exam demonstrated hyperdynamic cardiac contractility and collapse of the inferior vena cava (IVC) with probe compression more than 50% suggesting hypovolemia likely secondary to sepsis. Incidentally, Morrison’s pouch revealed a large right renal cyst but no signs of free fluid. A computed tomography of abdomen/pelvis showed a 10.8 x 9.5 cm right renal cyst and left lower lobe pneumonia.

Ultrasound Infectious Disease Visual EM

Pediatric Sepsis Case Scenario

Ilene Claudius, MD^*, Sandra Montero, RN^*, Madhu Hardasmalani, MD^{^}, Kellyn Pak, RN^* and Y. Liza Kearl, MD^{^}

DOI: https://doi.org/10.21980/J8MK5XIssue 2:2 No ratings yet.

Pediatric sepsis is a low-frequency, high impact condition. Nurses and physicians do not see it often, but must recognize and treat children with sepsis efficiently when they present. This makes pediatric sepsis education particularly amenable to simulation scenarios.

Pediatrics Infectious Disease Simulation

Acute Necrotizing Ulcerative Gingivitis (ANUG)

Nicholas E. Kman, MD^* and Vinny P. Kumar, MD^*

DOI: https://doi.org/10.21980/J8S88H Issue 2:2 No ratings yet.

Physical examination revealed inflamed gingiva, ulceration, and soft tissue necrosis (Image 1) along with mandibular lymphadenopathy (not shown). Given her symptoms, poor oral care, and her immunocompromised state, she was given a diagnosis of Acute Necrotizing Ulcerative Gingivitis (ANUG) or Vincent’s Angina.

ENT Infectious Disease Visual EM

Infectious Mononucleosis: Pharyngitis and Morbilliform Rash

Eric McCoy, MD, MPH^* and Amal Shafi, BS^*

DOI: https://doi.org/10.21980/J88C7H Issue 2:2 No ratings yet.

Her physical exam was significant for bilateral tonsillar exudates, cervical lymphadenopathy, and a morbilliform rash that included the palms (Figure 1-4). Laboratory testing was significant for white blood cell (WBC) count of 16.5 thous/mcl with an elevation in absolute lymphocytes of > 10 thous/mcl. The monospot and EBV (Epstein-Barr virus) panel were positive.

Infectious Disease Dermatology ENT Visual EM

Herpes Zoster

Hamid Ehsani-Nia, BS, MS^* and Robert Rowe, MD^{^}

DOI: https://doi.org/10.21980/J8C301 Issue 2:2 No ratings yet.

The patient was in mild distress, afebrile, with stable vital signs. His physical exam revealed an erythematous, grouped vesicular rash in various stages of progression including erythematous papules, clear vesicles, and pustular vesicles. Few lesions were scabbed over. No signs of crusting or scarring were appreciated. The distribution encompassed the entire left T4 dermatome both posteriorly and anteriorly. No other rashes were appreciated elsewhere on the body.

Infectious Disease Dermatology Visual EM

A Toddler with Abdominal Pain and Emesis

Saema Said, BS^* and Kevin Koenig, MD^*

DOI: https://doi.org/10.21980/J8XW2P Issue 2:2 No ratings yet.

In the long axis video, the appendix appears as an enlarged, non-compressible, blind-ending tubular structure (white arrow) with distinct appendiceal wall layers and lack of peristalsis. In the short axis video, the appendix appears as a target sign (yellow arrow) between the abdominal and psoas muscles. The maximal outer diameter (MOD) measures 11.8mm and the appendix wall measures 0.17mm. There is trace adjacent free fluid and echogenic periappendiceal fat. Transverse axis video and image (red arrow) demonstrate that the appendix is not compressible. These findings are consistent with acute appendicitis.

Abdominal/Gastroenterology Infectious Disease Pediatrics Ultrasound Visual EM

Neutropenic Fever

Shannon Toohey, MD, MA^*

DOI: https://doi.org/10.21980/J8KW2KIssue 1:2 No ratings yet.

Neutropenia is a common oncologic emergency, and it frequently develops as a result of myelosuppression from chemotherapy. Neutropenia is defined as absolute neutrophil count (ANC) <1000/mm3, with severe neutropenia being defined as ANC<500/mm3. Patients with fever and neutropenia should be presumed to have infectious etiology and started on antibiotics immediately. The 48-hour mortality associated with an untreated infection is 20%-50%.

Infectious Disease Oral Boards