A 35-year-old HIV positive patient arrives at the emergency department with complaints of gradual onset of mild generalised headache and fever. His most recent CD4 count was 120 (1000-1500). He reports one episode of vomiting. Upon physical examination, he has a temperature of 38°C and mild nuchal rigidity, but no photophobia or papilloedema. Given the likely diagnosis, what is the recommended treatment to initiate after a diagnostic lumbar puncture?
A 26-year-old man presents to gastroenterology with a 6-month history of unexplained chronic diarrhoea and unexplained chronic weight loss. An HIV test is sent as part of his work-up and returns positive. His CD4 count is 150. He is started on anti-retroviral therapy.
During microscopy of the patient’s stool sample, round oocysts measuring between 4 and 6 µm are seen. They stain red using the modified acid-fast stain, leading to a diagnosis of Cryptosporidium. Unfortunately, the first-line treatment of nitazoxanide is not available.
What other medication could potentially be used to treat this patient?
A 25 year-old artist presents with complaints of headache, neck stiffness, and photophobia. He has been feeling tired and irritable for the past four weeks. On examination, the right side of the palate does not elevate, and the tongue is deviated to the right upon protrusion. The rest of the neurological examination is normal. Plain computed tomography of the head is unremarkable. Lumbar puncture reveals turbid cerebrospinal fluid with 35 cells/mm³ (90% lymphocytes), protein level of 1.25 g/L, and glucose level of 1.6 mmol/L. What is the most likely diagnosis?
A 32-year-old Somali male presents on the medical take with a severe generalised headache associated with nausea and vomiting. He has been living in the UK for the last 10 years. He was diagnosed with HIV 5 years ago and has been well maintained on therapy with an undetectable viral load and a CD4 count of 500 cells/mm3.
He has a long history of headaches since the age of 12 which are normally controlled with simple analgesia. Over the last 2 days he has been suffering with a particularly bad attack which culminated in him becoming aggressive and vomiting profusely. He was noted to have a tonic-clonic seizure whilst in accident and emergency which resolved with diazepam.
Clinical examination reveals a pulse of 78 beats per minute, a blood pressure of 130/90, oxygen saturations of 98% on air and a temperature of 36.8 degrees. There was no focal neurological defects.
A CT scan subsequently showed cystic and calcified lesions within the brain and mild hydrocephalus.
What is the most likely diagnosis?
A 35-year-old woman who has received a liver transplant from an unrelated donor some 4 weeks earlier, presents to the clinic with complaints of fevers, arthralgia, abdominal pain and diarrhea. She had initially made a good recovery after her transplant. Upon testing, human herpes virus 5 is positive and there has been a rise in CRP and serum creatinine levels. The patient’s laboratory values are as follows:
Hb 10.2 g/l Na+ 138 mmol/l
Platelets 203 * 109/l K+ 5.2 mmol/l
WBC 10.9 * 109/l Urea 9.2 mmol/l
Neuts 8.7 * 109/l Creatinine 211 µmol/l
Lymphs 2.0 * 109/l CRP 88 mg/l
Eosin 0.1 * 109/l
What is the most appropriate course of action for this patient?
A 25-year-old woman returns from a backpacking trip in Thailand through a rainforest. Shortly after returning home, she develops a high fever accompanied by facial flushing and a severe headache with retro-orbital pain. She also experiences myalgia and joint pains, and has noticed bleeding from her gums. On examination, she is found to be pyrexic with a temperature of 40.5 °C. Her blood pressure is 110/70 mmHg, and her pulse is 110 beats per minute. She has a maculopapular rash, and there are petechiae and bleeding from the site where blood was drawn. Laboratory investigations reveal the following results: Hb 110 g/l, WCC 4.2 × 109/l (relative lymphocytosis), PLT 35 × 109/l, Na+ 134 mmol/l, K+ 5.2 mmol/l, Cr 120 μmol/l, ALT 190 IU/l, PTT 26.5 s. Thick and thin film are negative. What is the most likely diagnosis?
A 25-year-old Caucasian woman returned from a two week hiking trip in Peru four days ago. She had not taken malaria prophylaxis. She had been drinking alcohol moderately during her trip. She had unprotected sex during her holiday with a local man.
Yesterday she had felt hot and cold with pain all over her body and a headache. Today the pain is worst behind her eyes. It is a constant pain and there is no photophobia or neck stiffness. She has an erythematous rash over her trunk and back with patches of white skin surrounded by erythema. There is no lymphadenopathy.
She is observed in hospital for 48 hours and tests for HIV (including PCR and antibody), malaria and blood cultures were negative. Further tests remain unreported.
She recovers and is feeling much better. Prior to discharge, she asks if she is safe to go back to Peru next year.
What advice would you give her?
A 39-year-old man presents to the medical outpatient clinic with complaints of increasing breathlessness, particularly on exertion. He has also experienced several fainting episodes in the past few months, with associated chest sensations and rapid recovery. His medical history is unremarkable except for childhood treatment with antibiotics for an eye infection. He has been experiencing constipation and is currently taking Senna and Movicol. On examination, he has a displaced apex beat, normal heart sounds, and mild coarse crepitations at both lung bases. What is the most likely diagnosis?
A 56-year-old man presents to the emergency department with one day of fever and a severely painful left leg. He has a past medical history of hypertension. He takes ramipril. He smokes cannabis occasionally and drinks approximately 10 units of alcohol a week. He has recently completed treatment with aciclovir for an episode of chickenpox.
His observations are heart rate 111 beats per minute, blood pressure 86/48 mmHg, respiratory rate 21/minute, oxygen saturations 97% on room air and temperature 38.4ºC.
On examination, his left thigh is erythematous, tense and tender to touch. There is palpable crepitus.
Blood tests:
Hb 108 g/L Male: (135-180)
Female: (115 – 160)
Platelets 555 * 109/L (150 – 400)
WBC 23.1 * 109/L (4.0 – 11.0)
Na+ 131 mmol/L (135 – 145)
K+ 4.8 mmol/L (3.5 – 5.0)
Urea 14.2 mmol/L (2.0 – 7.0)
Creatinine 191 µmol/L (55 – 120)
CRP 351 mg/L (< 5)
What is the most significant risk factor for the development of this condition in a 56-year-old man with a history of hypertension, occasional cannabis use, and alcohol consumption?
Sarah is a 19-year-old woman who was admitted with a fever and disseminated rash. She had not received any prior vaccinations and had been in contact with her 2-year-old cousin who had developed a fever and disseminated blisters and vesicles containing clear fluid. Two weeks after seeing her cousin, Sarah began to experience flu-like symptoms and developed similar clear-fluid filled vesicles and blisters. She was admitted for further observation.
After three days, Sarah noticed that while most of her skin lesions were healing, one of the lesions on her thigh appeared to be red and becoming hot to the touch. The affected area of skin was approximately 3x3cm and was erythematous. She was started on IV flucloxacillin and over the next 12 hours, the erythema around the lesion continued to spread. The pain around her leg increased in intensity, requiring morphine to alleviate the pain. A bluish discolouration began to develop around the rash.
What is the probable causative organism responsible for the complication that has arisen?