A 25 year-old man has been referred to you for consultation from the Emergency Department. He experienced his first tonic-clonic seizure and a CT scan of his head revealed a contrast enhancing lesion in the left frontal lobe. During the interview, he mentioned having recurrent nosebleeds and dark stools for the past year.
What is the probable underlying diagnosis?
A 32 year-old male originally from Russia who is known to be HIV positive presents with a rash.
On examination, there are purple-red cutaneous macules and papules on the back, neck, and oral mucosal membrane.
Blood results reveal:
– Hb 141 g/l
– Platelets 327 * 109/l
– WBC 4.2 * 109/l
– Na+ 141 mmol/l
– K+ 3.7 mmol/l
– Urea 4.6 mmol/l
– Creatinine 59 µmol/l
– Bilirubin 27 µmol/l
– ALP 97 u/l
– ALT 44 u/l
– Albumin 30 g/l
– HIV viral load 14,000 copies / ml
– CD4 cell count 124 cell/mm3
A skin biopsy is performed, and the report shows the presence of spindle cells with moderate mitotic activity, abnormally dense and irregular blood vessels, and intracellular hyaline bodies.
What virus is likely responsible for these lesions?
A 38-year-old Sri-Lankan woman presents to the GP with a malar rash. Upon examination, she has an erythematous rash that is warm to the touch with some underlying edema over both cheeks and the bridge of her nose. She reports feeling low in energy over several months and describes a feeling of numbness in her feet and hands.
After conducting several investigations, including a serum complement C3 test and a serum C-reactive protein test, an outpatient rheumatology appointment is arranged. In the meantime, she is started on a course of steroids, which rapidly improves her symptoms and almost completely resolves the rash. However, she is left with persistent numbness that appears to be worsening.
What is the most likely underlying diagnosis for this 38-year-old Sri-Lankan woman?
A 68 year old man, originally from India, has been living in the UK for 12 years. He has type 2 diabetes mellitus which is controlled with metformin only.
For the past few years, he has had multiple lumps all over his body, but he hasn’t been too bothered by them as they haven’t gotten worse. He has been seeing the diabetic foot care team due to several non-healing ulcers on his feet.
Recently, he has been feeling increasingly unwell. He has had a fever, pain in his knees and elbows, sore and painful eyes. He also complains of painful swelling in his ring and little fingers on his right hand.
Upon examination, his temperature is 37.8C. His pulse is 91 beats/minute and his RR is 18 breaths/minute. His oxygen saturations are 97% on room air.
He has multiple nodular lesions over his whole body in a symmetrical distribution. The sizes of these nodules range from 2cm – 4cm. These lesions are not painful, and with the larger ones, he is unable to feel you touching them. On his shins, there are several hot painful nodules which are uncomfortable to touch. He has a saddle deformity of his nose. There are several scars on his hands, and an ulcer on the lateral dorsum of his foot. Cardiorespiratory and abdominal examination is essentially normal. Both knees and elbow are slightly erythematous and swollen. He has weakness abducting his little and index finger on his left hand and has no sensation in his left little finger. There is a non-painful 1×4 cm lump two centimetres distal to his left medical epicondyle.
Urinalysis reveals ++ of protein and + of blood.
Blood sugar: 8.8 mmol/L
Based on the clinical information provided, what investigation is most likely to confirm the diagnosis?
You are summoned to assess a 27-year-old man who has been admitted to the Neurosurgery Ward for a neurosurgical procedure for almost two weeks. He has been prescribed carbamazepine after the surgery.
He is scheduled to be discharged tomorrow, but he has been feeling unwell today and has been complaining of red and painful skin. He has noticed blistering on his arms over the past few hours and also reports mouth soreness.
In the last few hours, his pulse rate has increased to 130 beats per minute (bpm). His blood pressure (BP) is 105/62 mmHg. His temperature is 38.3 °C.
What intervention is most likely to improve his prognosis?
A 32-year-old man visits his primary care physician complaining of rapidly developing white patches on his skin over the face, trunk, and limbs for the past two months. During the examination, his blood pressure is 110/70 mmHg, and his heart rate is 96 bpm. He experiences postural hypotension. A diffuse swelling is detected in the front of his neck, which moves with swallowing. Upon further investigation, anti-microsomal and anti-thyroglobulin antibodies are found to be positive.
Lab Results Normal Range
Free T3 (fT4) 6.8 pmol/l 11–22 pmol/l
Free T4 (fT3) 2.3 pmol/l 3.5–5 pmol/l
Thyroid-stimulating hormone (TSH) 70 µU/l 0.17–3.2 µU/l
What would be the appropriate initial treatment for this patient?
A 35-year-old man presents with recurring episodes of guttate psoriasis. He has a history of recurrent tonsillitis, which has triggered several episodes of the psoriasis. Currently, he has developed a post-tonsillitis guttate psoriasis eruption on his trunk and limbs, affecting less than 10% of his body surface area.
What management and prevention options should be considered for this patient with guttate psoriasis?
A 50 year-old woman comes to her GP with a sore on her right shin that has been present for the past 5 months and has been gradually increasing in size. The lesion is tender and has a yellow-brown color. Additionally, there seems to be another smaller lesion growing next to the larger one. The patient has a medical history of type 1 diabetes mellitus and multiple sclerosis, which is currently in remission. She is taking insulin as her only regular medication. What is the best course of treatment for this patient?
A 54-year-old woman presents to the Emergency Department, complaining of changes affecting her left nipple. There is erythema around the nipple with crusting/bleeding and some scaling of the skin over the areola. She has a past history of hypertension and type II diabetes.
On examination, her blood pressure is 130/70 mmHg and pulse 82 bpm and regular. Her body mass index (BMI) is 30 kg/m2. You confirm the findings with respect to the left nipple. There are no palpable masses in either breast, and there is no lymphadenopathy.
What is the most appropriate next step in management?
What is the cause of pellagra?