Off food-related illnesses for a while, owing to reader complaints… A healthy young man spent 3 weeks in northern Vietnam, traveling from Hanoi to Haiphong City, trekking for 3 days in Cat Ba National Park. He and his two companions remained well other than for mild bouts of traveller’s diarrhoea. Although he had fallen a […]

A healthy 6-year-old girl was referred for a single day of diarrhoea (2 episodes) along with 3 episodes of involuntary anal orangey discharge that stained her trousers. Her stool was also remarked to be watery, orange-brown and oily. She complained of having some abdominal cramps, but was otherwise well, with no nausea, fever or dehydration. […]

A teenager developed persistent high fever (up to 39.5 degrees Celsius) two weeks after returning from a trip to a national park in Brunei. The other nine students and teacher-counsellor remained well other than occasional bouts of gastroenteritis. The school excursion had lasted a week, with two days spent camping in tents within the national […]

A middle-aged man with newly diagnosed diabetes mellitus presented with sudden onset right eye pain and tearing 2 days ago. This was associated with fever a day later, and he was unable to open his right eye fully because of the eyelid swelling. He had no history of trauma to the eye, no contact history […]

A middle-aged post-menopausal woman who was previously well presented with intermittent fever and lower abdominal pain for a month. She had lost 3 kg over this time time period. She had otherwise no symptoms suggestive of urinary tract infection, no change in bowel habits and no significant discharge per vagina. Clinical examination revealed mild tenderness […]

A middle-aged man presented with pruritus ani (i.e. irritation of the skin around the anus) for several months. He had been healthy and well until he developed a bad bout of diarrhoea from a trip to a nearby country half a year ago, where he has spent a week with other volunteers helping to build […]

A late middle-aged woman with liver cirrhosis (MELD score 18) from non-alcoholic steatohepatitis presented with fever for 2 days. She was hypotensive at the emergency department, but became normotensive after fluid resuscitation. A CT of the abdomen and pelvis showed left hydronephrosis secondary to a small ureteric stone, with inflammatory changes seen around the kidney. […]

An interesting X-ray. The patient, who is in the later part of the 8th decade of life, but otherwise walking independently at home, had a hip implant following an accident 6 years ago. Had recurrent left hip pain with multiple hospitalisations. Questions: What is the likely diagnosis and how should this elderly patient be managed? [Updated […]

A young man with no recent travel was diagnosed with acute myeloid leukemia (AML). He underwent allogeneic hematopoietic stem cell transplantation (allo-HSCT) with posaconazole and levifloxacin prophylaxis after completing standard induction and consolidation chemotherapy, complicated by culture-negative febrile neutropenia. Just after engraftment, he developed fever again (absolute neutrophil count of 370 cells/cubic millimetre of blood). […]

Probably the most beautiful parasite I have seen under the microscope. Question: What is the name of the parasite and what disease does it cause in humans? [Updated 28 September 2016] This rare (in humans) parasite is Dicroceolium dendriticum – the lancet liver fluke. Humans are only accidental definitive hosts, while ruminants such as sheep, goats […]