Not so much a clinical but a radiological vignette – a CT image from more than a decade ago. Question: What is the radiological sign and what is the diagnosis? [Updated 20th September 2016] The CT cut of the lungs shows a “water lily” sign (and thanks for those who suggested that it is an […]
Not all fever and rash in Singapore is Zika… A middle-aged man presented (way before the current Zika outbreak) with high fever for 5 days, associated with runny nose and sore throat. On the third day of illness, he developed a rash which started from his face before spreading to his body and limbs. He […]
A young odd-jobs man presented with cough for 3 months, associated with weight loss and fatigue at work. Finally seeking medical attention at a public hospital, he was found to have cavitation and infiltrates in the right upper lobe of the lung, with sputum microscopy showing high counts of acid-fast bacilli (AFB 4+). He was […]
A middle-aged man with sudden onset of painful lesions on both lower limbs. No prior significant exposures or clinical symptoms. No fever. Questions: What is the clinical diagnosis? How should this person be worked up and treated? This is a clear cut case of erythema nodosum. Skin biopsy would show panniculitis, but it is unnecessary […]
Here is a vignette contributed by a Respiratory colleague: A middle-aged lady with IgA nephropathy on hemodialysis for 6 months presented with a one-month history of fever. Septic work up was negative and she did not respond to multiple courses of antibiotics. A CT thorax was subsequently performed. Question(s): What are the differential diagnoses and what should be […]
Spot diagnosis. The patient was otherwise asymptomatic, but was somewhat appalled when the object in the first image passed out per rectum. Questions: What is the diagnosis? How did the patient acquire this? [Updated 2nd July 2016] This is clearly a tapeworm – there are no other human parasites that grow to such length. The […]
A middle-aged man was recently diagnosed with poor prognosis myelodysplastic syndrome (MDS). He was prescribed a course of subcutaneous azacitidine. One week after the first cycle (7 days) of the drug, he presented with pain over the injection sites (over his anterior abdominal wall), associated with high fever and weight loss. He was admitted to […]
A late middle-aged man with advanced lung cancer was switched to 3-weekly pembrolizumab after his malignancy progressed through multiple courses of chemotherapy. Pet CT at 12 weeks showed stable disease. However, he presented with sudden onset fever, worsening cough, and breathlessness after 6 months of immunotherapy. There was no contact or travel history of note, […]
A 3-year-old boy presented with mild left foot pain 6 weeks ago, which resulted in limping 3 weeks ago, followed by swelling over the dorsum of the foot less than a week ago. He was previously healthy except for perianal abscess which developed 1 week after birth.He had met (and exceeded several of) his development […]
A young local woman who was previously well went on a 9-day missionary trip to Pakistan, traveling between Karachi and Lahore as well as several villages in between. She had an episode of fever with chills midway through the trip, associated with diarrhoea two days later. Although the diarrhoea improved over the next two days, […]
MIPHIDIC 