A young man with HIV (latest CD4 count = 148 cells/cubic millimetre of blood) presented with diarrhoea of 2 weeks after traveling to Bangkok, Thailand for a holiday. There was no fever and no blood in the stool. A short course of oral antibiotics had not helped, and routine stool work-up – involving stool culture […]
A man in late middle-age, who in his youth had traveled extensively around the region, presented with nagging right upper abdominal discomfort for 2 weeks. He had no fever. The chest X-ray is shown below. Question: What is the abnormality seen and what infectious disease could this possibly be? [Updated 6th June 2015] There is a […]
An elderly (in her 60’s) woman went to the beach with her grandchildren, accompanying them as they dug for crabs and picked shells near a creek. Three days later, she presented with high fever accompanied by severe right lower limb pain and redness. She has a background history of diabetes mellitus which was not well controlled. […]
A young woman (in her 30’s) presented with a 3-day history of severe headache, low-grade fever (37.8 degrees Celsius) and photophobia. Clinical examination was unremarkable except for mild photophobia and mild neck stiffness. A CT head (non-contrast) done at the Emergency Department was normal, as was her full blood count and renal function panel. She […]
A middle-aged man with well-controlled diabetes mellitus was diagnosed with acute promyelocytic leukaemia (APML). He completed both induction and consolidation with all-trans retinoic acid (ATRA) and idarubicin, and was in remission. He was subsequently maintained on outpatient weekly low-dose methotrexate (25 mg/week) and 6-mercaptopurine. Six months later, he presented with fever and cough for 2 […]
A middle-aged woman presented with fever and lethargy, and was diagnosed with acute myeloid leukaemia (AML) after thorough work-up. She underwent standard induction chemotherapy (IA 3+7) and received fluconazole prophylaxis in view of cost concerns. She developed neutropenic fever 3 days after completion of chemotherapy, and was prescribed IV imipenem after an extended-spectrum beta-lactamase (ESBL)-producing Klebsiella […]
An elderly man who was 4 years post-coronary artery bypass grafting developed fever for a week, which he initially ignored as being “just a flu”. However, he developed central chest pain on the 7th day of fever, and was admitted to a local hospital. His WBC was 6,700 cells per mcL (65% neutrophils). The blood […]
An elderly woman (in her 60’s) who was on thrice-weekly hemodialysis for chronic renal failure presented to her family physician with a painful rash on her abdomen. This was vesicular in nature, extending across the left T10 dermatome, and was diagnosed as herpes zoster. She was prescribed oral acyclovir (reduced dose owing to renal failure) […]
A middle-aged man who had renal transplantation 5 years ago (but otherwise well) presented with fever and shortness of breath for 2 weeks. He was found to have a right pleural effusion on chest X-ray, and underwent a diagnostic pleural tap. The TB PCR was positive from the pleural fluid, and he was started on standard […]
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