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 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 […]

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 […]

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 […]