A late middle-aged gentleman presented with painful left knee swelling for 2 weeks. He had recently been diagnosed with primary autoimmune hemolytic anaemia, for which he was on the final week of a 12-week tapering course of high-dose prednisolone. There was no associated fever or other systemic symptoms. He had not traveled in the preceding […]

More a spot diagnosis than a vignette per se. Urine in the urine bag and tubing. There is no overt bleeding. Question: What condition is being treated here? [Updated 29th September 2017] This is quite a classic – bright orange urine as a result of rifampicin ingestion (for tuberculosis). Sweat and tears may also be […]

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 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). […]