Clinical Vignette 51

A late middle-aged man presented with high fever for a day. He had been hospitalized for acute gastroenteritis a week ago, receiving intravenous fluids and oral fluoroquinolones. Clinical examination was unremarkable except for erythema around the previous IV plug site – there were no cardiac murmurs and lung auscultation revealed normal breath sounds. He was […]

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Clinical Vignette 50

A young woman, approximately 11 weeks pregnant, had gone on an island staycation with her family. Four days prior to their return. her nephew developed a fever, with a vesicular rash appearing one day later. This was subsequently diagnosed to be chickenpox. She had been in close contact with her nephew throughout the staycation. She did not recall ever […]

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Clinical Vignette 49

A photograph from a Gram stain of a urethral swab. The young man, recently married, had presented with penile discharge and a burning sensation during micturition for 2 days. He denied promiscuity. Question: What is the diagnosis and what is an appropriate course of management? [Update 30 Oct 2015] The Gram stain shows Gram-negative diplococci […]

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Clinical Vignette 48

A middle-aged man who had a biventricular pacemaker inserted 3 weeks ago presented with fever as well as pain over the left upper chest wall. Clinical examination revealed erythema and tenderness over the pacemaker body insertion site, with just a small amount of pus expressed from the incision scar. Blood cultures and a swab of the […]

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Clinical Vignette 47

A teenaged girl presented with high fever (up to 40 degrees Celsius), headache, and a dry cough for 4 days. She did not have prior symptoms of an upper respiratory tract infection such as sore throat or runny nose. None of her friends or family members were recently ill, and she has not traveled out of […]

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Clinical Vignette 46

These pair of hands belong to a young woman who had fever for 2 days associated with sore throat.Her firstborn son had presented with similar symptoms a week ago. She had incidentally just discovered that she was pregnant, this being 6 weeks after her last menstrual period ending. Question: What is the diagnosis and what would be […]

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Clinical Vignette 45

A middle-aged (late 50’s) housewife presented with fever for 4 days, associated with headache and photophobia. There was no significant contact or travel history, and her only chronic medical condition was hypertension for which she was on atenolol (a beta-blocker). Brought in to the emergency department by her husband and son, she was found to […]

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Clinical Vignette 44

A middle-aged (44) man with sudden onset chest pain. Question: What is the ECG diagnosis? [Updated 29 August 2015] The ECG showed widespread ST elevation and – perhaps more specifically – widespread PR segment depression. This is consistent with acute pericarditis. The aetiology cannot be determined from the stem as no further information was given. However, this […]

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Clinical Vignette 43

A young woman who was 33 weeks pregnant presented with 2 weeks of low-grade fever associated with an enlarged right cervical lymph node. Fine needle aspiration of the lymph node had been performed by an ENT surgeon, showing an epithelioid granuloma and reactive follicular hyperplasia. TB PCR was negative. Serological testing results are shown below: EBV […]

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Clinical Vignette 42

A man in his late 50’s presented with generalised lethargy and low-grade fever for 3 days. He had a history of pulmonary tuberculosis 20 years ago, and had completed a 9-month course of therapy. The only other significant history was that of alcoholism and smoking. He was found to be hypotensive at the Emergency Department […]

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