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 […]
A middle-aged man in his late 50’s presented with fever for 3 days associated with poor appetite and epigastric discomfort. He had been prescribed augmentin by his general practitioner 2 days ago without relief of symptoms. His only premorbid conditions were hypertension and hyperlipidemia, and there was no travel or contact history of significance. Physical […]
A middle-aged housewife with a history of chronic eczema and penicillin allergy (“rash and eye swelling”) presented with 2 days of fever, chills and lethargy. The initial clinical examination was unremarkable except for ongoing eczema and fever. The initial laboratory tests were remarkable only for mild thrombocytopaenia (114) and neutrophilia. However, she had chest pain […]
A middle-aged woman underwent chemotherapy after being diagnosed with acute lymphoblastic leukaemia (ALL). She was re-admitted 4 days post-completion of #1A and #1B hyperCVAD with septic shock requiring dopamine support. Her absolute neutrophil count (ANC) was 0.02 and her initial chest X-ray was normal. She was treated with intravenous (IV) imipenem as per protocol, and blood cultures grew Pseudomonas […]
An elderly man was knocked down by a taxi while riding on his bicycle. He developed a right subarachnoid hemorrhage and became progressively drowsy, requiring emergent evacuation of the clot and insertion of an external ventricular drain (EVD). He got progressively better in the hospital, and the EVD was removed 12 days later. At that time, […]
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