A middle-aged man with Type 2 diabetes mellitus and hypertension developed extensive subarachnoid haemorrhage acutely, and underwent a 4-vessel cerebral angiogram during which an anterior communicating artery aneurysm was found and coiled. He recovered gradually with inpatient rehabilitation, and was sent home after 2 weeks of hospitalisation. However, he had developed a cough with mild […]
A middle-aged man presented with fever and dysuria for 5 days. He worked as a gardener at a large private housing estate, and suffered from both hypertension and type 2 diabetes mellitus. A CT pelvis was performed, with a representative image shown below. Question: What is the diagnosis and what is the bacterial aetiology? The CT […]
This elderly gentleman had pulmonary tuberculosis 40 years ago. He was also a chronic smoker of 60-odd years, smoking at least 10 cigarettes a day. He presented with paroxysmal coughing for 2 days (more than his usual “smoker’s cough”), accompanied initially by rusty, blood-streaked sputum, but developed frank hemoptysis (coughing out bright red blood) in the […]
The ECG from Clinical Vignette 17 was actually obtained from the patient described below: This middle-aged man, a sailor, was transferred to the hospital directly after his ship sailed into port. He had been ill for 2 months, with low-grade fever, weight loss of almost 8 kg, and shortness of breath upon exertion. His chest […]
Rather than a case description, it’s just an ECG this time, obtained from a middle-aged man almost two decades ago. Question: What is the ECG diagnosis? [Updated 24th January 2015] The ECG shows short voltages on all leads, and electrical alternans (i.e. alternating taller and shorter voltages) on the long lead 2 at the bottom. These […]
A middle-aged woman from Bangladesh sought treatment for acute lymphoblastic leukemia (ALL) in Singapore. Her diagnosis was first made in a hospital in Dhaka (the capital of Bangladesh), where she stayed for 10 days prior to her transfer here. She had presented with fever, muscle aches and increasing fatigue, and had received antibiotics for unremitting […]
This is a more “specialised” and technical clinical vignette. An elderly man was admitted to the intensive care unit (ICU) for acute respiratory distress from pulmonary oedema, and required intubation with mechanical ventilation. He had multiple co-morbid conditions including diabetes mellitus, hypertension, hyperlipidaemia, and ischaemic heart disease (with left ventricular ejection fraction of 35%). Three […]
A straightforward case for the Christmas week – Merry Christmas and Happy 2015, by the way! This young man returned from Gambia 2 weeks ago, and started having high fever for 5 days prior to seeking medical attention. He had been on a missionary trip, helping to build schools and houses in rural villages in […]
This is the same middle-aged man presented in the previous clinical vignette. He had undergone allogeneic stem cell transplantation (allo-HSCT) for underlying B-cell leukemia, with subsequent acute graft-versus-host disease (GVHD) of the liver. This was complicated 6 months later by RSV pneumonitis as previously described. His recovery was slow and required oxygen support even 3 […]
This middle-aged man had undergone allogeneic stem cell transplantation (allo-HSCT) for underlying B-cell leukemia. Six months later, he presented with fever and persistent cough for one day. At the emergency department, he was found to have bilateral rhonci, and was significantly tachypneic and hypoxic, requiring BiPAP ventilation in the intensive care unit (ICU). As a […]
MIPHIDIC 