Skin Case Studies - Part II

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CASE 4

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A 42-year-old man who works for a local construction contractor develops a sizeable and painful swollen area on the back of his neck. The swollen area is painful and large enough that it causes him considerable discomfort if he tries to button his shirt collar. A mild fever adds to the man's discomfort, so he comes to your walk-in clinic for advice.

His vital signs are normal, except for some fever (38.9ºC). The swollen area on his neck is located at the hairline and measures 2.4 x 3.7 cm. The center of this area is somewhat soft to the touch and appears to contain a substantial amount of pus. The overall appearance of the swollen area is that of an unusually large pustule surrounded by a distinct rash. There are no other remarkable physical findings.

The man is asked about his medical history. He remembers that, several days ago, his wife noticed some minor irritation surrounding the hair follicles in the area that is now swollen. Except for occasional appearances of boils on his skin over the past few years, the man has enjoyed very good health.


Question 4.1: What is your diagnosis?

Question 4.2: What tests should you do?

Question 4.3: How did this infection come about?

Question 4.4: What is the pathologic process that leads to abscess formation?

Question 4.5: Is this a dangerous disease?

Question 4.6: What other problems does this agent cause?

Question 4.7: What virulence factors does this agent possess?

Question 4.8: How should you treat this case?

Question 4.9: What is the prognosis?



CASE 5

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It is 1962 in a medium-cited city in Wisconsin. A 7-year-old girl comes home from a long, hard day in her second grade class with a cough, a runny nose, and a touch of fever. Over the next three days, the girl's fever intensifies (eventually reaching 40.5ºC) and she exhibits malaise, increased nasal discharge, and mild conjunctivitis with lacrimation. It is the middle of winter (remember, this is happening in Wisconsin of all places), and children have to spend most of their time indoors. Moreover, the annual flu epidemic has reached this family's home town and has been going around in the schools, so the girl's mother figures that this is a case of flu that will soon begin to decrease in intensity.

On the fourth day of the girl's illness, a non-pruritic, maculopapular rash develops behind her ears and quickly spread to her forehead. Over the next 24 hours, the rash continues to spread down the trunk and along the extremities, eventually covering the palms and soles. The rash becomes confluent in some locations and the girl experiences occasional rounds of vomiting and diarrhea. Her mother, of course, realizes that this is not a case of influenza. In fact, her mother has a pretty good idea of what this actually is (as did most mothers during that time period).


Question 5.1: Do you know what this is?

Question 5.2: What is the differential?

Question 5.3: How does this disease differ from similar diseases?

Question 5.4: What is the causative agent?

Question 5.5: How is this disease transmitted?

Question 5.6: How does the disease progress?

Question 5.7: How significant is this disease?

Question 5.8: What is this boy's prognosis?

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