Medical Question
12 year-old boy without significant past medical history presented with substernal chest pain. He was diagnosed to have left lower lobe pneumonia and was receiving oral antibiotics for 2 days prior to this referral. His chest pain subsided after albuterol nebulizer treatment in a local hospital, but he was found to have elevations of cardiac troponin I (cTnI) and creatine kinase (CK)-MB with ST changes on electrocardiogram (ECG), and was referred for further evaluation.
Family History
Lab Results
- cTnI 20.5 ng/mL (<0.1), total CK 229 U/L (0-200), CK-MB 30 U/L (CK-MB relative index 13.1) in initial presentation
- cTnI 6.99 ng/mL (<0.1), total CK 86 U/L with CK-MB 4.7 U/L (CK-MB relative index 5.5) 12 hs after the initial laboratory results
- Na 142 mEq/L, K 4.3 mEq/L, Cl 109 mEq/L, CO2 23 mmol/L, BUN 13 mg/dL, Creatine 0.6 mg/dL, Glu 82 mg/dL
- Total Cholesterol 158 mg/dL (144-173), HDL-Cholesterol 18 mg/dL (46-61), LDL-Cholesterol 110 mg/dL (82-109), VLDL-Cholesterol 30 mg/dL (7-12), Triglycerides 185 mg/dL (46-74)
- Viral titers and blood counts: Not obtained
Electrocardiogram:
- ST segment elevations in leads I, II, III and V6 It is consistent with myocardial ischemia/infarction involving the right coronary artery.
—A 26 year old female had a 13 year history of poorly controlled insulin-dependent diabetes mellitus that led to renal failure and blindness. She required peritoneal dialysis which was complicated by multiple infections of the peritoneal catheter. She also was obese and hypertensive. She presented to the hospital with abdominal cellulitis, fevers, and chills. On physical examination, she had ulcerated areas of skin underneath the pannus. She underwent debridement of the wound and was diagnosed with necrotizing fascitis. Despite antibiotic treatment and wound care, the wound was not healing and required a second debridement several weeks later. Her peritoneal dialysate was also noted to be cloudy and cultures were obtained which were positive for Enterococcus faecalis and a wet mount preperationan also showed unusual organism. Because of her continued sepsis and poor prognosis, her family and team of physicians followed the patent's previously expressed wishes and proceeded with comfort measures only. The patient was transferred to a hospital nearer her home and she died several days later.
Answer: Protothecal Peritonitis
—The patient was a 64-year-old female with left nipple discharge and an inverted nipple. The patient stated that left nipple retraction was chronic for many years, and described crusting of the left nipple. Digital diagnostic mammogram showed calcifications in the anterior left breast, some vascular, some coarse benign-appearing and others punctate benign-appearing. There were also benign-appearing calcifications in the anterior right breast. Ultrasound of the left retroareolar area revealed a focally dilated duct at 5 o'clock with abrupt termination of dilation approximately 2 cm from the nipple. No intraductal mass was identified. Consequently, punch biopsy was done at 3 o'clock left nipple to further evaluate the lesion.
what is the Diagnosis of this Disease
Answer: PAGET'S DISEASE OF THE BREAST
—The patient is a 41-year-old Caucasian female who was admitted to the hospital for evaluation of high blood cortisol level. Her complaints were fatigue, weakness, lethargy, decreased concentration and decreased memory over the last 18 months. She also gained 40 lbs over the last two months with central distribution of weight gain and neck obesity. Her physical examination was remarkable for cushingoid appearance with body weight of 211 lbs, palmar erythema and hirsutism. Dexamethasone suppression test results were consistent with Cushing's disease. A magnetic resonance imaging (MRI) examination of the pituitary did not show any abnormal findings. However, CT scan of the chest with contrast revealed a left upper lobe lung nodule, measuring 1.5x1.5 cm.
What is the diagnosis of this case ?
Answer:Atypical lung carcinoma
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