Teaching Cases
In this section of our website there is a collection of medical cases (mainly from the Infectious Diseases/Clinical Microbiology field) with several teaching points. The language of this section is English.
The chief complaint, history of present illness, medical history, physical examination, and diagnostic work up are presented in a succinct way in the first part leading to a question for the reader about diagnosis or management (the usual question is: ''What is your diagnosis?'')
Differential diagnosis, final diagnosis, treatment, teaching points, references, and acknowledgements are presented in the second part that appears if you click on the box "Click here for the diagnosis".
While the majority of cases in our website come from our group, occasionally cases from other institutions from Greece or abroad may appear.
For questions and/or comments please communicate with Matthew E. Falagas, MD, MSc, at m.falagas@aibs.gr or matthew.falagas@tufts.edu.
Fever in a patient with liver metastasis of bowel carcinoma - 1/12/2007
A 62-year-old patient presented with fever and abdominal pain in the right upper quadrant. He had an 18-month history of adenocarcinoma of the colon (T3N1M1) with liver metastases, for which he underwent a right hemicolectomy and received chemotherapy with irinotecan…
Lesions on blue skin base - 1/10/2007
A 32-year-old male presented with a 24-hour history of rash. He reported tingling and mild pain radiating to his right arm that started 2 days earlier. On physical examination, he had normal vital signs. There was a vesicular rash on…
Severe shortness of breath after PTCA - 1/9/2007
A 71-year-old woman was admitted to the hospital due to acute myocardial infarction. Prior medical history included arterial hypertension, insulin-dependent diabetes mellitus, and hyperthyroidism. The patient had no history of tobacco or alcohol use. On admission, she was afebrile. Oxygen…
Orofacial pain and fever - 1/8/2007
A 61-year-old male patient was referred to our hospital because of gradual painful enlargement of the left parotid, buccal and parapharyngeal region, of three days duration. The patient complained of difficulty and pain while attempting to open his mouth or…
Steep elevation of creatinine in a patient with acute flank pain - 1/7/2007
A 46-year-old, Caucasian, male patient presented to the emergency department suffering, for 12 hours, from acute, severe, left flank pain radiating to the left lower quadrant, with associated emesis. The patient reported minimal urine output after symptoms had started. Past…
Fever, confusion, and headache - 1/6/2007
A 45-year-old female patient presented with fever, confusion, nuchal rigidity, and vomiting to the emergency department of our hospital. She had a runny nose for the three days prior to admission and frontal headache. Her past medical history was significant…
Multifocal myositis in an apparently healthy adult - 1/5/2007
A 64-year old female presented with fever, diffuse muscle pains and extensive areas of erythema and edema over her thighs and arms. She reported that these skin lesions developed over a few days. In addition the patient noticed generalized edema.…
Pericardial and pleural effusion - 1/4/2007
A female patient from Greece, born in 1955, visited our office in January 1998 for evaluation of recurrent right pleural effusion (Figure). The patient was treated for Hodgkin's disease (supra-clavicular and mediastinal lymph node enlargement) with radiation and chemotherapy in…
Recurrent abdominal wall inflammation - 1/3/2007
A 59-year-old female presented with superficial hypogastric pain and low grade fever of one week duration. The patient had a history of ovarian cancer for which she underwent two abdominal operations as well as chemotherapy two years earlier. Six months…
Fever and left lower abdominal quadrant pain - 1/2/2007
A 68-year-old male was admitted to our hospital due to fever and abdominal pain in the left lower quadrant that started 2 days prior to admission. His past medical history was significant for coronary artery by-pass surgery 15 years earlier,…
Streaky lesions after insect bites - 1/1/2007
A 24-year-old man presented to our office because of fever and redness of his left lower extremity. The patient had been bitten at his left foot by an insect two days prior to his presentation. He could not recognize the…
Impetigo-like vegetating nasal lesion - 1/12/2006
A 56-year-old female patient seeked medical advice because of mild fever and a face lesion of two-week duration. Her past medical history was significant for diabetes mellitus (managed with insulin), mild chronic renal insufficiency and breast cancer for which she…
Rash, abdominal pain, hematochezia, and dysuria - 1/11/2006
A 47-year-old female patient presented with haematochezia and fatigue. She reported that she had 4 bowel motions, which were dark red in colour without mucus. 3 weeks prior to presentation she noticed a rash that begun on the lower limbs…
Periorbital and facial swelling and fever - 1/10/2006
A 55-year-old female patient presented to us with a 10-day history of malaise, lethargy, and fever up to 39.50 C accompanied by rigors. She also complained of diffuse myalgias, arthralgias, and bilateral facial edema. Her past medical history was significant…
Fever, knee pain and calf swelling - 1/9/2006
A 53-year old woman presented to us because of pain and swelling of the right knee joint for the previous 2 days before admission. She took non-steroidal anti-inflammatory medication but experienced only minimal and temporary relief for a few hours.…
Leg edema and fever - 1/8/2006
A 46-year-old female patient complained of mild fever, weakness, left extremity swelling, and fullness of the left inguinal area that became progressively worse over a period of 1 month. She was seen by her primary care physician who did not…
Shortness of breath in an HIV-infected patient - 1/7/2006
A 36-year-old man was diagnosed to be infected with HIV in November 2000 and was started on azidothymidine/lamivudine /nevirapine in January 2001. He tolerated this treatment well for 20 months, achieving suppression of the viral load to undetectable levels and…
Recurrent vomiting and dyspepsia - 1/6/2006
A 43-year-old male presented to the Emergency Department complaining for vomiting and dyspepsia. He refused persistently to give any more details. He asked for an intramuscular injection of metoclopramide, refusing further investigation, since "he already knew his problem ("recurrent gastritis")".…
Gangrenous, hemorrhagic, bullous cellulitis - 1/4/2006
A 57-year-old man was admitted to the intensive care unit (ICU) after initial resuscitation and hemodynamical stabilization in the emergency ward (EW), where he presented in a comatose state with shock (blood pressure 60/40 mmHg, heart rate 140 pulses/min, body…
Scalp necrosis in an elderly woman - 1/12/2005
A 90-year-old woman presented to the emergency department complaining of a 3-month history of headache, and recent blindness of her right eye. She also reported weakness and weight loss (5 kg during the last 3 months prior to her presentation)…
Persistent Klebsiella septicemia - 1/10/2005
A 15-year-old girl was admitted to the hospital because of mild abdominal pain and fever up to 37.8°C of 2-day duration. Specifically, she developed peri-umbilical abdominal pain that gradually moved to the right lower abdominal quadrant. In addition, she vomited…
Cellulitis of the axillary area - 1/9/2005
A 28-year-old white man was admitted to our hospital because of chronic swelling and redness of the left sub-axillary area. No fever, pruritus, or sweating was reported. His past medical history was unremarkable. The patient reported that, after switching deodorant,…
Recurrent omphalitis - 1/8/2005
A 23-year-old man presented with one year history of recurrent pyorrhoea from the umbilical area. Specifically, the patient had 5 episodes of omphalitis during the last year prior to his admission to the hospital. All episodes were successfully treated with…
Not just a usual community-acquired infection - 1/7/2005
In this teaching case we used the format of presentation of successive parts of the history, physical examination, and management accompanied by discussion (in bold characters) of a commentator. A 64-year-old male presented to the Emergency Room of the local…
Painful facial swelling - 1/6/2005
A 58-year-old man was admitted to the hospital complaining of a 3-day history of fever, malaise and a painful swelling of the right parotid gland. For 2 days before his admission, he had been taking amoxicillin and metronidazole, as the…
Fever and shortness of breath - 1/5/2005
A 67-year-old female patient was admitted to our unit due to fever and shortness of breath. Her past medical history was significant for breast cancer, which was treated with mastectomy in November 2003. She received chemotherapy from December 2003 until…
Severe panniculitis - 1/4/2005
A 36-year-old woman was admitted to the hospital because of fever and abdominal pain of one-week duration. Fever was up to 39 degrees Celsius and was accompanied by chills. The pain was located in the right lower quadrant of the…
Limitations in the management of aortic graft infection - 1/3/2005
A 56-year-old female from Greece with a history of Takayasu's disease (diagnosed in 1992) was admitted in late November 2002 to our unit because of fever, which started in April 2002. She was diagnosed at another hospital to have aortofemoral…
Fever and left tibia erythema and pain - 1/2/2005
A 73-year-old male patient was admitted to our hospital because of fever and pain of the left tibia. His past medical history was significant for diabetes mellitus (managed with oral antidiabetic agents) and lung cancer for which he underwent resection…
Back pain and fever after facet joint injection - 1/1/2005
A 78-year-old male was presented to his local orthopedic surgeon for low back pain. The patient had no neurologic deficits, and with the presumptive diagnosis of degenerative spondylosis, he has been treated with non-steroidal anti-inflammatory medications and physiotherapy for 3…
Recurrent post-sternotomy mediastinitis - 1/12/2004
Representative case report A 55-year-old man presented to us with pyorrhea from the sternotomy site of 11 months duration. His past medical history was significant for a coronary artery bypass grafting (CABG) operation that was performed 2 years earlier [using…
Multiple skin lesions - 1/11/2004
A 56-year-old white male was admitted to the hospital due to multiple skin lesions. In addition, he complained for dysuria and hematuria within the last month prior to his admission, with clinical characteristics compatible with urethritis or prostatitis. One month…
Pulmonary cavitary lesion - 1/10/2004
A 35-year-old man with no significant past medical history suffered from relapsing infections of the upper respiratory tract and episodes of nasal bleeding for five months. Chest radiography, which was perfomed in a local hospital, showed a big infiltrate in…
Asymptomatic hepatic lesion - 1/9/2004
A 37-year-old Greek woman presented for a routine "check up" physical examination. Her past medical history included mitral valve prolapse, an episode of herpes zoster of the first branch of the left trigeminal nerve, and a cyst in the left…
Chronic thoracic spine pain - 1/8/2004
A 49-year-old woman complaining of thoracic spine pain for 18 months was admitted to the hospital for evaluation. The pain was accompanied by profuse sweating but she did not report any fever. Physical examination revealed tenderness of the affected area…
Skin lesions after corticosteroid use - 1/7/2004
A 53-year-old female visited our office for dermatopathy of 'the right side of the trunk'. For one week prior to the appearance of the lesions she was feeling pain and 'a strange, creeping sensation' over the affected area. The patient…