Fever with rash

A male patient of 20 years presented to emergency with complaints of fever and altered sensorium of 1 day duration. On examination this rash was present. What is the diagnosis?

a) Purpura fulminans
b) Rocky Mountain Spotted Fever
c) Sterptococcal cellulitis
d) Dengue Fever



Answer is a) Purpura Fulminans ( Severe Meningococcal septic rash)

Massive intracutaneous hemorrhages are apparent in a patient with meningococcemia. The bleeding is related in part to thrombocytopenia, which is often part of the syndrome of disseminated intravascular coagulation, and in part to vascular damage caused by the meningococci, which can often be found invading the blood vessels. The lesions shown here are sometimes referred to as “purpura fulminans” and are associated with a high mortality rate.

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Diagnose It

A 40 year female having swelling of right foot since 11 years. The nodules on the swelling were painful, drained periodically and made weight bearing difficult. She had received courses of antibiotics with partial responses. What is the diagnosis?

a) Tuberculous osteomyelitis
b) Blastomycosis
c) Madura foot
d) Histoplasmosis
e) Leishmaniasis



Answer is c) Madura foot.

Examination showed soft-tissue swelling, multiple red, boggy, subcutaneous nodules, and draining sinus tracts. Culture of a specimen from a punch biopsy failed to grow any organisms. However, histologic analysis revealed whitish-yellow granules and the presence of non–acid-fast filamentous bacteria consistent with Madura foot. This condition can be caused by either filamentous actinobacteria (actinomycotic mycetoma) or true fungi (eumycotic mycetoma). The pale color of the granules combined with the fact that the patient was from Mexico, where most mycetomas are caused by actinomadura species, made actinomycotic mycetoma the more likely diagnosis. Magnetic resonance imaging of the foot was performed, and the scan obtained indicated possible osteomyelitis.

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Nails

What is the diagnosis?

a) Melanoma
b) Onychomycosis
c) Psoriasis
d) Yellow Nail syndrome
e) Zinc Deficiency

Answer is Yellow Nail Syndrome.

The yellow-nail syndrome is often seen in association with chronic sinusitis or bronchiectasis and lymphedema, and can be misdiagnosed as fungal nail infection.

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